- Scan ID:
- 95366b9b-f2a9-4a6f-bc70-7dfb6180e6b2Finished
- Submitted URL:
- https://form.jotform.com/221986420711050
- Report Finished:
Links · 0 found
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JavaScript Variables · 95 found
Global JavaScript variables loaded on the window object of a page, are variables declared outside of functions and accessible from anywhere in the code within the current scope
| Name | Type |
|---|---|
| onbeforetoggle | object |
| documentPictureInPicture | object |
| onscrollend | object |
| favicon | object |
| isDarkMode | boolean |
| $ | function |
| jQuery | function |
| simplify | function |
| isSignaturePadInitialized | boolean |
| initializeSignaturePad | function |
Console log messages · 0 found
Messages logged to the web console
HTML
The raw HTML body of the page
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only screen and (min-width:40rem){[class].sm\:line-clamp-2{display:-webkit-box;-webkit-line-clamp:1;-webkit-box-orient:vertical}[class].sm\:line-clamp-2{-webkit-line-clamp:2}[class].sm\:border-t-0{border-top-width:0}[class].sm\:border-b-0{border-bottom-width:0}[class].sm\:overflow-auto{overflow:auto}[class].sm\:static{position:static}[class].sm\:text-center,[dir=rtl] [class].sm\:rtl\:text-center{text-align:center}[class].sm\:px-0{padding-left:0;padding-right:0}[class].sm\:pb-0{padding-bottom:0}[class].sm\:pl-0{padding-left:0}[class].sm\:pr-0{padding-right:0}[class].sm\:px-2{padding-left:.5rem;padding-right:.5rem}[class].sm\:pr-2{padding-right:.5rem}[class].sm\:py-3{padding-top:.75rem;padding-bottom:.75rem}[class].sm\:pr-3{padding-right:.75rem}[class].sm\:p-4{padding:1rem}[class].sm\:px-4{padding-left:1rem;padding-right:1rem}[class].sm\:py-4{padding-top:1rem;padding-bottom:1rem}[dir=rtl] [class].sm\:rtl\:pl-4{padding-left:1rem}[class].sm\:pr-4,[dir=rtl] [class].sm\:rtl\:pr-4{padding-right:1rem}[class].sm\:px-7{padding-left:1.75rem;padding-right:1.75rem}[class].sm\:px-8{padding-left:2rem;padding-right:2rem}[class].sm\:pr-10{padding-right:2.5rem}[class].sm\:px-12{padding-left:3rem;padding-right:3rem}[class].sm\:py-0\.5{padding-top:.125rem;padding-bottom:.125rem}[class].sm\:space-y-0>*+*{margin-top:0}[class].sm\:text-md{font-size:1rem;line-height:1.25rem}[class].sm\:text-lg{font-size:1.125rem;line-height:1.375rem}[class].sm\:text-xl{font-size:1.25rem;line-height:1.5rem}[class].sm\:text-4xl{font-size:2rem;line-height:2.5rem}[class].sm\:justify-center{justify-content:center}[class].sm\:justify-start{justify-content:flex-start}[class].sm\:justify-end{justify-content:flex-end}[class].sm\:justify-between{justify-content:space-between}[class].sm\:justify-around{justify-content:space-around}[class].sm\:justify-evenly{justify-content:space-evenly}[class].sm\:justify-self-auto{justify-self:auto}[class].sm\:justify-self-start{justify-self:start}[class].sm\:justify-self-end{justify-self:end}[class].sm\:justify-self-center{justify-self:center}[class].sm\:justify-self-stretch{justify-self:stretch}[class].sm\:self-auto{align-self:auto}[class].sm\:self-center{align-self:center}[class].sm\:self-start{align-self:flex-start}[class].sm\:self-end{align-self:flex-end}[class].sm\:self-stretch{align-self:stretch}[class].sm\:self-baseline{align-self:baseline}[class].sm\:items-center{align-items:center}[class].sm\:items-start{align-items:flex-start}[class].sm\:items-end{align-items:flex-end}[class].sm\:items-stretch{align-items:stretch}[class].sm\:items-baseline{align-items:baseline}[class].sm\:min-w-36{min-width:9rem}[class].sm\:min-w-sm{min-width:40rem}[class].sm\:max-w-32{max-width:8rem}[class].sm\:max-h-44{max-height:11rem}[class].sm\:max-w-3\/4{max-width:75%}[class].sm\:max-h-4\/5{max-height:80%}[class].sm\:max-w-full{max-width:100%}[class].sm\:max-h-50vh{max-height:50vh}[class].sm\:cols-none{grid-template-columns:repeat(none,minmax(0,1fr))}[class].sm\:cols-1{grid-template-columns:repeat(1,minmax(0,1fr))}[class].sm\:cols-2{grid-template-columns:repeat(2,minmax(0,1fr))}[class].sm\:cols-3{grid-template-columns:repeat(3,minmax(0,1fr))}[class].sm\:cols-4{grid-template-columns:repeat(4,minmax(0,1fr))}[class].sm\:cols-5{grid-template-columns:repeat(5,minmax(0,1fr))}[class].sm\:cols-6{grid-template-columns:repeat(6,minmax(0,1fr))}[class].sm\:cols-7{grid-template-columns:repeat(7,minmax(0,1fr))}[class].sm\:cols-8{grid-template-columns:repeat(8,minmax(0,1fr))}[class].sm\:cols-9{grid-template-columns:repeat(9,minmax(0,1fr))}[class].sm\:cols-10{grid-template-columns:repeat(10,minmax(0,1fr))}[class].sm\:cols-11{grid-template-columns:repeat(11,minmax(0,1fr))}[class].sm\:cols-12{grid-template-columns:repeat(12,minmax(0,1fr))}[class].sm\:col-start-auto{grid-column-start:auto}[class].sm\:col-end-auto{grid-column-end:auto}[class].sm\:col-start-1{grid-column-start:1}[class].sm\:col-end-1{grid-column-end:1}[class].sm\:col-start-2{grid-column-start:2}[class].sm\:col-end-2{grid-column-end:2}[class].sm\:col-start-3{grid-column-start:3}[class].sm\:col-end-3{grid-column-end:3}[class].sm\:col-start-4{grid-column-start:4}[class].sm\:col-end-4{grid-column-end:4}[class].sm\:col-start-5{grid-column-start:5}[class].sm\:col-end-5{grid-column-end:5}[class].sm\:col-start-6{grid-column-start:6}[class].sm\:col-end-6{grid-column-end:6}[class].sm\:col-start-7{grid-column-start:7}[class].sm\:col-end-7{grid-column-end:7}[class].sm\:col-start-8{grid-column-start:8}[class].sm\:col-end-8{grid-column-end:8}[class].sm\:col-start-9{grid-column-start:9}[class].sm\:col-end-9{grid-column-end:9}[class].sm\:col-start-10{grid-column-start:10}[class].sm\:col-end-10{grid-column-end:10}[class].sm\:col-start-11{grid-column-start:11}[class].sm\:col-end-11{grid-column-end:11}[class].sm\:col-start-12{grid-column-start:12}[class].sm\:col-end-12{grid-column-end:12}[class].sm\:row-start-auto{grid-row-start:auto}[class].sm\:row-end-auto