Solved

Display Drop Down Field Based on Select - Drop Down Value

Posted on 2009-07-15
9
1,452 Views
Last Modified: 2012-05-07
I'm trying to set up a form element that makes two drop down menus accessible if specific values are selected in the "Profession" field. There will be five values that will make the primary and secondary fields available so I need to know how to make this available to multiple values in the drop down menu. Below is what I have so far.
<html>

<head>

<script type="text/javascript">

function changeOpt(theForm){

  document.getElementById('row1').style.display=(theForm.type_id.options[theForm.type_id.selectedIndex].value=="ccc")? 'block':'none'

}

 

window.onload=function() {

  changeOpt(document.forms[0]);

}

</script>

</head>

<body>

<form>

 

<P>

<select name="type_id" onChange="changeOpt(this.form)">

<option value="">Click to Select</option>

<option value="aaa">Job One

<option value="bbb">Job Two

<option value="ccc">Job Three

</select>

 

<table>

<tr>

<td> 

<P>

 </td>

 </tr>

 

 <!-- I want this whole row below to hide or view based on selection -->

 <tr id="row1" style="display:none">

 <td>

 

<P>

Primary Specialty: <select name="primary_specialty">

<option value="RN">Registered Nurse</option><option value="LPN">Licensed Practioner Nurse</option>

</select>

<br><br>

Secondary Specialty:<select name="secondary_specialty">

<option value="RN">Registered Nurse</option><option value="LPN">Licensed Practioner Nurse</option>

</select>

 

</td>

</tr>

</table>

 

</form>

</body>

</html>

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Comment
Question by:AGDeacon
  • 5
  • 4
9 Comments
 
LVL 12

Accepted Solution

by:
Chad Haney earned 500 total points
ID: 24862561
Is this what you are talking about?

<html>

<head>

<script type="text/javascript">
 

  //Add each value you want to show the dropdowns to the opVals array.

  var opVals = new Array("aaa","ccc");
 
 

function arrayContains(haystack, needle)

{

  for(var i=0;i<haystack.length;i++)

  {

    if(haystack[i]==needle){return true;}

  }

  return false;

}
 

function changeOpt(theForm){

  document.getElementById('row1').style.display=(arrayContains(opVals, theForm.type_id.options[theForm.type_id.selectedIndex].value))? 'block':'none'

}

 

window.onload=function() {

  changeOpt(document.forms[0]);

}

</script>

</head>

<body>

<form>

 

<P>

<select name="type_id" onChange="changeOpt(this.form)">

<option value="">Click to Select</option>

<option value="aaa">Job One</option>

<option value="bbb">Job Two</option>

<option value="ccc">Job Three</option>

</select>

 

<table>

<tr>

<td> 

<P>

 </td>

 </tr>

 

 <!-- I want this whole row below to hide or view based on selection -->

 <tr id="row1" style="display:none">

 <td>

 

<P>

Primary Specialty: <select name="primary_specialty">

<option value="RN">Registered Nurse</option><option value="LPN">Licensed Practioner Nurse</option>

</select>

<br><br>

Secondary Specialty:<select name="secondary_specialty">

<option value="RN">Registered Nurse</option><option value="LPN">Licensed Practioner Nurse</option>

</select>

 

</td>

</tr>

</table>

 

</form>

</body>

</html>

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0
 

Author Comment

by:AGDeacon
ID: 24935636
This code is working for me, but it is creating an aesthetic issue.  For some reason when "Profession" is selected, the drop downs that appear below it are pushed up against the left side. The link to the test site is below.

http://drawninwardmedia.com/nursecore/apply.php


<?php require_once('Connections/fullApp.php'); ?>

<?php
 

mysql_select_db($database_fullApp, $fullApp);

$query_fullApp = "SELECT * FROM applications";

$fullApp = mysql_query($query_fullApp, $fullApp) or die(mysql_error());

$row_fullApp = mysql_fetch_assoc($fullApp);

$totalRows_fullApp = mysql_num_rows($fullApp);

?>

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">

<html xmlns="http://www.w3.org/1999/xhtml">

<head>

<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1" />

<title>Apply with NurseCore</title>

<link href="styles/new-style.css" rel="stylesheet" type="text/css" />

<script language="javascript">

var findJob = new Image(); //Create Image Object

var findNurse = new Image(); 

var apply = new Image();

var recent = new Image();

</script>
 

<script type="text/javascript" language="javascript">
 
 

function HandleFileButtonClick()  {

    document.register.resume.click();

    document.register.txtFakeText.value = document.register.resume.value;

}  	
 
 

	

function refresh_states() {

        var country = document.register.country.options[document.register.country.selectedIndex].value;

       // alert(country);
 

        if (country == 228)  {

                document.getElementById('statslabel').style.display = 'inline';

                document.register.province.style.display = 'none';

                document.register.state.style.display = 'inline';

                } else if (country == 38)  {

                document.getElementById('statslabel').style.display = 'inline';

                document.register.state.style.display = 'none';

                document.register.province.style.display = 'inline';

        } else {

                document.getElementById('statslabel').style.display = 'none';

                document.register.state.style.display = 'none';

                document.register.province.style.display = 'none';

        }

}
 

function LimitAttach(file) {

         allowSubmit = false;

         if (!file) return;

         extArray = new Array(".doc", ".pdf", ".txt");

         while (file.indexOf("\\") != -1)

         file = file.slice(file.indexOf("\\") + 1);

         ext = file.slice(file.indexOf(".")).toLowerCase();

         for (var i = 0; i < extArray.length; i++) {

              if (extArray[i] == ext) { allowSubmit = true; break; }

         }

         if (allowSubmit)

             return true;

         else

             return false;

}
 

function update_specialty() {

      var prof = document.register.profession.selectedIndex;

          var matched = 0; // try to indicate match so we can turn ps off or on

     //   alert(prof);

        

                if (document.register.profession.options[prof].value == "1")  {

                        document.register.primary1.style.display = 'inline';

                        document.register.secondary1.style.display = 'inline';

                        document.register.selectedPS.value = 1;

                                        matched = 1;

                } else {

                        document.register.primary1.style.display = 'none';

                        document.register.secondary1.style.display = 'none';

                }
 

                

                if (document.register.profession.options[prof].value == "2")  {

                        document.register.primary2.style.display = 'inline';

                        document.register.secondary2.style.display = 'inline';

                        document.register.selectedPS.value = 2;

                                        matched = 1;

                } else {

                        document.register.primary2.style.display = 'none';

                        document.register.secondary2.style.display = 'none';

                }
 

                

                if (document.register.profession.options[prof].value == "53")  {

                        document.register.primary53.style.display = 'inline';

                        document.register.secondary53.style.display = 'inline';

                        document.register.selectedPS.value = 53;

                                        matched = 1;

                } else {

                        document.register.primary53.style.display = 'none';

                        document.register.secondary53.style.display = 'none';

                }
 

                

                if (document.register.profession.options[prof].value == "55")  {

                        document.register.primary55.style.display = 'inline';

                        document.register.secondary55.style.display = 'inline';

                        document.register.selectedPS.value = 55;

                                        matched = 1;

                } else {

                        document.register.primary55.style.display = 'none';

                        document.register.secondary55.style.display = 'none';

