Apply For A Job

Name

${ parent.decodeEntities(`First Name`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-first-name" as=${html``} />

${ parent.decodeEntities(`2nd Initial`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="second_initial" as=${html``} />

${ parent.decodeEntities(`Last Name`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="last_name" as=${html``} />

Address

${ parent.decodeEntities(`street`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="street" as=${html``} />

${ parent.decodeEntities(`Apartment `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="apartment_" as=${html``} />

${ parent.decodeEntities(`City`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="city" as=${html``} />

${ parent.decodeEntities(`State`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="state" as=${html``} />

${ parent.decodeEntities(`Zip `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="Zip" as=${html``} />

Phone

${ parent.decodeEntities(`Home`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-telephone" as=${html``} />

${ parent.decodeEntities(`Cell`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="cell" as=${html``} />

${ parent.decodeEntities(`Other`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-other" as=${html``} />

Electronic

${ parent.decodeEntities(`Email Address`) } parent.activateValidation({"message":"This field is required.","emailMessage":"Please enter a valid Email address","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-email" as=${html``} />

Date of Birth

${ parent.decodeEntities(`Day`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="dob_day" as=${html``} />

${ parent.decodeEntities(`Month `) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="dob_month" as=${html``} />

${ parent.decodeEntities(`Year`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="dob_year" as=${html``} />

SIN

${ parent.decodeEntities(`Social Insurance Number`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="Social_Insurance_Number" as=${html``} />

License

${ parent.decodeEntities(`Type of License`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="license_type" as=${html``} />

${ parent.decodeEntities(`Issuing Authority/Board `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="license_authority_" as=${html``} />

${ parent.decodeEntities(`License Number`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="license_number" as=${html``} />

${ parent.decodeEntities(`License Expiration Date `) } <${props.Flatpickr} name="license_expiration" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(``) } " options=${{"minDate":"","maxDate":"","dateFormat":"m-d-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('license_expiration')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['license_expiration'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":false}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="license_expiration" as=${html``} />

Gender

${ parent.decodeEntities(`Gender`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Male' === parent.getValue('gender')} /> ${ parent.decodeEntities(`Male`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Female' === parent.getValue('gender')} /> ${ parent.decodeEntities(`Female`) }

<${validation.ErrorMessage} errors=${validation.errors} name="gender" as=${html``} />

Languages

${ parent.decodeEntities(`What languages do you speak? `) } <${validation.ErrorMessage} errors=${validation.errors} name="languages" as=${html``} />

Emergency Contact

${ parent.decodeEntities(`Local Contact Name & Phone `) } <${validation.ErrorMessage} errors=${validation.errors} name="emergency_local" as=${html``} />

${ parent.decodeEntities(`Out-of-Area Contact Name & Phone`) } <${validation.ErrorMessage} errors=${validation.errors} name="emergency_out" as=${html``} />

Education

Formal

${ parent.decodeEntities(`Diploma`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="diploma" as=${html``} />

${ parent.decodeEntities(`Certificate`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="certificate" as=${html``} />

${ parent.decodeEntities(`Degree`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="Degree" as=${html``} />

${ parent.decodeEntities(`Other 1`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="other_formal1" as=${html``} />

${ parent.decodeEntities(`Other 2`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="other_formal2" as=${html``} />

Insurance

${ parent.decodeEntities(`Malpractice Insurance Carrier & Address`) } <${validation.ErrorMessage} errors=${validation.errors} name="malpractice_carrier" as=${html``} />

${ parent.decodeEntities(`Policy Number `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="policy_number" as=${html``} />

${ parent.decodeEntities(`Policy Expiry Date`) } <${props.Flatpickr} name="policy_expiry" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(``) } " options=${{"minDate":"","maxDate":"","dateFormat":"m-d-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('policy_expiry')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['policy_expiry'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":false}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="policy_expiry" as=${html``} />

Informal Certifications

${ parent.decodeEntities(`Do you have current First Aid Certification (State Level): `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="first_aid" as=${html``} />

${ parent.decodeEntities(`Expiry Date`) } <${props.Flatpickr} name="first_aid_expiry" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(``) } " options=${{"minDate":"","maxDate":"","dateFormat":"m-d-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('first_aid_expiry')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['first_aid_expiry'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":false}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="first_aid_expiry" as=${html``} />