{grid-row-end:auto}[class].sm\:row-start-1{grid-row-start:1}[class].sm\:row-end-1{grid-row-end:1}[class].sm\:row-start-2{grid-row-start:2}[class].sm\:row-end-2{grid-row-end:2}[class].sm\:row-start-3{grid-row-start:3}[class].sm\:row-end-3{grid-row-end:3}[class].sm\:row-start-4{grid-row-start:4}[class].sm\:row-end-4{grid-row-end:4}[class].sm\:row-start-5{grid-row-start:5}[class].sm\:row-end-5{grid-row-end:5}[class].sm\:row-start-6{grid-row-start:6}[class].sm\:row-end-6{grid-row-end:6}[class].sm\:row-start-7{grid-row-start:7}[class].sm\:row-end-7{grid-row-end:7}[class].sm\:row-start-8{grid-row-start:8}[class].sm\:row-end-8{grid-row-end:8}[class].sm\:row-start-9{grid-row-start:9}[class].sm\:row-end-9{grid-row-end:9}[class].sm\:row-start-10{grid-row-start:10}[class].sm\:row-end-10{grid-row-end:10}[class].sm\:row-start-11{grid-row-start:11}[class].sm\:row-end-11{grid-row-end:11}[class].sm\:row-start-12{grid-row-start:12}[class].sm\:row-end-12{grid-row-end:12}[class].sm\:gap-0{gap:0}[class].sm\:gap-2{gap:.5rem}[cla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0 2px #252d5b0a,0 4px 8px #545f6f29}[class].sm\:h-5{height:1.25rem}[class].sm\:w-5{width:1.25rem}[class].sm\:h-8{height:2rem}[class].sm\:h-10{height:2.5rem}[class].sm\:w-10{width:2.5rem}[class].sm\:h-20{height:5rem}[class].sm\:w-20{width:5rem}[class].sm\:h-28{height:7rem}[class].sm\:w-32{width:8rem}[class].sm\:w-40{width:10rem}[class].sm\:h-44{height:11rem}[class].sm\:w-48{width:12rem}[class].sm\:w-52{width:13rem}[class].sm\:w-56{width:14rem}[class].sm\:w-60{width:15rem}[class].sm\:w-64{width:16rem}[class].sm\:h-88{height:22rem}[class].sm\:w-120{width:30rem}[class].sm\:h-auto{height:auto}[class].sm\:w-auto{width:auto}[class].sm\:w-1\/2{width:50%}[class].sm\:w-10\/12{width:83.333333%}[class].sm\:h-full{height:100%}[class].sm\:radius-lg{border-radius:.5rem}[class].sm\:mx-0{margin-left:0;margin-right:0}[dir=rtl] [class].sm\:rtl\:ml-0{margin-left:0}[class].sm\:mt-0{margin-top:0}[class].sm\:mb-0{margin-bottom:0}[class].sm\:ml-2{margin-left:.5rem}[class].sm\:mr-2{margin-right:.5rem}[class].sm\:mb-2{margin-bottom:.5rem}[class].sm\:mt-3{margin-top:.75rem}[class].sm\:my-4{margin-top:1rem;margin-bottom:1rem}[class].sm\:ml-4{margin-left:1rem}[class].sm\:mr-4,[dir=rtl] [class].sm\:rtl\:mr-4{margin-right:1rem}[class].sm\:-mx-7{margin-left:-1.75rem;margin-right:-1.75rem}[class].sm\:mt-20{margin-top:5rem}[class].sm\:mb-20{margin-bottom:5rem}[class].sm\:ml-2\.5{margin-left:.625rem}[class].sm\:m-auto{margin:auto}[class].sm\:mx-auto{margin-left:auto;margin-right:auto}[class].sm\:ml-auto{margin-left:auto}[dir=rtl] [class].sm\:rtl\:mr-auto{margin-right:auto}}@media only screen and (min-width:48rem){[dir=rtl] [class].md\:rtl\:border-l-0{border-left-width:0}[class].md\:border-l{border-left-width:1px}[dir=rtl] [class].md\:rtl\:border-r{border-right-width:1px}[class].md\:border-b{border-bottom-width:1px}[class].md\:px-0{padding-left:0;padding-right:0}[class].md\:pl-0{padding-left:0}[class].md\:pr-0,[dir=rtl] [class].md\:rtl\:pr-0{padding-right:0}[class].md\:p-3{padding:.75rem}[class].md\:py-3{padding-top:.75rem;padding-bottom:.75rem}[class].md\:pl-3{padding-left:.75rem}[class].md\:pr-3{padding-right:.75rem}[class].md\:px-4{padding-left:1rem;padding-right:1rem}[class].md\:pt-4{padding-top:1rem}[class].md\:pb-4{padding-bottom:1rem}[class].md\:pl-4{padding-left:1rem}[class].md\:pr-4{padding-right:1rem}[class].md\:px-5{padding-left:1.25rem;padding-right:1.25rem}[class].md\:p-6{padding:1.5rem}[class].md\:py-6{padding-top:1.5rem;padding-bottom:1.5rem}[class].md\:pb-6{padding-bottom:1.5rem}[class].md\:px-8{padding-left:2rem;padding-right:2rem}[class].md\:py-8{padding-top:2rem;padding-bottom:2rem}[class].md\:pr-8{padding-right:2rem}[class].md\:px-10{padding-left:2.5rem;padding-right:2.5rem}[class].md\:pb-10{padding-bottom:2.5rem}[class].md\:pt-12{padding-top:3rem}[class].md\:pt-16{padding-top:4rem}[class].md\:pr-20{padding-right:5rem}[class].md\:pb-24{padding-bottom:6rem}[class].md\:pb-40{padding-bottom:10rem}[dir=rtl] [class].md\:rtl\:pl-60{padding-left:15rem}[class].md\:pr-60{padding-right:15rem}[class].md\:text-sm{font-size:.875rem;line-height:1.125rem}[class].md\:text-md{font-size:1rem;line-height:1.25rem}[class].md\:text-lg{font-size:1.125rem;line-height:1.375rem}[class].md\:text-xl{font-size:1.25rem;line-height:1.5rem}[class].md\:text-2xl{font-size:1.5rem;line-height:1.75rem}[class].md\:text-3xl{font-size:1.75rem;line-height:2rem}[class].md\:text-4xl{font-size:2rem;line-height:2.5rem}[class].md\:line-height-xl{line-height:1.5rem}[class].md\:line-height-3xl{line-height:2rem}[class].md\:line-height-4xl{line-height:2.5rem}[class].md\:justify-center{justify-content:center}[class].md\:justify-start{justify-content:flex-start}[class].md\:justify-end{justify-content:flex-end}[class].md\:justify-between{justify-content:space-between}[class].md\:justify-around{justify-content:space-around}[class].md\:justify-evenly{justify-content:space-evenly}[class].md\:justify-self-auto{justify-self:auto}[class].md\:justify-self-start{justify-self:start}[class].md\:justify-self-end{justify-self:end}[class].md\:justify-self-center{justify-self:center}[class].md\:justify-self-stretch{justify-self:stretch}[class].md\:self-auto{align-self:auto}[class].md\:self-center{align-self:center}[class].md\:self-start{align-self:flex-start}[class].md\:self-end{align-self:flex-end}[class].md\:self-stretch{align-self:stretch}[class].md\:self-baseline{align-self:baseline}[class].md\:items-center{align-items:center}[class].md\:items-start{align-items:flex-start}[class].md\:items-end{align-items:flex-end}[class].md\:items-stretch{align-items:stretch}[class].md\:items-baseline{align-items:baseline}[class].md\:min-h-10{min-height:2.5rem}[class].md\:min-h-12{min-height:3rem}[class].md\:min-h-16{min-height:4rem}[class].md\