                }
 

                

                if (document.register.profession.options[prof].value == "64")  {

                        document.register.primary64.style.display = 'inline';

                        document.register.secondary64.style.display = 'inline';

                        document.register.selectedPS.value = 64;

                                        matched = 1;

                } else {

                        document.register.primary64.style.display = 'none';

                        document.register.secondary64.style.display = 'none';

                }
 

                

                if (document.register.profession.options[prof].value == "65")  {

                        document.register.primary65.style.display = 'inline';

                        document.register.secondary65.style.display = 'inline';

                        document.register.selectedPS.value = 65;

                                        matched = 1;

                } else {

                        document.register.primary65.style.display = 'none';

                        document.register.secondary65.style.display = 'none';

                }
 

                

                if (document.register.profession.options[prof].value == "69")  {

                        document.register.primary69.style.display = 'inline';

                        document.register.secondary69.style.display = 'inline';

                        document.register.selectedPS.value = 69;

                                        matched = 1;

                } else {

                        document.register.primary69.style.display = 'none';

                        document.register.secondary69.style.display = 'none';

                }
 

                

                if (document.register.profession.options[prof].value == "78")  {

                        document.register.primary78.style.display = 'inline';

                        document.register.secondary78.style.display = 'inline';

                        document.register.selectedPS.value = 78;

                                        matched = 1;

                } else {

                        document.register.primary78.style.display = 'none';

                        document.register.secondary78.style.display = 'none';

                }
 

                        if (matched == 1) {

                document.register.primary_specialty.style.display = 'none';

                document.register.secondary_specialty.style.display = 'none';

        } else {

                document.register.primary_specialty.style.display = 'inline';

                document.register.secondary_specialty.style.display = 'inline';              

        }

}
 

function check_form() {

        var err = 0;

        var err_txt = "";

        var miss_txt = "";

        var intro_miss = "\n\rPlease provide information for the following required fields: ";

        if (document.register.firstname.value == "" ) {

                err++;

                miss_txt += "\n\r\tFirst Name";

        }

        if (document.register.lastname.value == "" ) {

                err++;

                miss_txt += "\n\r\tLast Name";

        }

        if (document.register.address.value == "" ) {

                err++;

                miss_txt += "\n\r\tAddress";

        }

        if (document.register.city.value == "" ) {

                err++;

                miss_txt += "\n\r\tCity";

        }

        var country = document.register.country.options[document.register.country.selectedIndex].value;

        if (document.register.state.options[document.register.state.selectedIndex].value == "" && (country == 228)) {

                err++;

                miss_txt += "\n\r\tState/Province";

        }

        if (document.register.province.options[document.register.province.selectedIndex].value == "" && (country == 38)) {

                err++;

                miss_txt += "\n\r\tState/Province";

        }         

        if (document.register.zip.value == "" && (country == 228 || country == 38)) {

                err++;

                miss_txt += "\n\r\tZip/Postal code";

        }

        if (document.register.phone.value == "" ) {

                err++;

                miss_txt += "\n\r\tPhone";

        } else {

                 var re = /^\s*[0-9]{3}\-[0-9]{3}\-[0-9]{4}\s*$/gi;

            if (!document.register.phone.value.match(re)) {

                         var re2 = /^\s*[0-9]{10}\s*$/gi;

                    if (!document.register.phone.value.match(re2)) {

                        err++;

                        err_txt += "\n\rPlease provide a valid phone number, formatted XXX-XXX-XXXX\n\r";

                                }

            }

        }

        if (document.register.alt_phone.value != "" ) {

                 var re = /^\s*[0-9]{3}\-[0-9]{3}\-[0-9]{4}\s*$/gi;

            if (!document.register.alt_phone.value.match(re)) {

                         var re2 = /^\s*[0-9]{10}\s*$/gi;

                    if (!document.register.alt_phone.value.match(re2)) {

                        err++;

                        err_txt += "\n\rPlease provide a valid alternate phone number, formatted XXX-XXX-XXXX\n\r";

                                }

            }

        }
 

        if (document.register.profession.selectedIndex <= 0 ) {

                err++;

                miss_txt += "\n\r\tProfession";

        }

        if ( document.register.primary_specialty.style.display == 'none') {

        				var myPSPick = 0;

        				myPSPick = eval('document.register.primary' + document.register.profession.options[document.register.profession.selectedIndex].value + '.selectedIndex');

                if (myPSPick <=0) {

                err++;

                miss_txt += "\n\r\tPrimary Specialty";

              }

        }

        if (document.register.experience_level.selectedIndex <= 0 ) {

                err++;

                miss_txt += "\n\r\tExperience Level";

        }

        if (document.register.primary_assignment_type.selectedIndex <= 0 ) {

                err++;

                miss_txt += "\n\r\tPrimary Assignment Type";

        }

        //alert(document.register.location.selectedIndex);

        //if (document.getElementById('location') && document.getElementById('location').options[document.getElementById('location').selectedIndex].value == "" ) {

        if (document.register.location.selectedIndex == -1){

                err++;

                miss_txt += "\n\r\tLocation Preference(s)";

        }
 

        if (document.register.hear_about.selectedIndex <= 0 ) {

                err++;

                miss_txt += "\n\r\tHow did you hear about Crdentia?";

        }

        if (document.register.terms.checked == false) {

                err++;

                err_txt += "\n\rIn order to submit your registration, you must first accept the Terms and Conditions by clicking the checkbox at the bottom of the registration page.\n\r";

        }

        if (document.register.email.value == "" ) {

                err++;

                miss_txt += "\n\r\tEmail";

        } else {

                 var re = /^\s*([a-zA-Z0-9\.\-\+\'\&\*\/=\?\^\{\}~_]{1,100})@([a-zA-Z0-9\.\-_]){1,100}\.([a-zA-Z]{2,4})\s*$/gi;

                 if (!document.register.email.value.match(re)) {

                         err++;

                        err_txt += "\n\rPlease provide a valid e-mail address, formatted XXXXXXX@XXXX.XXX\n\r";

                 }

        }
 

        var checkOK = "0123456789abcdefghijklmnopqrstuvwxyzABCDEFGHIJKLMNOPQRSTUVWXYZ";

        var checkStr = document.register.password.value;

        var allValid = true;
 

        if (checkStr.length < 4)

        {

                allValid = false;

        }

        else

        {

                for (i = 0;  i < checkStr.length;  i++)

                {

                        ch = checkStr.charAt(i);
 

                        for (j = 0;  j < checkOK.length;  j++)

                                if (ch == checkOK.charAt(j))

                                        break;
 

                        if (j == checkOK.length)

                        {

                                allValid = false;

                                break;

                        }

                }

        }
 

        if (document.register.password.value == "" ) {

                err++;

                miss_txt += "\n\r\tPassword";

        } else if (!allValid) {

                err++;

                err_txt += "\n\rPasswords must contain at least four alpha or numeric characters. Please do not use symbols or punctuation in your password.\n\r";

        } else if (document.register.password.value != document.register.repassword.value) {

                err++;

                err_txt += "\n\rWe're sorry. The passwords you supplied do not match. Please re-enter your password.\n\r";