${ parent.decodeEntities(`Do you have current CPR? `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="first_aid" as=${html``} />

${ parent.decodeEntities(`Expiry Date`) } <${props.Flatpickr} name="cpr_expiry" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(``) } " options=${{"minDate":"","maxDate":"","dateFormat":"m-d-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('cpr_expiry')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['cpr_expiry'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":false}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="cpr_expiry" as=${html``} />

${ parent.decodeEntities(`Have you taken a Food Safety course? `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="food_safety" as=${html``} />

${ parent.decodeEntities(`Other Informal 1 (Specify)`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="first_aid" as=${html``} />

${ parent.decodeEntities(`Other Informal 2`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="other_informal2" as=${html``} />

Restrictions

Work Limitations

${ parent.decodeEntities(`Hearing Limitation?`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('hearing_yesno')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('hearing_yesno')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="hearing_yesno" as=${html``} />

${ parent.decodeEntities(`Hearing Explanation`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="hearing_text" as=${html``} />

${ parent.decodeEntities(`Speech Limitation?`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('speech_yesno')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('speech_yesno')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="speech_yesno" as=${html``} />

${ parent.decodeEntities(`Speech Explanation`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="speech_text" as=${html``} />

${ parent.decodeEntities(`Lifting Limitation?`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('lifting_yesno')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('lifting_yesno')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="lifting_yesno" as=${html``} />

${ parent.decodeEntities(`Lifting Explanation`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="lifting_text" as=${html``} />

${ parent.decodeEntities(`Health Limitation? `) }

<${validation.ErrorMessage} errors=${validation.errors} name="health_yesno" as=${html``} />

${ parent.decodeEntities(`Health Explanation`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="health_text" as=${html``} />

${ parent.decodeEntities(`Physical Limitation?`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('physical_yesno')} /> ${ parent.decodeEntities(`Yes`) }

<${validation.ErrorMessage} errors=${validation.errors} name="physical_yesno" as=${html``} />

${ parent.decodeEntities(`Physical Explanation`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="physical_text" as=${html``} />

${ parent.decodeEntities(`Emotional Limitation? `) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('emotional_yesno')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('emotional_yesno')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="emotional_yesno" as=${html``} />

${ parent.decodeEntities(`Emotional Explanation`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="emotional_text" as=${html``} />

${ parent.decodeEntities(`Other Limitation?`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('other_yesno')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('other_yesno')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="other_yesno" as=${html``} />

${ parent.decodeEntities(`Other Limitation Explanation`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="other_text" as=${html``} />

Availability for Work

Availability Options

${ parent.decodeEntities(`Availability Options `) }

parent.handleCheckbox(el, 'onLoad')} className="mf-checkbox multi-option-input-type" id="mf-input-checkbox-f201b93">

parent.handleCheckbox(el.target, 'onClick') } aria-invalid=${validation.errors['availability'] ? 'true' : 'false'} ref=${el => { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} } /> ${ parent.decodeEntities(`Full-time`) }

<${validation.ErrorMessage} errors=${validation.errors} name="availability" as=${html``} />

${ parent.decodeEntities(`Sunday`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('sunday-radio')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('sunday-radio')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="sunday-radio" as=${html``} />

${ parent.decodeEntities(`Sunday From-To `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="sunday" as=${html``} />

${ parent.decodeEntities(`Monday`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('monday-radio')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('monday-radio')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="monday-radio" as=${html``} />

${ parent.decodeEntities(`Monday From-To`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="monday" as=${html``} />

${ parent.decodeEntities(`Wednesday`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('wednesday-radio')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('wednesday-radio')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="wednesday-radio" as=${html``} />

${ parent.decodeEntities(`Wednesday From-To`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="wednesday" as=${html``} />

${ parent.decodeEntities(`Thursday`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'value-1' === parent.getValue('thursday-radio')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'value-2' === parent.getValue('thursday-radio')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="thursday-radio" as=${html``} />

${ parent.decodeEntities(`Thursday From-To`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="sunday" as=${html``} />

${ parent.decodeEntities(`Friday`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('friday-radio')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('friday-radio')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="friday-radio" as=${html``} />

${ parent.decodeEntities(`Friday From-To`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="friday" as=${html``} />

${ parent.decodeEntities(`Saturday `) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('saturday_-radio')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('saturday_-radio')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="saturday_-radio" as=${html``} />