:min-h-24{min-height:6rem}[class].md\:min-h-36{min-height:9rem}[class].md\:min-w-40{min-width:10rem}[class].md\:min-w-76{min-width:19rem}[class].md\:min-h-120{min-height:30rem}[class].md\:min-w-md{min-width:48rem}[class].md\:max-w-20{max-width:5rem}[class].md\:max-w-56{max-width:14rem}[class].md\:max-w-92{max-width:23rem}[class].md\:max-w-md{max-width:48rem}[class].md\:max-w-xl{max-width:80rem}[class].md\:cols-none{grid-template-columns:repeat(none,minmax(0,1fr))}[class].md\:cols-1{grid-template-columns:repeat(1,minmax(0,1fr))}[class].md\:cols-2{grid-template-columns:repeat(2,minmax(0,1fr))}[class].md\:cols-3{grid-template-columns:repeat(3,minmax(0,1fr))}[class].md\:cols-4{grid-template-columns:repeat(4,minmax(0,1fr))}[class].md\:cols-5{grid-template-columns:repeat(5,minmax(0,1fr))}[class].md\:cols-6{grid-template-columns:repeat(6,minmax(0,1fr))}[class].md\:cols-7{grid-template-columns:repeat(7,minmax(0,1fr))}[class].md\:cols-8{grid-template-columns:repeat(8,minmax(0,1fr))}[class].md\:cols-9{grid-template-columns:repeat(9,minmax(0,1fr))}[class].md\:cols-10{grid-template-columns:repeat(10,minmax(0,1fr))}[class].md\:cols-11{grid-template-columns:repeat(11,minmax(0,1fr))}[class].md\:cols-12{grid-template-columns:repeat(12,minmax(0,1fr))}[class].md\:col-start-auto{grid-column-start:auto}[class].md\:col-end-auto{grid-column-end:auto}[class].md\:col-start-1{grid-column-start:1}[class].md\:col-end-1{grid-column-end:1}[class].md\:col-start-2{grid-column-start:2}[class].md\:col-end-2{grid-column-end:2}[class].md\:col-start-3{grid-column-start:3}[class].md\:col-end-3{grid-column-end:3}[class].md\:col-start-4{grid-column-start:4}[class].md\:col-end-4{grid-column-end:4}[class].md\:col-start-5{grid-column-start:5}[class].md\:col-end-5{grid-column-end:5}[class].md\:col-start-6{grid-column-start:6}[class].md\:col-end-6{grid-column-end:6}[class].md\:col-start-7{grid-column-start:7}[class].md\:col-end-7{grid-column-end:7}[class].md\:col-start-8{grid-column-start:8}[class].md\:col-end-8{grid-column-end:8}[class].md\:col-start-9{grid-column-start:9}[class].md\:col-end-9{grid-column-end:9}[class].md\:col-start-10{grid-column-start:10}[class].md\:col-end-10{grid-column-end:10}[class].md\:col-start-11{grid-column-start:11}[class].md\:col-end-11{grid-column-end:11}[class].md\:col-start-12{grid-column-start:12}[class].md\:col-end-12{grid-column-end:12}[class].md\:row-start-auto{grid-row-start:auto}[class].md\:row-end-auto{grid-row-end:auto}[class].md\:row-start-1{grid-row-start:1}[class].md\:row-end-1{grid-row-end:1}[class].md\:row-start-2{grid-row-start:2}[class].md\:row-end-2{grid-row-end:2}[class].md\:row-start-3{grid-row-start:3}[class].md\:row-end-3{grid-row-end:3}[class].md\:row-start-4{grid-row-start:4}[class].md\:row-end-4{grid-row-end:4}[class].md\:row-start-5{grid-row-start:5}[class].md\:row-end-5{grid-row-end:5}[class].md\:row-start-6{grid-row-start:6}[class].md\:row-end-6{grid-row-end:6}[class].md\:row-start-7{grid-row-start:7}[class].md\:row-end-7{grid-row-end:7}[class].md\:row-start-8{grid-row-start:8}[class].md\:row-end-8{grid-row-end:8}[class].md\:row-start-9{grid-row-start:9}[class].md\:row-end-9{grid-row-end:9}[class].md\:row-start-10{grid-row-start:10}[class].md\:row-end-10{grid-row-end:10}[class].md\:row-start-11{grid-row-start:11}[class].md\:row-end-11{grid-row-end:11}[class].md\:row-start-12{grid-row-start:12}[class].md\:row-end-12{grid-row-end:12}[class].md\:gap-0{gap:0}[class].md\:gap-4{gap:1rem}[class].md\:gap-5{gap:1.25rem}[class].md\:gap-16{gap:4rem}[class].md\:gap-20{gap:5rem}[class].md\:flex-row{flex-direction:row}[class].md\:flex-col{flex-direction:column}[class].md\:flex-row-reverse{flex-direction:row-reverse}[class].md\:flex-col-reverse{flex-direction:column-reverse}[class].md\:shrink-0{flex-shrink:0}[class].md\:shrink-1{flex-shrink:1}[class].md\:grow-0{flex-grow:0}[class].md\:grow-1{flex-grow:1}[class].md\:flex-wrap{flex-wrap:wrap}[class].md\:flex-nowrap{flex-wrap:nowrap}[class].md\:order-first{order:-9999}[class].md\:order-last{order:9999}[class].md\:order-none{order:0}[class].md\:inline-flex{display:inline-flex}[class].md\:block{display:block}[class].md\:flex{display:flex}[class].md\:hidden{display:none}[class].md\:inline{display:inline}[class].md\:hiddenjf{display:none}[class].md\:font-bold{font-weight:700}[class].md\:h-8{height:2rem}[class].md\:h-12{height:3rem}[class].md\:w-12{width:3rem}[class].md\:h-14{height:3.5rem}[class].md\:w-14{width:3.5rem}[class].md\:h-16{height:4rem}[class].md\:w-52{width:13rem}[class].md\:h-64{height:16rem}[class].md\:w-120{width:30rem}[class].md\:h-auto{height:auto}[class].md\:w-auto{width:auto}[class].md\:w-2\/6{width:33.333333%}[class].md\:h-full{height:100%}[class].md\:w-full{width:100%}[class].md\:basis-80{flex-basis:20rem}[class].md\:basis-92{flex-basis:23rem}[class].md\:top-0{top:0}[class].md\:right-0{right:0}[class].md\:right-3{right:.75rem}[class].md\:right-6{right:1.5rem}[class].md\:bottom-9{bottom:2.25rem}[class].md\:top-18{top:4.5rem}[class].md\:top-1\/2{top:50%}[class].md\:left-auto{left:auto}[class].md\:bottom-auto{bottom:auto}[class].md\:radius-none{border-radius:0}[class].md\:radius-tr-none{border-top-right-radius:0}[class].md\:radius-bl-none{border-bottom-left-radius:0}[class].md\:radius-r-md,[class].md\:radius-tr-md{border-top-right-radius:.375rem}[class].md\:radius-r-md{border-bottom-right-radius:.375rem}[class].md\:radius-bl-md{border-bottom-left-radius:.375rem}[class].md\:radius-tl-lg{border-top-left-radius:.5rem}[class].md\:radius-tr-lg{border-top-right-radius:.5rem}[class].md\:radius-bl-lg{border-bottom-left-radius:.5rem}[dir=rtl] [class].md\:rtl\:left-0{left:0}[dir=rtl] [class].md\:rtl\:right-auto{right:auto}[class].md\:-translate-y-1\/2{--translate-y:-50%}[class].md\:ml-0{margin-left:0}[class].md\:mr-0{margin-right:0}[class].md\:mt-0{margin-top:0}[class].md\:mb-0{margin-bottom:0}[class].md\:mb-1{margin-bottom:.25rem}[class].md\:mb-2{margin-bottom:.5rem}[class].md\:ml-3{margin-left:.75rem}[class].md\:mt-4{margin-top:1rem}[class].md\:mb-4{margin-bottom:1rem}[class].md\:mb-5{margin-bottom:1.25rem}[class].md\:-mb-5{margin-bottom:-1.25rem}[class].md\:mt-6{margin-top:1.5rem}[class].md\:mb-6{margin-bottom:1.5rem}[class].md\:mb-7{margin-bottom:1.75rem}[class].md\:my-8{margin-top:2rem;margin-bottom:2rem}[class].md\:mb-8{margin-bottom:2rem}[class].md\:-mt-8{margin-top:-2rem}[class].md\:mx-10{margin-left:2.5rem;margin-right:2.5rem}[class].md\:ml-10{margin-left:2.5rem}[class].md\:mr-10{margin-right:2.5rem}[class].md\:mb-12{margin-bottom:3rem}[class].md\:mt-18{margin-top:4.5rem}[class].md\:-mt-24{margin-top:-6rem}}@media