        }
 

        if (document.register.resume.value != '' && !LimitAttach(document.register.resume.value)) {

        err++;

        err_txt += "\n\rThe resume upload feature only supports documents saved in three approved file formats. Please upload a resume file in Microsoft Word (.doc), Adobe Acrobat (.pdf) or Text (.txt) format. If you have uploaded a valid file format, check to see that your file name contains one of the three approved file extensions listed above (e.g. myresume.doc, myresume.pdf, myresume.txt).\n\r";

        }
 

if (err > 0) {

        if (miss_txt != "") {

                err_txt = intro_miss+miss_txt+"\n\r"+err_txt;
 

        }

        alert(err_txt);

        return false;

}        else {

        return true;

}

}

</script>
 

<script type="text/javascript">

 

  //Add each value you want to show the dropdowns to the opVals array.

  var opVals = new Array("Licensed_Practical_Nurse","Licensed_Vocational_Nurse","Registered_Nurse");

 

 

function arrayContains(haystack, needle)

{

  for(var i=0;i<haystack.length;i++)

  {

    if(haystack[i]==needle){return true;}

  }

  return false;

}

 

function changeOpt(theForm){

  document.getElementById('row1').style.display=(arrayContains(opVals, theForm.Profession.options[theForm.Profession.selectedIndex].value))? 'block':'none'

}

 

window.onload=function() {

  changeOpt(document.forms[0]);

}

</script>
 

</head>
 

<body>
 

<div id="container" style="background: url(images/homepage_bg_strip2.jpg) repeat-y; overflow: hidden;">
 

	<div id="nav">

	<div class="right">

	    <table width="350" cellspacing="0">

          <tr>

            <td><a href="apply.html" style="text-decoration:none;"><img name="apply" src="images/applytoday_unselected.jpg" onmouseover="document.apply.src='images/applytoday_selected.jpg';" onmouseout="document.apply.src='images/applytoday_unselected.jpg';" border="0"></a></td>

        </table>

	  </div>

  </div>

  

   <div id="sub_nav" style=" background-image: url(images/bg_white_strip.jpg); background-repeat: repeat-y; width: 790px;" >

	

		<a href="index.php"><img class="home" name="navHome" src="images/nav_homebutton1.jpg" onmouseover="document.navHome.src='images/nav_homebutton2.jpg';" onmouseout="document.navHome.src='images/nav_homebutton1.jpg';" border="0"></a> <a href="about.html"><img class="about" name="navAbout" src="images/needanurse_nav_aboutbutton1-02.jpg" onmouseover="document.navAbout.src='images/nav_aboutbutton2.jpg';" onmouseout="document.navAbout.src='images/needanurse_nav_aboutbutton1-02.jpg';" border="0"></a> <a href="locations.html"><img class="location" name="navLocations" src="images/needanurse_nav_locationsbutton1.jpg" onmouseover="document.navLocations.src='images/nav_locationsbutton2.jpg';" onmouseout="document.navLocations.src='images/needanurse_nav_locationsbutton1.jpg';" border="0"></a></a> <a href="contact.html"><img class="contact" name="navContact" src="images/nav_contactbutton2.jpg" onmouseover="document.navContact.src='images/nav_contactbutton2.jpg';" onmouseout="document.navContact.src='images/nav_contactbutton2.jpg';" border="0"></a>	</div>

	 

  <div id="content" style=" background-image: url(images/red_subpage_bg.jpg); background-repeat: no-repeat; width: 790px;">

		

		<div style="float: left; padding: 0 0 0 0; width: 520px;">

  

		<img src="images/registration.jpg" />

  

		</div>

		

		<div style=" float: right; margin: 70px 45px 0 0;">

		

		<div><a href="findjob.html"><img name="findJob" src="images/home_findajob_button1.jpg" onmouseover="document.findJob.src='images/home_findajob_button-RO.jpg';" onmouseout="document.findJob.src='images/home_findajob_button1.jpg';" border="0"></a><br /><a href="findnurse.html"><img name="findNurse" src="images/home_findanurse_button1.jpg" onmouseover="document.findNurse.src='images/home_findanurse_buttonRO.jpg';" onmouseout="document.findNurse.src='images/home_findanurse_button1.jpg';" border="0"></a></div>

		

		</div>

		

		<div style="height: 250px;">

		

		</div>

		

		<div id="secondary" style="color: #FFFFFF; width: 625px;">

			

			

		<h1 style="color: #FFFFFF; font-size: 24px; padding: 0 0 10px 0;">Quick Registration</h1>

                                                 

                                                  <p style="font-size: 12px; padding:10px 0 0 0;">Register with NurseCore in just a few, short easy steps! This information will be used to match you with one of the thousands of career opportunities we have available! Please fill

out all fields below. Required fields are marked with an asterisk (<span class="asterisc">*</span>).</p>

	<br/>

<a href="full_app.php" style="color: #f9bd43;">If you wish to submit your full application, click here.</a>

	<br />

<form enctype="multipart/form-data" action="apply_send.php" method="POST" name="register" onsubmit="return check_form();">

                                        <table width="530" cellspacing="0" cellpadding="0" border="0" style="font-size: 12px; margin-top: 20px;">

                                          <tbody><tr>

                                    <td valign="top"><div style="float: left;">Contact Information<input name="id" type="hidden" value="" /><input name="type" type="hidden" value="Q" /></div> <div style="float: right;"> <sup class="asterisc">*</sup>Required Field</div></td><td style="width: 6px;">&nbsp;</td>

                          </tr>

                        </tbody></table>

                                        <br/>

                                        <table width="527px" cellspacing="0" cellpadding="1" border="0" style="font-size: 12px;">

                                        <tbody><tr><td class="cellright">First Name<sup class="asterisc">*</sup></td>

                                        <td class="cellleft"><input type="text" style="width: 154px;" name="First_Name"/></td>

                                        <td style="padding-right: 5px; text-align: right;">Last Name<sup class="asterisc">*</sup></td>

                                        <td style="width: 148px;" class="cellleft"><input type="text" style="width: 145px;" name="Last_Name"/></td>

                                        </tr>

										<tr><td>&nbsp;</td></tr>

                                        <tr><td class="cellright">Address<sup class="asterisc">*</sup></td>

                                        <td colspan="3" class="cellleft"><input type="text" style="width: 410px;" name="Address"/></td>

                                        </tr>

										<tr><td>&nbsp;</td></tr>

                                        <tr><td class="cellright">Address (cont'd)<sup class="asterisc"> </sup></td>

                                        <td colspan="3" class="cellleft"><input type="text" style="width: 410px;" name="Address_2"/></td>

                                        </tr>

										<tr><td>&nbsp;</td></tr>

                                        <tr>

                                        <td class="cellright">City<sup class="asterisc">*</sup></td>

                                        <td class="cellleft"><input type="text" style="width: 154px;" name="City"/></td>

                                        <td style="width: 150px;" class="cellleft">&nbsp;</td>

                                        </tr>

										<tr><td>&nbsp;</td></tr>

                <tr>

                                        <td class="cellright"><span id="statslabel">State<sup class="asterisc">*</sup>&nbsp;</span></td>