${ parent.decodeEntities(`Saturday From-To`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="friday" as=${html``} />

${ parent.decodeEntities(`Minimum Hours per Day`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="min_hours" as=${html``} />

${ parent.decodeEntities(`Maximum Hours per Day `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="max_hours" as=${html``} />

Type of Work Seeking

Type of Position(s) Preferred

${ parent.decodeEntities(`Preferred Positions `) }

parent.handleCheckbox(el, 'onLoad')} className="mf-checkbox multi-option-input-type" id="mf-input-checkbox-7f77cf8">

parent.handleCheckbox(el.target, 'onClick') } aria-invalid=${validation.errors['position'] ? 'true' : 'false'} ref=${el => { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} } /> ${ parent.decodeEntities(`Home Maker`) }

<${validation.ErrorMessage} errors=${validation.errors} name="position" as=${html``} />

${ parent.decodeEntities(`Other Preferred Position (Specify)`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="position_other" as=${html``} />

${ parent.decodeEntities(`Live-in care usually requires that you to in a client’s home continuously for 3-4 days at a time every week. Indicate which shifts you will accept:`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'value-1' === parent.getValue('monday-radio')} /> ${ parent.decodeEntities(`Weekdays (Monday a.m. to Friday a.m.) `) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'value-2' === parent.getValue('monday-radio')} /> ${ parent.decodeEntities(`Weekends: (Friday a.m. to Monday a.m.)`) }

<${validation.ErrorMessage} errors=${validation.errors} name="monday-radio" as=${html``} />

Clients Not Willing/Able

${ parent.decodeEntities(`Clients Not Willing/Able`) }

parent.handleCheckbox(el, 'onLoad')} className="mf-checkbox multi-option-input-type" id="mf-input-checkbox-ab2b249">

parent.handleCheckbox(el.target, 'onClick') } aria-invalid=${validation.errors['clients_not'] ? 'true' : 'false'} ref=${el => { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} } /> ${ parent.decodeEntities(`Dementias/Alzheimer’s`) }

<${validation.ErrorMessage} errors=${validation.errors} name="clients_not" as=${html``} />

${ parent.decodeEntities(`Other: (Specify)`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="clients_other" as=${html``} />

Duties Not Willing/Able

${ parent.decodeEntities(`Duties Not Willing/Able`) }

parent.handleCheckbox(el, 'onLoad')} className="mf-checkbox multi-option-input-type" id="mf-input-checkbox-e8d22fd">

parent.handleCheckbox(el.target, 'onClick') } aria-invalid=${validation.errors['duties_not'] ? 'true' : 'false'} ref=${el => { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} } /> ${ parent.decodeEntities(`Bathing `) }

<${validation.ErrorMessage} errors=${validation.errors} name="duties_not" as=${html``} />

Experience

${ parent.decodeEntities(`Indicate which of the following you have experience in:`) }

parent.handleCheckbox(el, 'onLoad')} className="mf-checkbox multi-option-input-type" id="mf-input-checkbox-2c171ac">

parent.handleCheckbox(el.target, 'onClick') } aria-invalid=${validation.errors['experience_details_'] ? 'true' : 'false'} ref=${el => { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} } /> ${ parent.decodeEntities(`Bathing/Showering `) }

<${validation.ErrorMessage} errors=${validation.errors} name="experience_details_" as=${html``} />

Assignment Location

${ parent.decodeEntities(`Are you restricted in the geographical location you are willing/able to work? `) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('location_restrictions')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('location_restrictions')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="location_restrictions" as=${html``} />

${ parent.decodeEntities(`Explain:`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="location_restrictionsEXPLAIN" as=${html``} />

Transportation

Type

${ parent.decodeEntities(`Transportation Type`) }

parent.handleCheckbox(el, 'onLoad')} className="mf-checkbox multi-option-input-type" id="mf-input-checkbox-f26ae0d">

parent.handleCheckbox(el.target, 'onClick') } aria-invalid=${validation.errors['transport_type'] ? 'true' : 'false'} ref=${el => { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} } /> ${ parent.decodeEntities(`Private Vehicle `) }

<${validation.ErrorMessage} errors=${validation.errors} name="transport_type" as=${html``} />

Driver’s License

${ parent.decodeEntities(`Do you have a valid Driver’s License?`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="drivers_license" as=${html``} />