only screen and (min-width:64rem){[class].lg\:py-0{padding-top:0;padding-bottom:0}[class].lg\:px-2{padding-left:.5rem;padding-right:.5rem}[class].lg\:px-3{padding-left:.75rem;padding-right:.75rem}[class].lg\:py-3{padding-top:.75rem;padding-bottom:.75rem}[class].lg\:pb-6{padding-bottom:1.5rem}[class].lg\:p-8{padding:2rem}[class].lg\:py-8{padding-top:2rem;padding-bottom:2rem}[class].lg\:px-12{padding-left:3rem;padding-right:3rem}[class].lg\:pt-12{padding-top:3rem}[class].lg\:pr-16{padding-right:4rem}[class].lg\:text-xs{font-size:.75rem;line-height:1rem}[class].lg\:text-sm{font-size:.875rem;line-height:1.125rem}[class].lg\:text-md{font-size:1rem;line-height:1.25rem}[class].lg\:text-3xl{font-size:1.75rem;line-height:2rem}[class].lg\:text-6xl{font-size:2.5rem;line-height:2.875rem}[class].lg\:text-7xl{font-size:3rem;line-height:3.25rem}[class].lg\:line-height-xl{line-height:1.5rem}[class].lg\:line-height-4xl{line-height:2.5rem}[class].lg\:justify-center{justify-content:center}[class].lg\:justify-start{justify-content:flex-start}[class].lg\:justify-end{justify-content:flex-end}[class].lg\:justify-between{justify-content:space-between}[class].lg\:justify-around{justify-content:space-around}[class].lg\:justify-evenly{justify-content:space-evenly}[class].lg\:justify-self-auto{justify-self:auto}[class].lg\:justify-self-start{justify-self:start}[class].lg\:justify-self-end{justify-self:end}[class].lg\:justify-self-center{justify-self:center}[class].lg\:justify-self-stretch{justify-self:stretch}[class].lg\:self-auto{align-self:auto}[class].lg\:self-center{align-self:center}[class].lg\:self-start{align-self:flex-start}[class].lg\:self-end{align-self:flex-end}[class].lg\:self-stretch{align-self:stretch}[class].lg\:self-baseline{align-self:baseline}[class].lg\:items-center{align-items:center}[class].lg\:items-start{align-items:flex-start}[class].lg\:items-end{align-items:flex-end}[class].lg\:items-stretch{align-items:stretch}[class].lg\:items-baseline{align-items:baseline}[class].lg\:min-h-56{min-height:14rem}[class].lg\:min-w-92{min-width:23rem}[class].lg\:min-w-120{min-width:30rem}[class].lg\:max-w-72{max-width:18rem}[class].lg\:max-h-80{max-height:20rem}[class].lg\:max-w-88{max-width:22rem}[class].lg\:cols-none{grid-template-columns:repeat(none,minmax(0,1fr))}[class].lg\:cols-1{grid-template-columns:repeat(1,minmax(0,1fr))}[class].lg\:cols-2{grid-template-columns:repeat(2,minmax(0,1fr))}[class].lg\:cols-3{grid-template-columns:repeat(3,minmax(0,1fr))}[class].lg\:cols-4{grid-template-columns:repeat(4,minmax(0,1fr))}[class].lg\:cols-5{grid-template-columns:repeat(5,minmax(0,1fr))}[class].lg\:cols-6{grid-template-columns:repeat(6,minmax(0,1fr))}[class].lg\:cols-7{grid-template-columns:repeat(7,minmax(0,1fr))}[class].lg\:cols-8{grid-template-columns:repeat(8,minmax(0,1fr))}[class].lg\:cols-9{grid-template-columns:repeat(9,minmax(0,1fr))}[class].lg\:cols-10{grid-template-columns:repeat(10,minmax(0,1fr))}[class].lg\:cols-11{grid-template-columns:repeat(11,minmax(0,1fr))}[class].lg\:cols-12{grid-template-columns:repeat(12,minmax(0,1fr))}[class].lg\:col-start-auto{grid-column-start:auto}[class].lg\:col-end-auto{grid-column-end:auto}[class].lg\:col-start-1{grid-column-start:1}[class].lg\:col-end-1{grid-column-end:1}[class].lg\:col-start-2{grid-column-start:2}[class].lg\:col-end-2{grid-column-end:2}[class].lg\:col-start-3{grid-column-start:3}[class].lg\:col-end-3{grid-column-end:3}[class].lg\:col-start-4{grid-column-start:4}[class].lg\:col-end-4{grid-column-end:4}[class].lg\:col-start-5{grid-column-start:5}[class].lg\:col-end-5{grid-column-end:5}[class].lg\:col-start-6{grid-column-start:6}[class].lg\:col-end-6{grid-column-end:6}[class].lg\:col-start-7{grid-column-start:7}[class].lg\:col-end-7{grid-column-end:7}[class].lg\:col-start-8{grid-column-start:8}[class].lg\:col-end-8{grid-column-end:8}[class].lg\:col-start-9{grid-column-start:9}[class].lg\:col-end-9{grid-column-end:9}[class].lg\:col-start-10{grid-column-start:10}[class].lg\:col-end-10{grid-column-end:10}[class].lg\:col-start-11{grid-column-start:11}[class].lg\:col-end-11{grid-column-end:11}[class].lg\:col-start-12{grid-column-start:12}[class].lg\:col-end-12{grid-column-end:12}[class].lg\:row-start-auto{grid-row-start:auto}[class].lg\:row-end-auto{grid-row-end:auto}[class].lg\:row-start-1{grid-row-start:1}[class].lg\:row-end-1{grid-row-end:1}[class].lg\:row-start-2{grid-row-start:2}[class].lg\:row-end-2{grid-row-end:2}[class].lg\:row-start-3{grid-row-start:3}[class].lg\:row-end-3{grid-row-end:3}[class].lg\:row-start-4{grid-row-start:4}[class].lg\:row-end-4{grid-row-end:4}[class].lg\:row-start-5{grid-row-start:5}[class].lg\:row-end-5{grid-row-end:5}[class].lg\:row-start-6{grid-row-start:6}[class].lg\:row-end-6{grid-row-end:6}[class].lg\:row-start-7{grid-row-start:7}[class].lg\:row-end-7{grid-row-end:7}[class].lg\:row-start-8{grid-row-start:8}[class].lg\:row-end-8{grid-row-end:8}[class].lg\:row-start-9{grid-row-start:9}[class].lg\:row-end-9{grid-row-end:9}[class].lg\:row-start-10{grid-row-s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Finally, I authorize the Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test.