                                        <td class="cellleft">
 

<select style="width: 160px;" name="State">

<option value="" selected="selected">Click to Select</option>

<option value="Alabama">Alabama</option>

<option value="Alaska">Alaska</option>

<option value="Arizona">Arizona</option>

<option value="Arkansas">Arkansas</option>

<option value="California">California</option>

<option value="Colorado">Colorado</option>

<option value="Connecticut">Connecticut</option>

<option value="Delaware">Delaware</option>

<option value="District of Columbia">District of Columbia</option>

<option value="Florida">Florida</option>

<option value="Georgia">Georgia</option>

<option value="Hawaii">Hawaii</option>

<option value="Idaho">Idaho</option>

<option value="Illinois">Illinois</option>

<option value="Indiana">Indiana</option>

<option value="Iowa">Iowa</option>

<option value="Kansas">Kansas</option>

<option value="Kentucky">Kentucky</option>

<option value="Louisiana">Louisiana</option>

<option value="Maine">Maine</option>

<option value="Maryland">Maryland</option>

<option value="Massachusetts">Massachusetts</option>

<option value="Michigan">Michigan</option>

<option value="Minnesota">Minnesota</option>

<option value="Mississippi">Mississippi</option>

<option value="Missouri">Missouri</option>

<option value="Montana">Montana</option>

<option value="Nebraska">Nebraska</option>

<option value="Nevada">Nevada</option>

<option value="New Hampshire">New Hampshire</option>

<option value="New Jersey">New Jersey</option>

<option value="New Mexico">New Mexico</option>

<option value="New York">New York</option>

<option value="North Carolina">North Carolina</option>

<option value="North Dakota">North Dakota</option>

<option value="Ohio">Ohio</option>

<option value="Oklahoma">Oklahoma</option>

<option value="Oregon">Oregon</option>

<option value="Pennsylvania">Pennsylvania</option>

<option value="Rhode Island">Rhode Island</option>

<option value="South Carolina">South Carolina</option>

<option value="South Dakota">South Dakota</option>

<option value="Tennessee">Tennessee</option>

<option value="Texas">Texas</option>

<option value="Utah">Utah</option>

<option value="Vermont">Vermont</option>

<option value="Virginia">Virginia</option>

<option value="Washington">Washington</option>

<option value="West Virginia">West Virginia</option>

<option value="Wisconsin">Wisconsin</option>

<option value="Wyoming">Wyoming</option>
 

</select>
 

</td>
 

                                        <td style="padding-right: 5px; text-align: right;"><span style="white-space: nowrap;">&nbsp;Zip/Postal Code<sup class="asterisc">*</sup></span></td>

                                        <td style="width: 150px;" class="cellleft"><input type="text" style="width: 145px;" name="Zip"/></td></tr>

                                <tr>

										<tr><td>&nbsp;</td></tr>

                                        <td class="cellright">Phone<sup class="asterisc">*</sup></td>

                                        <td class="cellleft"><input type="text" style="width: 154px;" name="Phone"/></td>

                                        <td style="padding-right: 5px; text-align: right;">Alternate Phone<sup class="asterisc"> </sup></td>

                                        <td style="width: 150px;" class="cellleft"><input type="text" style="width: 145px;" name="Alt_Phone"/></td></tr>

<tr>

<td class="cellleft2"/>

<td valign="top" class="cellleft2"><div>XXX-XXX-XXXX</div></td>

<td class="cellleft2"/>

<td valign="top" class="cellleft2"><div>XXX-XXX-XXXX</div></td>

</tr>

<tr><td>&nbsp;</td></tr>

<tr><td>Email</td><td><input name="email" type="text" style="width: 145px;" /></td></tr>
 
 

          </tbody></table>

                                        <br/>

                                        <table width="530" cellspacing="0" cellpadding="0" border="0" style="font-size: 12px;">

                                          <tbody><tr>

                                    <td valign="top"><div style="float: left;">Professional Information</div> <div style="float: right;"> <sup class="asterisc">*</sup>Required Field</div></td><td style="width: 6px;"></td>

                          </tr>

                        </tbody></table>

                                                <br/>

                                                <table width="538" cellspacing="0" cellpadding="1" border="0" style="font-size: 12px;">

                                        <tbody><tr><td class="cellright">Profession<sup class="asterisc">*</sup></td>

                                        <td colspan="2" class="cellleft">

                                        <select name="Profession" onChange="changeOpt(this.form)">

<option value="">Click to Select</option>

<option value="Licensed_Practical_Nurse">Licensed Practical Nurse (LPN)</option><option value="Licensed_Vocational_Nurse">Licensed Vocational Nurse (LVN)</option><option value="Registered_Nurse">Registered Nurse (RN)</option><option value="Certified_Nurse_Assistant">Certified Nurse Assistant (CNA)</option><option value="Admin/Office">Admin/Office</option><option value="Anesthesiologist_ Assistant">Anesthesiologist Assistant</option><option value="Audiologist">Audiologist</option><option value="Behavioral_Health_Technician">Behavioral Health Technician (BHT)</option><option value="Cardiac_Monitor_OR_EKG_Technician">Cardiac Monitor / EKG Technician</option><option value="Certified_Occupational_Therapy Assistant">Certified Occupational Therapy Assistant (COTA)</option><option value="Certified_Registered_Nurse_Anesthetist">Certified Registered Nurse Anesthetist (CRNA)</option><option value="Dental_Assistant">Dental Assistant</option><option value="Dental_Hygienist">Dental Hygienist</option><option value="EEG_Technician">EEG Technician</option><option value="Emergency_Medical_Technician">Emergency Medical Technician (EMT)</option><option value="Home_Health_Aide">Home Health Aide (HHA)</option><option value="Medical_Assistant">Medical Assistant (MA)</option><option value="Medical_Coder">Medical Coder</option><option value="Medical_Lab">Medical Lab</option><option value="Medical_Records_Clerk">Medical Records Clerk</option><option value="Medication_Aide">Medication Aide</option><option value="Mental_Health_Technician">Mental Health Technician (MHT)</option><option value="Nurse_Practitioner">Nurse Practitioner</option><option value="Occupational_Therapist">Occupational Therapist</option><option value="Operating_Room_Technician">Operating Room Technician (ORT)</option><option value="Pharmacist">Pharmacist</option><option value="Pharmacy_Technician">Pharmacy Technician</option><option value="Phlebotomist">Phlebotomist</option><option value="Physical_Therapist">Physical Therapist</option><option value="Physical_Therapist_Assistant">Physical Therapist Assistant</option><option value="Physician">Physician</option><option value="Physician_Assistant">Physician Assistant</option><option value="Polysomnographic_Tech">Polysomnographic Tech</option><option value="Radiation_Therapist_OR_Dosimetrist">Radiation Therapist/Dosimetrist</option><option value="Radiological_Tech">Radiological Tech</option><option value="Registered_Polysomnographic_Tech">Registered Polysomnographic Tech</option><option value="Therapist_OR_Dosimetrist">Respiratory Therapist</option><option value="Scrub_Technician">Scrub Technician</option><option value="Speech_OR_Language_Therapist_Assistant">Speech/Language Therapist Assistant</option><option value="Speech_OR_Language_Therapist_OR_Pathologist">Speech/Language Therapist/Pathologist</option><option value="Sterile_Processing_Tech">Sterile Processing Tech</option><option value="Surgical_Assistant">Surgical Assistant</option><option value="Surgical_Technologist">Surgical Technologist</option><option value="Unit_Clerk">Unit Clerk</option>