Transporting Clients

${ parent.decodeEntities(`Are you willing to transport clients in your private vehicle?`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="transport_private_vehicle_" as=${html``} />

${ parent.decodeEntities(`Do you have adequate vehicle insurance? `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="adequate_vehicle_insurance_" as=${html``} />

${ parent.decodeEntities(`Are you willing to drive a client’s vehicle? `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="drive_client_vehicle" as=${html``} />

${ parent.decodeEntities(`Are you willing to escort a client in their own vehicle? `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="escort_client_vehicle" as=${html``} />

${ parent.decodeEntities(`Are you willing to escort a client on public transportation? `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="Are_you_willing_to_escort_a_client_on_public_transportation__" as=${html``} />

${ parent.decodeEntities(`Comments`) } <${validation.ErrorMessage} errors=${validation.errors} name="transport_comments_" as=${html``} />

Abuse Investigation Fields

${ parent.decodeEntities(`Have you ever been investigated for abuse, neglect or domestic violence? `) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'Yes' === parent.getValue('abuse_investigated')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('abuse_investigated')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="abuse_investigated" as=${html``} />

${ parent.decodeEntities(`If yes, explain `) } <${validation.ErrorMessage} errors=${validation.errors} name="abuse_explanation" as=${html``} />

Employment History/References

Work Related #1 (Last Position)

${ parent.decodeEntities(`Company Name`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="company1_name" as=${html``} />

${ parent.decodeEntities(`Address`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="company1_address" as=${html``} />

${ parent.decodeEntities(`Telephone No. & Email Address`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="company1_contact" as=${html``} />

${ parent.decodeEntities(`Supervisor’s Name `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="company1_supervisor" as=${html``} />

${ parent.decodeEntities(`Position Held `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="company1_position" as=${html``} />

${ parent.decodeEntities(`Length of Employment `) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="company1_length_" as=${html``} />

${ parent.decodeEntities(`Reason for Leaving`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="company1_reason" as=${html``} />

${ parent.decodeEntities(`Name of patients work with within one year preceding the date of application:`) } <${validation.ErrorMessage} errors=${validation.errors} name="company1_patients" as=${html``} />

${ parent.decodeEntities(`Areas of working experience and period of time during which the experience was acquired:`) } <${validation.ErrorMessage} errors=${validation.errors} name="company1_experience_" as=${html``} />

Work Related #2 (2nd Last Position)

Work Related #3 (3rd Last Position)

${ parent.decodeEntities(`Nature of Friendship (friend, co-worker, family etc.) (other than relative.)`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="ref1_relationship" as=${html``} />

Work Related #3 (3rd Last Position)

Upload Documents

${ parent.decodeEntities(`HHA license`) }

parent.activateValidation({"message":"This field is required.","required":false,"file_types":[".jpg",".jpeg",".gif",".png"],"type_message":"Invalid file extension","size_limit":256,"limit_message":"File size cannot exceed 256 kb"}, el) } /> ${ parent.decodeEntities(`Choose a file`) }

${ (parent.state.formData['mf-hha-license'] || []).length > 0 ? parent.state.formData['mf-hha-license'].map((file, idx) => html` ${file.name} parent.removeUploadedFile('mf-hha-license', idx)} title="Remove" >× `) : html`${parent.getFileLabel('mf-hha-license', 'No file chosen.')}` }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-hha-license" as=${html``} />

${ parent.decodeEntities(`Physical/Medical`) }

${ (parent.state.formData['mf-physical-medical'] || []).length > 0 ? parent.state.formData['mf-physical-medical'].map((file, idx) => html` ${file.name} parent.removeUploadedFile('mf-physical-medical', idx)} title="Remove" >× `) : html`${parent.getFileLabel('mf-physical-medical', 'No file chosen.')}` }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-physical-medical" as=${html``} />

${ parent.decodeEntities(`State photo Identification`) }

${ (parent.state.formData['mf-state'] || []).length > 0 ? parent.state.formData['mf-state'].map((file, idx) => html` ${file.name} parent.removeUploadedFile('mf-state', idx)} title="Remove" >× `) : html`${parent.getFileLabel('mf-state', 'No file chosen.')}` }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-state" as=${html``} />

${ parent.decodeEntities(`Social security card`) }

parent.activateValidation({"message":"This field is required.","required":false,"file_types":[".jpg",".jpeg",".gif",".png"],"type_message":"Invalid file extension","size_limit":-1,"limit_message":"This field is required."}, el) } /> ${ parent.decodeEntities(`Choose a file`) }