\nI understand that only duly-authorized Company officers, employees, and agents will have access to information furnished or obtained in connection with the test; that they will maintain and protect the confidentiality of such information to the greatest extent possible; and that they will share such information only to the extent necessary to make employment decisions and to respond to inquiries or notices from government entities.\nl will hold harmless the Company, its company physician, and any testing laboratory the Company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if a Company or laboratory representative makes en error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the Company, its company physician, and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above. \nThis policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered.\nI UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN AND\u002FOR ALCOHOL TEST UNDER THIS POLICY WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT, AND I AGREE TO SUBMIT TO ANY SUCH TEST.","type":"control_text"},{"name":"input56","qid":"56","text":"As part of AllStar Security Group, we perform a hiring background and investigation, we may obtain consumer reports or prepare an investigative consumer report. 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I certify that I have made true, correct, and complete answers and statements on my employment application, any supplements to it and interview in the knowledge that they will be relied upon in considering my application for employment. I agree to provide additional information that may be requested to process my employment application. I authorize without reservation any part or agency connected to furnish the above-mentioned information. This authorization is valid during the course of my employment to the extent permitted by law.\nI hereby do authorize you to contact my current employer for Employment and Reference Verification. 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I authorize the Texas Department of Public Safety (DPS) to access Texas and Federal criminal history record information that pertains to me and disseminate that information to the designated Authorized Agency or Qualified Entity with which I am or am seeking to be employed or to serve as a volunteer, through the DPS Fingerprint-based Applicant Clearinghouse of Texas and as authorized by Texas Government Code Chapter 411 and any other applicable State of Federal statute or policy. I authorize the Texas Department of Public safety to submit my fingerprints and other application information to the FBI to disclose potentially pertinent information to the DPS during the processing of this application and for as long hereafter as may be relevant to the activity for which this application is being submitted. I understand that the FBI may also retain my fingerprints and other applicant information in the FBI's permanent collection of fingerprints and related information, where all such data will be subject to comparisons against other submissions received by the FBI and to further disseminations by the FBI as may be authorized under the Privacy Act of 1974 (5 USC 553a). I understand my fingerprints will be searched by and against civil, criminal and latent fingerprints in the Next Generation Identifications (NGI) system. I understand that I am entitled to obtain a copy of any criminal history record check and challenge the accuracy and completeness of the information before a final determination is made by the Qualified Entity. I also understand the Qualified Entity may deny me access to children, the elderly, or individuals with disabilities until the criminal history record check is completed. 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<div role="main" class="form-all">
<ul class="form-section page-section">
<li id="cid_1" class="form-input-wide" data-type="control_head" data-css-selector="id_1">
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<h1 id="header_1" class="form-header" data-component="header">All Star Security Group Application and Questionnaire</h1>
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<li class="form-line jf-required" data-type="control_dropdown" id="id_105" data-css-selector="id_105"><label class="form-label form-label-top form-label-auto" id="label_105" for="input_105" aria-hidden="false"> Which position location are you applying for?<span class="form-required">*</span> </label>
<div id="cid_105" class="form-input-wide jf-required" data-layout="half"> <select class="form-dropdown validate[required]" id="input_105" name="q105_whichPosition" style="width:310px" data-component="dropdown" required="" aria-label="Which position location are you applying for?">
<option value="">Please Select</option>
<option value="Garland">Garland</option>
<option value="Fort Worth">Fort Worth</option>
<option value="Dallas">Dallas</option>
<option value="Both Dallas & Fort Worth">Both Dallas & Fort Worth</option>
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<h2 id="header_49" class="form-header" data-component="header">Applicant and Certification Information</h2>
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</li>
<li class="form-line jf-required" data-type="control_fullname" id="id_11" data-css-selector="id_11"><label class="form-label form-label-top form-label-extended form-label-auto" id="label_11" for="first_11" aria-hidden="false"> Applicant Name<span class="form-required">*</span> </label>
<div id="cid_11" class="form-input-wide jf-required" data-layout="full">