</select>                                    

                                        </td></tr>

						   				<tr><td>&nbsp;</td></tr>

                                        <tr id="row1" style="display:none">

<td>Primary Specialty:<br /><br />Secondary Specialty:</td>

<td colspan="2"><select name="primary_specialty">

<option value="None">Click to Select</option><option value="Burns_ICU">Burns ICU</option><option value="Cardiac_Cath">Cardiac Cath</option><option value="Cardiac_ICU">Cardiac ICU</option><option value="Cardiovascular_ICU">Cardiovascular ICU</option><option value="Critical_Care">Critical Care</option><option value="Dialysis">Dialysis</option><option value="Emergency_Room">Emergency Room</option><option value="Geriatrics_OR_Long_Term_Care">Geriatrics/Long Term Care</option><option value="Homecare">Homecare</option><option value="ICU">ICU</option><option value="Labor_and_Delivery">Labor and Delivery</option><option value="Medical_ICU">Medical ICU</option><option value="Medical_OR_Surgical">Medical/Surgical</option><option value="Medical_OR_Surgical-Neurology">Medical/Surgical - Neurology</option><option value="Medical_OR_Surgical-Orthopedic">Medical/Surgical - Orthopedic</option><option value="Neonatal_Intensive_Care_Unit">Neonatal Intensive Care Unit</option><option  value="Neuro_ICU">Neuro ICU</option><option value="Newborn_Nursery">Newborn Nursery</option><option value="OBGYN">OB/GYN</option><option value="Occupational_Medicine">Occupational Medicine</option><option value="Office_Nurse">Office Nurse</option><option value="Oncology">Oncology</option><option value="Oncology_OR_Chemo">Oncology/Chemo</option><option value="Oncology_OR_Non-Chemo">Oncology/Non-Chemo</option><option value="Operating_Room">Operating Room</option><option value="PACU_OR_Recovery_Room">PACU/Recovery Room</option><option value="Pediatric_Non-ICU">Pediatric Non-ICU</option><option value="Peds_Intensive_Care_Unit">Peds Intensive Care Unit</option><option value="Post_Partum">Post Partum</option><option value="Progressive_Care_Unit">Progressive Care Unit</option><option value="Psychiatry">Psychiatry</option><option value="Rehab">Rehab</option><option value="School_Setting">School Setting</option><option value="Step_Down_ICU">Step Down ICU</option><option value="Surgical_ICU">Surgical ICU</option><option value="Telemetry">Telemetry</option><option value="Blood_Bank">Blood Bank</option><option value="Cytologist">Cytologist</option><option value="Histologist">Histologist</option><option value="Medical_Technician">Medical Technician</option><option value="Medical_Technologist">Medical Techno</option><option value="Administrators">Administrators</option><option value="Allergy_and_Immunology">Allergy and Immunology</option><option value="Anesthesiology">Anesthesiology</option><option value="Colon_and_Rectal_ Surgery">Colon and Rectal Surgery</option><option value="Dermatology">Dermatology</option><option value="Emergency_Medicine">Emergency Medicine</option><option value="Epidemiology">Epidemiology</option><option value="Epileptology">Epileptology</option><option value="Family Practice">Family Practice</option><option value="General_Preventative_Medicine">General Preventative Medicine</option><option value="General_Surgery">General Surgery</option><option value="Hospitalist">Hospitalist</option><option value="IM_Dermatology">IM/Dermatology</option><option value="IM_Emergency Med">IM/Emergency Med</option><option value="IM_Emergency_Critical Care">IM/Emergency/Critical Care</option><option value="IM_Neurology">IM/Neurology</option><option value="IM_PMR">IM/PMR</option><option value="IM_Preventative Medicine">IM/Preventative Medicine</option><option value="IM_Psychiatry">IM/Psychiatry</option><option value="Internal_Medicine">Internal Medicine</option><option value="Med_Peds">Med-Peds</option><option value="Molecular_Genetic_Pathology">Molecular Genetic Pathology</option><option value="Neuro_Diag._Rad_Neuro_Rad">Neuro/Diag. Rad/Neuro Rad</option><option value="Neurological_Surgery">Neurological Surgery</option><option value="Neurology">Neurology</option><option value="Nuclear_Medicine">Nuclear Medicine</option><option value="Ophthalmology">Ophthalmology</option><option value="Orthopedic_Surgery">Orthopedic Surgery</option><option value="Otolaryngology">Otolaryngology</option><option value="Pathology">Pathology</option><option value="Pediatrics">Pediatrics</option><option value="Pediatrics_Bariatric">Pediatrics Bariatric</option><option value="Peds_EM">Peds/EM</option><option value="Peds_EMR">Peds/EMR</option><option value="Peds_Psych_C&amp;A">Peds/Psych/C&amp;A</option><option value="Physical_Medicine_&amp;_Rehab">Physical Medicine &amp; Rehab</option><option value="Physician_Assistant">Physician Assistant</option><option value="Plastic_Surgery">Plastic Surgery</option><option value="Preventative_Medicine">Preventative Medicine</option><option value="Psych_FP">Psych/FP</option><option value="Psychiatry">Psychiatry</option><option value="Radiation_Oncology">Radiation Oncology</option><option value="Radiology">Radiology</option><option value="Sports_Medicine">Sports Medicine</option><option value="Thoracic_Surgery">Thoracic Surgery</option><option value="Urology">Urology</option><option value="Cardiothoracic">Cardiothoracic</option><option value="PA_General">PA - General</option><option value="PA_Neuro">PA - Neuro</option><option value="PA_Ortho">PA - Ortho</option><option value="Cardiac_Cath">Cardiac Cath</option><option value="Cardiovascular_Technologist">Cardiovascular Technologist</option><option value="CAT_Scan_Technologist">CAT Scan Technologist</option><option value="Diagnostic_Medical_Sonographer">Diagnostic Medical Sonographer</option><option value="Echocardiography">Echocardiography</option><option value="Fluoroscopy">Fluoroscopy</option><option value="General_X-Ray">General X-Ray</option><option value="Mammography">Mammography</option><option value="MRI_Technologist">MRI Technologist</option><option value="Nuclear_Medicine_Technology">Nuclear Medicine Technology</option><option value="Special_Procedures">Special Procedures</option><option value="Ultrasound_Sonographer">Ultrasound Sonographer</option><option value="Vascular_Technologist">Vascular Technologist</option><option value="Surgical_Tech-General_Surgery">Surgical Tech - General Surgery</option><option value="Surgical_Tech-Neuro">Surgical Tech - Neuro</option><option value="Surgical_Tech-OBGYN">Surgical Tech - OBGYN</option><option value="Surgical_Tech-Open_Heart">Surgical Tech - Open Heart</option><option value="Surgical_Tech-Orthopedic">Surgical Tech - Orthopedic</option><option value="Surgical_Tech-Plastics">Surgical Tech - Plastics</option><option value="Surgical_Tech-Vascular">Surgical Tech - Vascular</option><option value=64>Other</option>