${ (parent.state.formData['mf-social-security'] || []).length > 0 ? parent.state.formData['mf-social-security'].map((file, idx) => html` ${file.name} parent.removeUploadedFile('mf-social-security', idx)} title="Remove" >× `) : html`${parent.getFileLabel('mf-social-security', 'No file chosen.')}` }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-social-security" as=${html``} />

${ parent.decodeEntities(`Work Authorization card`) }

parent.activateValidation({"message":"This field is required.","required":false,"file_types":[".jpg",".jpeg",".gif",".png"],"type_message":"Invalid file extension","size_limit":-1,"limit_message":"This field is required."}, el) } /> ${ parent.decodeEntities(`Choose a file`) }

${ (parent.state.formData['mf-work-authorization'] || []).length > 0 ? parent.state.formData['mf-work-authorization'].map((file, idx) => html` ${file.name} parent.removeUploadedFile('mf-work-authorization', idx)} title="Remove" >× `) : html`${parent.getFileLabel('mf-work-authorization', 'No file chosen.')}` }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-work-authorization" as=${html``} />

${ parent.decodeEntities(`Direct deposit form`) }

parent.activateValidation({"message":"This field is required.","required":false,"file_types":[".jpg",".jpeg",".gif",".png"],"type_message":"Invalid file extension","size_limit":-1,"limit_message":"This field is required."}, el) } /> ${ parent.decodeEntities(`Choose a file`) }

${ (parent.state.formData['mf-direct-deposite'] || []).length > 0 ? parent.state.formData['mf-direct-deposite'].map((file, idx) => html` ${file.name} parent.removeUploadedFile('mf-direct-deposite', idx)} title="Remove" >× `) : html`${parent.getFileLabel('mf-direct-deposite', 'No file chosen.')}` }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-direct-deposite" as=${html``} />

${ parent.decodeEntities(``) }

parent.handleCheckbox(el, 'onLoad')} className="mf-checkbox multi-option-input-type" id="mf-input-checkbox-7fab4b1">

parent.handleCheckbox(el.target, 'onClick') } aria-invalid=${validation.errors['policy'] ? 'true' : 'false'} ref=${el => { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} } /> ${ parent.decodeEntities(`I certify that, to the best of my knowledge, the answers given are true and complete and that purposeful misrepresentation may result in rejection of my application. I hereby authorize Beyondcaregiver Healthcare LLC Healthcare LLC to request and receive from all prior employers within one year of the date of this application all pertinent information concerning my prior employment and its termination, including the reasons for such terminations. Additionally, I hereby release and discharge any of the above, and Beyondcaregiver Healthcare LLC Healthcare LLC from any liability of any kind or nature. I also understand that it is my responsibility to keep such information current and accurate by updating it as often as necessary. I agree to a physical examination, if requested, and understand that failure to meet any medical and/or health requirements for the position may prevent my employment with the Agency. I also understand that employment, for certain positions, may be conditional upon successful completion of a substance abuse screening test and a criminal background check I further understand that, if hired, I may be required to provide proof that I am a citizen of the United States or proof that I am currently authorized to work in the United States.`) }

<${validation.ErrorMessage} errors=${validation.errors} name="policy" as=${html``} />

${ parent.decodeEntities(`Signature`) }

<${props.SignaturePad} clearButton="true" penColor="" name="mf-signature" onEnd=${function () { parent.handleSignature(this) }} /> parent.activateValidation({"message":"This field is required.","required":false}, el) } />

<${validation.ErrorMessage} errors=${validation.errors} name="mf-signature" as=${html``} />

${ parent.decodeEntities(`Date`) } <${props.Flatpickr} name="mf-date" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(`Date`) } " options=${{"minDate":"","maxDate":"","dateFormat":"m-d-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('mf-date')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['mf-date'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":false}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-date" as=${html``} />

`} ${is_dummy_markup ? message_position === 'bottom' ? props.ResponseDummyMarkup(message_successIcon, message_proClass) : '' : ''} ${is_dummy_markup ? ' ' : message_position === 'bottom' ? props.SubmitResponseMarkup`${parent}${state}${message_successIcon}${message_errorIcon}${message_proClass}` : ''} `