<div data-wrapper-react="true" class="extended"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_11" name="q11_applicantName[first]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_11 given-name" size="10" data-component="first" aria-labelledby="label_11 sublabel_11_first" required="" value=""><label class="form-sub-label" for="first_11" id="sublabel_11_first" style="min-height:13px">First Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="middle"><input type="text" id="middle_11" name="q11_applicantName[middle]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_11 additional-name" size="10" data-component="middle" aria-labelledby="label_11 sublabel_11_middle" required="" value=""><label class="form-sub-label" for="middle_11" id="sublabel_11_middle" style="min-height:13px">Middle Initial</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_11" name="q11_applicantName[last]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_11 family-name" size="15" data-component="last" aria-labelledby="label_11 sublabel_11_last" required="" value=""><label class="form-sub-label" for="last_11" id="sublabel_11_last" style="min-height:13px">Last Name</label></span></div>
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<li class="form-line jf-required" data-type="control_textbox" id="id_22" data-css-selector="id_22"><label class="form-label form-label-top form-label-auto" id="label_22" for="input_22" aria-hidden="false"> Application Date<span class="form-required">*</span> </label>
<div id="cid_22" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_22" name="q22_applicationDate" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_22" required="" value=""> </div>
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<li class="form-line jf-required" data-type="control_address" id="id_13" data-css-selector="id_13"><label class="form-label form-label-top form-label-auto" id="label_13" for="input_13_addr_line1" aria-hidden="false"> Mailing Address<span class="form-required">*</span> </label>
<div id="cid_13" class="form-input-wide jf-required" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_13_addr_line1" name="q13_mailingAddress[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="section-input_13 address-line1" data-component="address_line_1" aria-labelledby="label_13 sublabel_13_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_13_addr_line1" id="sublabel_13_addr_line1" style="min-height:13px">Number/Street Address/Apt #</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_13_addr_line2" name="q13_mailingAddress[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_13 address-line2" data-component="address_line_2" aria-labelledby="label_13 sublabel_13_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_13_addr_line2" id="sublabel_13_addr_line2" style="min-height:13px">City</label></span></span></div>
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<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_13_postal" name="q13_mailingAddress[postal]" class="form-textbox validate[required] form-address-postal" data-defaultvalue="" autocomplete="section-input_13 postal-code" data-component="zip" aria-labelledby="label_13 sublabel_13_postal" required="" value="" maxlength="20"><label class="form-sub-label" for="input_13_postal" id="sublabel_13_postal" style="min-height:13px">County</label></span></span></div>
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<li class="form-line" data-type="control_address" id="id_15" data-css-selector="id_15"><label class="form-label form-label-top form-label-auto" id="label_15" for="input_15_addr_line1" aria-hidden="false"> Physical Address (if different from mailing address) </label>
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<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_addr_line1" name="q15_physicalAddress[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_15 address-line1" data-component="address_line_1" aria-labelledby="label_15 sublabel_15_addr_line1" value="" maxlength="100"><label class="form-sub-label" for="input_15_addr_line1" id="sublabel_15_addr_line1" style="min-height:13px">Number/Street Address/Apt #</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_addr_line2" name="q15_physicalAddress[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_15 address-line2" data-component="address_line_2" aria-labelledby="label_15 sublabel_15_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_15_addr_line2" id="sublabel_15_addr_line2" style="min-height:13px">City</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_city" name="q15_physicalAddress[city]" class="form-textbox form-address-city" data-defaultvalue="" autocomplete="section-input_15 address-level2" data-component="city" aria-labelledby="label_15 sublabel_15_city" value="" maxlength="60"><label class="form-sub-label" for="input_15_city" id="sublabel_15_city" style="min-height:13px">State</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_state" name="q15_physicalAddress[state]" class="form-textbox form-address-state" data-defaultvalue="" autocomplete="section-input_15 address-level1" data-component="state" aria-labelledby="label_15 sublabel_15_state" value="" maxlength="60"><label class="form-sub-label" for="input_15_state" id="sublabel_15_state" style="min-height:13px">Zip Code</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_postal" name="q15_physicalAddress[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_15 postal-code" data-component="zip" aria-labelledby="label_15 sublabel_15_postal" value="" maxlength="20"><label class="form-sub-label" for="input_15_postal" id="sublabel_15_postal" style="min-height:13px">County</label></span></span></div>
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</li>
<li class="form-line jf-required" data-type="control_phone" id="id_12" data-css-selector="id_12"><label class="form-label form-label-top form-label-auto" id="label_12" for="input_12_full"> Phone Number<span class="form-required">*</span> </label>