</select>

<br /><br />

<select name="secondary_specialty">

<option value="None">Click to Select</option><option value="Burns_ICU">Burns ICU</option><option value="Cardiac_Cath">Cardiac Cath</option><option value="Cardiac_ICU">Cardiac ICU</option><option value="Cardiovascular_ICU">Cardiovascular ICU</option><option value="Critical_Care">Critical Care</option><option value="Dialysis">Dialysis</option><option value="Emergency_Room">Emergency Room</option><option value="Geriatrics_OR_Long_Term_Care">Geriatrics/Long Term Care</option><option value="Homecare">Homecare</option><option value="ICU">ICU</option><option value="Labor_and_Delivery">Labor and Delivery</option><option value="Medical_ICU">Medical ICU</option><option value="Medical_OR_Surgical">Medical/Surgical</option><option value="Medical_OR_Surgical-Neurology">Medical/Surgical - Neurology</option><option value="Medical_OR_Surgical-Orthopedic">Medical/Surgical - Orthopedic</option><option value="Neonatal_Intensive_Care_Unit">Neonatal Intensive Care Unit</option><option  value="Neuro_ICU">Neuro ICU</option><option value="Newborn_Nursery">Newborn Nursery</option><option value="OBGYN">OB/GYN</option><option value="Occupational_Medicine">Occupational Medicine</option><option value="Office_Nurse">Office Nurse</option><option value="Oncology">Oncology</option><option value="Oncology_OR_Chemo">Oncology/Chemo</option><option value="Oncology_OR_Non-Chemo">Oncology/Non-Chemo</option><option value="Operating_Room">Operating Room</option><option value="PACU_OR_Recovery_Room">PACU/Recovery Room</option><option value="Pediatric_Non-ICU">Pediatric Non-ICU</option><option value="Peds_Intensive_Care_Unit">Peds Intensive Care Unit</option><option value="Post_Partum">Post Partum</option><option value="Progressive_Care_Unit">Progressive Care Unit</option><option value="Psychiatry">Psychiatry</option><option value="Rehab">Rehab</option><option value="School_Setting">School Setting</option><option value="Step_Down_ICU">Step Down ICU</option><option value="Surgical_ICU">Surgical ICU</option><option value="Telemetry">Telemetry</option><option value="Blood_Bank">Blood Bank</option><option value="Cytologist">Cytologist</option><option value="Histologist">Histologist</option><option value="Medical_Technician">Medical Technician</option><option value="Medical_Technologist">Medical Techno</option><option value="Administrators">Administrators</option><option value="Allergy_and_Immunology">Allergy and Immunology</option><option value="Anesthesiology">Anesthesiology</option><option value="Colon_and_Rectal_ Surgery">Colon and Rectal Surgery</option><option value="Dermatology">Dermatology</option><option value="Emergency_Medicine">Emergency Medicine</option><option value="Epidemiology">Epidemiology</option><option value="Epileptology">Epileptology</option><option value="Family Practice">Family Practice</option><option value="General_Preventative_Medicine">General Preventative Medicine</option><option value="General_Surgery">General Surgery</option><option value="Hospitalist">Hospitalist</option><option value="IM_Dermatology">IM/Dermatology</option><option value="IM_Emergency Med">IM/Emergency Med</option><option value="IM_Emergency_Critical Care">IM/Emergency/Critical Care</option><option value="IM_Neurology">IM/Neurology</option><option value="IM_PMR">IM/PMR</option><option value="IM_Preventative Medicine">IM/Preventative Medicine</option><option value="IM_Psychiatry">IM/Psychiatry</option><option value="Internal_Medicine">Internal Medicine</option><option value="Med_Peds">Med-Peds</option><option value="Molecular_Genetic_Pathology">Molecular Genetic Pathology</option><option value="Neuro_Diag._Rad_Neuro_Rad">Neuro/Diag. Rad/Neuro Rad</option><option value="Neurological_Surgery">Neurological Surgery</option><option value="Neurology">Neurology</option><option value="Nuclear_Medicine">Nuclear Medicine</option><option value="Ophthalmology">Ophthalmology</option><option value="Orthopedic_Surgery">Orthopedic Surgery</option><option value="Otolaryngology">Otolaryngology</option><option value="Pathology">Pathology</option><option value="Pediatrics">Pediatrics</option><option value="Pediatrics_Bariatric">Pediatrics Bariatric</option><option value="Peds_EM">Peds/EM</option><option value="Peds_EMR">Peds/EMR</option><option value="Peds_Psych_C&amp;A">Peds/Psych/C&amp;A</option><option value="Physical_Medicine_&amp;_Rehab">Physical Medicine &amp; Rehab</option><option value="Physician_Assistant">Physician Assistant</option><option value="Plastic_Surgery">Plastic Surgery</option><option value="Preventative_Medicine">Preventative Medicine</option><option value="Psych_FP">Psych/FP</option><option value="Psychiatry">Psychiatry</option><option value="Radiation_Oncology">Radiation Oncology</option><option value="Radiology">Radiology</option><option value="Sports_Medicine">Sports Medicine</option><option value="Thoracic_Surgery">Thoracic Surgery</option><option value="Urology">Urology</option><option value="Cardiothoracic">Cardiothoracic</option><option value="PA_General">PA - General</option><option value="PA_Neuro">PA - Neuro</option><option value="PA_Ortho">PA - Ortho</option><option value="Cardiac_Cath">Cardiac Cath</option><option value="Cardiovascular_Technologist">Cardiovascular Technologist</option><option value="CAT_Scan_Technologist">CAT Scan Technologist</option><option value="Diagnostic_Medical_Sonographer">Diagnostic Medical Sonographer</option><option value="Echocardiography">Echocardiography</option><option value="Fluoroscopy">Fluoroscopy</option><option value="General_X-Ray">General X-Ray</option><option value="Mammography">Mammography</option><option value="MRI_Technologist">MRI Technologist</option><option value="Nuclear_Medicine_Technology">Nuclear Medicine Technology</option><option value="Special_Procedures">Special Procedures</option><option value="Ultrasound_Sonographer">Ultrasound Sonographer</option><option value="Vascular_Technologist">Vascular Technologist</option><option value="Surgical_Tech-General_Surgery">Surgical Tech - General Surgery</option><option value="Surgical_Tech-Neuro">Surgical Tech - Neuro</option><option value="Surgical_Tech-OBGYN">Surgical Tech - OBGYN</option><option value="Surgical_Tech-Open_Heart">Surgical Tech - Open Heart</option><option value="Surgical_Tech-Orthopedic">Surgical Tech - Orthopedic</option><option value="Surgical_Tech-Plastics">Surgical Tech - Plastics</option><option value="Surgical_Tech-Vascular">Surgical Tech - Vascular</option><option value=64>Other</option>

</select>

</td></tr>
 

										<tr><td>&nbsp;</td></tr>

                                        <tr><td class="cellright">Experience Level<sup class="asterisc">*</sup></td>

                                        <td colspan="2" class="cellleft"><select style="width: 200px;" name="Experience_Level">

                                        <option value="">Click to Select</option>

<option value="Entry level">Entry Level</option><option value="1 - 2 years">1-2 years</option><option value="2 - 4 years">2-4 years</option><option value="5 - 7 years">5-7 years</option><option value="7 - 10 years">7-10 years</option><option value="10+ years">10+ years</option>                                        </select></td></tr>

										<tr><td>&nbsp;</td></tr>

                                        <tr><td class="cellright">Primary Assignment Type<sup class="asterisc">*</sup></td>

                                        <td colspan="2" class="cellleft"><select style="width: 200px; float: left;" name="Primary_Assignment_Type">

                                        <option value="" selected="selected">Click to Select</option>

<option value="Allied Health - Direct Hire">Allied Health - Direct Hire</option><option value="Allied Health - Long-Term">Allied Health - Long-Term</option><option value="Allied Health - Per Diem">Allied Health - Per Diem</option><option value="Allied Health - Short-Term">Allied Health - Short-Term</option><option value="Home Care">Home Care</option><option value="Local Nurse - Direct Hire">Local Nurse - Direct Hire</option><option value="Local Nurse - Long-Term">Local Nurse - Long-Term</option><option value="Local Nurse - Per Diem">Local Nurse - Per Diem</option><option value="Local Nurse - Short-Term">Local Nurse - Short-Term</option><option value="Locum Tenens">Locum Tenens</option><option value="Travel Nurse">Travel Nurse</option>                                        

                                        </select></td>

                                        </tr>

										<tr><td>&nbsp;</td></tr>

                                        <tr><td class="cellright">Secondary Assignment Type<sup class="asterisc"> </sup></td>

                                        <td colspan="2" class="cellleft"><select style="width: 200px; float: left;" name="Secondary_Assignment_Type">

                                        <option value="" selected="selected">Click to Select</option>

<option value="Allied Health - Direct Hire">Allied Health - Direct Hire</option><option value="Allied Health - Long-Term">Allied Health - Long-Term</option><option value="Allied Health - Per Diem">Allied Health - Per Diem</option><option value="Allied Health - Short-Term">Allied Health - Short-Term</option><option value="Home Care">Home Care</option><option value="Local Nurse - Direct Hire">Local Nurse - Direct Hire</option><option value="Local Nurse - Long-Term">Local Nurse - Long-Term</option><option value="Local Nurse - Per Diem">Local Nurse - Per Diem</option><option value="Local Nurse - Short-Term">Local Nurse - Short-Term</option><option value="Locum Tenens">Locum Tenens</option><option value="Travel Nurse">Travel Nurse</option>                                        

                                        </select></td>

                                        </tr> 

										<tr><td>&nbsp;</td></tr>                                   

                                        <tr><td class="cellrightt">Attach Your Resume<sup class="asterisc"> </sup></td>

                                        <td class="cellleftt"><input type="file" style="display: block; width: 282px;" name="attachment" value="attachment" allow="text"/><tr><td>   </td><td>Supported file formats are .doc, .pdf and .txt</td></tr>

                                     	<tr><td>&nbsp;</td></tr>

                                        <tr>

                                          <td class="cellright">How did you hear about NurseCore?<sup class="asterisc">*</sup></td>

                                          <td colspan="2" class="cellleft"><select style="width: 200px;" name="Heard_About">

                                        <option value="" selected="selected">Click to Select</option>

<option value="Career Fair">Career Fair</option>

<option value="CareerBuilder.com">CareerBuilder.com</option>

<option value="Direct Mail/Postcard">Direct Mail/Postcard</option>

<option value="Email Message">Email Message</option>

<option value="Internet Search">Internet Search</option>

<option value="Magazine Ad">Magazine Ad</option>

<option value="Newspaper Ad">Newspaper Ad</option>

<option value="Other">Other</option>

<option value="Word of Mouth/Referral">Word of Mouth/Referral</option>
 

                                          </select></td></tr>

                                        <tr><td style="padding-top: 10px;" class="cellrightt">Already working with a NurseCore Client Service Specialist? If so, please give us<sup class="asterisc"> </sup>

                                          their name.<sup class="asterisc"> </sup></td>

                                        <td colspan="2" class="cellleftt"><input type="text" style="width: 200px;" name="Specialist"></td></tr>

										<tr><td> </td></tr>

                                        </tbody></table>

										

	<font size="2" face="Arial, Helvetica">

Which of our offices would you like to receive this application?

</font></font></p>

	<br />

<table width="550" cellspacing="0" cellpadding="7" border="0">

<tbody><tr><td width="33%" valign="top">
 

	<table border="0">

	<tbody>

	<tr><td> </td></tr>

	<tr><td colspan="2"><font size="2" face="Arial, Helvetica">

	<strong>Arizona</strong></font></td></tr>

	<tr><td><font size="1">Mesa</font></td><td><input type="checkbox" value="Mesa" name="location_mesa"/></td></tr>

	<tr><td><font size="1">Phoenix</font></td><td><input type="checkbox" value="Phoenix" name="location_phoenix"/></td></tr>

		<tr><td><font size="1">Tucson</font></td><td><input type="checkbox" value="Tucson" name="location_tucson"/></td></tr>

	</tbody></table>
 

<p>
 
 

<table border="0">

	<tbody>

	<tr><td> </td></tr>

	<tr><td colspan="2"><font size="2" face="Arial, Helvetica">

	<strong>California</strong></font></td></tr>

	<tr><td><font size="1">Santa Barbara</font></td><td><input type="checkbox" value="Santa_Barbara" name="location_santabarbara"/></td></tr>

	<tr><td><font size="1">Santa Maria</font></td><td><input type="checkbox" value="Santa_Maria" name="location_santamaria"/></td></tr>

	</tbody></table>
 
 

</p><p>
 
 

<table border="0">

	<tbody>

	<tr><td> </td></tr>

	<tr><td colspan="2"><font size="2" face="Arial, Helvetica">

	<strong>Nevada</strong></font></td></tr>

	<tr><td><font size="1">Las Vegas</font></td><td><input type="checkbox" value="Vegas" name="location_lasvegas"/></td></tr>

	

</tbody></table>
 
 

</p><p>
 
 
 

</p></td><td width="33%" valign="top">
 
 

<table border="0">

	<tbody>

	<tr><td> </td></tr>

	<tr><td colspan="2"><font size="2" face="Arial, Helvetica">

	<strong>New York</strong></font></td></tr>

	<tr><td><font size="1">Albany</font></td><td><input type="checkbox" value="Albany" name="location_albany"/></td></tr>

	<tr><td><font size="1">Syracuse</font></td><td><input type="checkbox" value="Syracuse" name="location_syracuse"/></td></tr>

	<tr><td><font size="1">Rochester</font></td><td><input type="checkbox" value="Rochester" name="location_rochester"/></td></tr>

	</tbody></table>
 

<p>
 

<table border="0">

	<tbody>

	<tr><td> </td></tr>

	<tr><td colspan="2"><font size="2" face="Arial, Helvetica">

	<strong>Florida</strong></font></td></tr>

		<tr><td><font size="1">Fort Myers</font></td><td><input type="checkbox" value="Ft_Myers" name="location_fortmeyers"/></td></tr>

	<tr><td><font size="1">Gainseville</font></td><td><input type="checkbox" value="Gainseville" name="location_gainseville"/></td></tr>
 

	<tr><td><font size="1">Miami</font></td><td><input type="checkbox" value="Miami" name="location_miami"/></td></tr>

	

<tr><td><font size="1">Clearwater</font></td><td><input type="checkbox" value="Clearwater" name="location_clearwater"/></td></tr>
 