<div id="cid_12" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="tel" id="input_12_full" name="q12_phoneNumber[full]" data-type="mask-number" class="mask-phone-number form-textbox validate[required, Fill Mask]" data-defaultvalue="" autocomplete="section-input_12 tel-national" style="width:310px" data-masked="true" placeholder="(000) 000-0000" data-component="phone" aria-labelledby="label_12 sublabel_12_masked" required="" value="" inputmode="text" maskvalue="(###) ###-####"><label class="form-sub-label" for="input_12_full" id="sublabel_12_masked" style="min-height:13px">Please enter a valid phone number.</label></span> </div>
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<li class="form-line jf-required" data-type="control_email" id="id_20" data-css-selector="id_20"><label class="form-label form-label-top form-label-auto" id="label_20" for="input_20" aria-hidden="false"> Email<span class="form-required">*</span> </label>
<div id="cid_20" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_20" name="q20_email" class="form-textbox validate[required, Email]" data-defaultvalue="" autocomplete="section-input_20 email" style="width:310px" size="310" data-component="email" aria-labelledby="label_20 sublabel_input_20" required="" value=""><label class="form-sub-label" for="input_20" id="sublabel_input_20" style="min-height:13px">[email protected]</label></span> </div>
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<div id="cid_16" class="form-input-wide jf-required" data-layout="full">
<div data-wrapper-react="true" class="extended"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_16" name="q16_dateOf[first]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_16 given-name" size="10" data-component="first" aria-labelledby="label_16 sublabel_16_first" required="" value=""><label class="form-sub-label" for="first_16" id="sublabel_16_first" style="min-height:13px">Month</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="middle"><input type="text" id="middle_16" name="q16_dateOf[middle]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_16 additional-name" size="10" data-component="middle" aria-labelledby="label_16 sublabel_16_middle" required="" value=""><label class="form-sub-label" for="middle_16" id="sublabel_16_middle" style="min-height:13px">Day</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_16" name="q16_dateOf[last]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_16 family-name" size="15" data-component="last" aria-labelledby="label_16 sublabel_16_last" required="" value=""><label class="form-sub-label" for="last_16" id="sublabel_16_last" style="min-height:13px">Year</label></span></div>
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</li>
<li class="form-line jf-required" data-type="control_fullname" id="id_26" data-css-selector="id_26"><label class="form-label form-label-top form-label-extended form-label-auto" id="label_26" for="prefix_26" aria-hidden="false"> Other Applicant Information<span class="form-required">*</span> </label>
<div id="cid_26" class="form-input-wide jf-required" data-layout="full">
<div data-wrapper-react="true" class="extended"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="prefix"><input type="text" id="prefix_26" name="q26_otherApplicant[prefix]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_26 honorific-prefix" size="4" data-component="prefix" aria-labelledby="label_26 sublabel_26_prefix" required="" value=""><label class="form-sub-label" for="prefix_26" id="sublabel_26_prefix" style="min-height:13px">Birth City</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_26" name="q26_otherApplicant[first]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_26 given-name" size="10" data-component="first" aria-labelledby="label_26 sublabel_26_first" required="" value=""><label class="form-sub-label" for="first_26" id="sublabel_26_first" style="min-height:13px">Birth State</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="middle"><input type="text" id="middle_26" name="q26_otherApplicant[middle]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_26 additional-name" size="10" data-component="middle" aria-labelledby="label_26 sublabel_26_middle" required="" value=""><label class="form-sub-label" for="middle_26" id="sublabel_26_middle" style="min-height:13px">Birth County</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_26" name="q26_otherApplicant[last]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_26 family-name" size="15" data-component="last" aria-labelledby="label_26 sublabel_26_last" required="" value=""><label class="form-sub-label" for="last_26" id="sublabel_26_last" style="min-height:13px">SSN#</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_fullname" id="id_21" data-css-selector="id_21"><label class="form-label form-label-top form-label-extended form-label-auto" id="label_21" for="first_21" aria-hidden="false"> Emergency Contact </label>
<div id="cid_21" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true" class="extended"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_21" name="q21_emergencyContact[first]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_21 given-name" size="10" data-component="first" aria-labelledby="label_21 sublabel_21_first" value=""><label class="form-sub-label" for="first_21" id="sublabel_21_first" style="min-height:13px">Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="middle"><input type="text" id="middle_21" name="q21_emergencyContact[middle]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_21 additional-name" size="10" data-component="middle" aria-labelledby="label_21 sublabel_21_middle" value=""><label class="form-sub-label" for="middle_21" id="sublabel_21_middle" style="min-height:13px">Relationship</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_21" name="q21_emergencyContact[last]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_21 family-name" size="15" data-component="last" aria-labelledby="label_21 sublabel_21_last" value=""><label class="form-sub-label" for="last_21" id="sublabel_21_last" style="min-height:13px">Phone</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_fullname" id="id_24" data-css-selector="id_24"><label class="form-label form-label-top form-label-extended form-label-auto" id="label_24" for="first_24" aria-hidden="false"> Non-Commisioned Officer Certification </label>