<tr><td><font size="1">Ocala</font></td><td><input type="checkbox" value="Ocala" name="location_ocala"/></td></tr>
 

<tr><td><font size="1">Port Charlotte</font></td><td><input type="checkbox" value="Port_Charlotte" name="location_portcharlotte"/></td></tr>
 

<tr><td><font size="1">Sarasota</font></td><td><input type="checkbox" value="Sarasota" name="location_sarasota"/></td></tr>
 

<tr><td><font size="1">St. Petersburg</font></td><td><input type="checkbox" value="St_Petersburg" name="location_stpetersburg"/></td></tr>
 

	</tbody></table>
 
 
 
 
 

</p></td><td width="33%" valign="top">
 

<table border="0">

	<tbody>

	<tr><td> </td></tr>

	<tr><td colspan="2"><font size="2" face="Arial, Helvetica">

	<strong>Texas</strong></font></td></tr>
 

	<tr><td><font size="1">Arlington</font></td><td><input type="checkbox" value="Arlington" name="location_arlington"/></td></tr>
 

	<tr><td><font size="1">Fort Worth</font></td><td><input type="checkbox" value=" Ft_Worth" name="location_fortworth"/></td></tr>
 

</tbody></table>
 

<p><table border="0">

	<tbody>

	<tr><td> </td></tr>

	<tr><td colspan="2"><font size="2" face="Arial, Helvetica">

	<strong>Colorado</strong></font></td></tr>

	<tr><td><font size="1">Denver</font></td><td><input type="checkbox" value="Denver" name="location_denver"/></td></tr>

<tr><td><font size="1">Colorado Springs</font></td><td><input type="checkbox" value="Colorado_Springs" name="location_coloradosprings"/></td></tr>
 

</tbody></table></p>
 

</td></tr></tbody></table>
 
 

<p><table border="0">

	<tr><td><font size="2" face="Arial, Helvetica">Which office would you like to have contact you?</font></td></tr>

    <tr><td>

    <select name="locations" id="">

	<option selected="selected">- Select -</option>

    	<option value="None"> - Arizona - </option>

        	<option value="Mesa">Mesa</option>

            <option value="Phoenix">Phoenix</option>

            <option value="Tucson">Tucscon</option>

        <option value="None"> - California - </option>

        	<option value="Santa_Barbara">Santa Barbara</option>

            <option value="Santa_Maria">Santa Maria</option>

        <option value="None"> - Colorado - </option>

        	<option value="Colorado_Springs">Colorado Springs</option>

            <option value="Denver">Denver</option>

       	<option value="None"> - Florida - </option>

        	<option value="Clearwater">Clearwater</option>

            <option value="Fort_Myers">Ft. Myers</option>

            <option value="Gainesville">Gainesville</option>

            <option value="Miami">Miami</option>

            <option value="Ocala">Ocala</option>

            <option value="Port_Charlotte">Port Charlotte</option>

            <option value="Sarasota">Sarasota</option>

            <option value="St_Petersburg">St Petersburg</option>

        <option value="None"> - Nevada - </option>

        	<option value="Las_Vegas">Las Vegas</option>

        <option value="None"> - New York - </option>

        	<option value="Albany">Albany</option>

            <option value="Syracuse">Syracuse</option>

            <option value="Rochester">Rochester</option>

        <option value="None"> - Texas - </option>

        	<option value="Arlington">Arlington</option>

            <option value="Fort_Worth">Ft Worth</option>

    </select>

</td></tr>
 

<tr><td>&nbsp;</td></tr>
 

<tr>

	<td><font size="2" face="Arial, Helvetica">Would you being willing to travel?</font></td>

    <td><font size="2" face="Arial, Helvetica">Yes<input name="willing_to_travel" type="checkbox" value="y" /></font></td>

</tr>

</table>
 
 
 
 

</p></td></tr></tbody></table>
 

<table width="550" border="0">
 

	<tr>

	

		<td style="font-size: 12px; padding: 10px 0 10px 0;">

		Pursuant to Title VI of the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Age Discrimination in Employment Act of 1975, the Vietnam Era Veterans Readjustment Act of 1984, Executive Order 11246, and the Americans With Disabilities Act of 1992, their implementing regulations, or any other federal, state or local law, order rule or regulation, NurseCore does not discriminate in the provision of services or in employment on the basis of age, race, color, marital status, religion, creed, sex, veteran or military status, national origin, physical or mental disability, or any other legally protected category.

		</td>

	

	</tr>
 

</table>

										

                                        <br/>

                                        <table width="530" cellspacing="0" cellpadding="0" border="0" style="font-size: 12px;">

                                          <tbody>

                                                <tr>

                                                <td style="padding-top: 3px;" class="cellleft"><input type="hidden" value="1" name="submit_check"/><input type="submit" value="Submit"/>

                                                  </td>

                                                </tr>

                                          </tbody></table>

                                        <input type="hidden" name="MM_insert" value="register" />

</form>

                              

			

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        <div style="float: left;">

          <p style="color:#FFFFFF; font-size: 10px; padding: 15px 0 0 55px;"> Questions? Call us at 877-895-6861 or <a href="mailto:contactus@nursecore.net">contactus@nursecore.net</a> </p>

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          <p style="color:#FFFFFF; font-size: 10px; padding: 15px 55px 0 0;"><span style="padding-right: 75px;"><a href="privacy.html">Privacy Policy</a></span>&copy; 2008 NurseCore all rights reserved.</p>

        </div>

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  </div>

			

			

</div>

			
 

		</div>
 

</body>

</html>

<?php

mysql_free_result($fullApp);

?>

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0
 

Author Comment

by:AGDeacon
ID: 24935651
I realize there is quite a few lines of code. Line 518 is where the problematic fields are.

Thanks in advance.
0
 
LVL 12

Expert Comment

by:Chad Haney
ID: 24936605
problem is with display:block,  this changes the formatting of the row.  Change this to display:table-row;
0
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Author Comment

by:AGDeacon
ID: 24936806
I'm not seeing where display: block is coming into play. Can you give me a line number?
0
 
LVL 12

Expert Comment

by:Chad Haney
ID: 24936982
Try this change.  its in your scripts.  Use auto instead of the table-row, this should work better.
function changeOpt(theForm){

  document.getElementById('row1').style.display=(arrayContains(opVals, theForm.Profession.options[theForm.Profession.selectedIndex].value))? 'block':'none'

}

 

to this
 

function changeOpt(theForm){

  document.getElementById('row1').style.display=(arrayContains(opVals, theForm.Profession.options[theForm.Profession.selectedIndex].value))? 'auto':'none'

}

 

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0
 

Author Comment

by:AGDeacon
ID: 24937997
Now the secondary fields don't even show up when I change the lines of script out. Did it work locally when you changed those lines?
0
 
LVL 12

Expert Comment

by:Chad Haney
ID: 24938760
interesting.  auto worked when directly in the code, but doesnt work when called by javascript.  looks like using table-row did work properly.


function changeOpt(theForm){

  document.getElementById('row1').style.display=(arrayContains(opVals, theForm.Profession.options[theForm.Profession.selectedIndex].value))? 'table-row':'none'

}

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0
 

Author Comment

by:AGDeacon
ID: 24939030
That works great, thanks.
0

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