<div id="cid_24" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true" class="extended"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_24" name="q24_noncommisionedOfficer[first]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_24 given-name" size="10" data-component="first" aria-labelledby="label_24 sublabel_24_first" value=""><label class="form-sub-label" for="first_24" id="sublabel_24_first" style="min-height:13px">Date Issued</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="middle"><input type="text" id="middle_24" name="q24_noncommisionedOfficer[middle]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_24 additional-name" size="10" data-component="middle" aria-labelledby="label_24 sublabel_24_middle" value=""><label class="form-sub-label" for="middle_24" id="sublabel_24_middle" style="min-height:13px">Date Renewal</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_24" name="q24_noncommisionedOfficer[last]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_24 family-name" size="15" data-component="last" aria-labelledby="label_24 sublabel_24_last" value=""><label class="form-sub-label" for="last_24" id="sublabel_24_last" style="min-height:13px">Expiration Date</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_fullname" id="id_25" data-css-selector="id_25"><label class="form-label form-label-top form-label-extended form-label-auto" id="label_25" for="first_25" aria-hidden="false"> Commisioned Officer Certification </label>
<div id="cid_25" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true" class="extended"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_25" name="q25_commisionedOfficer[first]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_25 given-name" size="10" data-component="first" aria-labelledby="label_25 sublabel_25_first" value=""><label class="form-sub-label" for="first_25" id="sublabel_25_first" style="min-height:13px">Date Issued</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="middle"><input type="text" id="middle_25" name="q25_commisionedOfficer[middle]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_25 additional-name" size="10" data-component="middle" aria-labelledby="label_25 sublabel_25_middle" value=""><label class="form-sub-label" for="middle_25" id="sublabel_25_middle" style="min-height:13px">Date Renewal</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_25" name="q25_commisionedOfficer[last]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_25 family-name" size="15" data-component="last" aria-labelledby="label_25 sublabel_25_last" value=""><label class="form-sub-label" for="last_25" id="sublabel_25_last" style="min-height:13px">Expiration Date</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_dropdown" id="id_27" data-css-selector="id_27"><label class="form-label form-label-top form-label-auto" id="label_27" for="input_27" aria-hidden="false"> Do you have any other registrations with the PSB?<span class="form-required">*</span> </label>
<div id="cid_27" class="form-input-wide jf-required" data-layout="half"> <select class="form-dropdown validate[required]" id="input_27" name="q27_doYou" style="width:310px" data-component="dropdown" required="" aria-label="Do you have any other registrations with the PSB?">
<option value="">Please Select</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_28" data-css-selector="id_28"><label class="form-label form-label-top form-label-auto" id="label_28" for="input_28" aria-hidden="false"> If yes, what is the expiration date of the other registrations? </label>
<div id="cid_28" class="form-input-wide" data-layout="half"> <input type="text" id="input_28" name="q28_ifYes" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_28" value=""> </div>
</li>
<li id="cid_50" class="form-input-wide" data-type="control_head" data-css-selector="id_50">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_50" class="form-header" data-component="header">Application Information</h2>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_textbox" id="id_51" data-css-selector="id_51"><label class="form-label form-label-top form-label-auto" id="label_51" for="input_51" aria-hidden="false"> Full Legal Name<span class="form-required">*</span> </label>
<div id="cid_51" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_51" name="q51_fullLegal" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_51" required="" value=""> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_68" data-css-selector="id_68"><label class="form-label form-label-top form-label-auto" id="label_68" for="input_68" aria-hidden="false"> Alias/Other Names Used (including maiden name, Sr., Jr., hyphens, changes made through Dept Homeland Security, etc.) </label>
<div id="cid_68" class="form-input-wide" data-layout="half"> <input type="text" id="input_68" name="q68_aliasotherNames" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_68" value=""> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_69" data-css-selector="id_69"><label class="form-label form-label-top form-label-auto" id="label_69" for="input_69" aria-hidden="false"> How long were alias used for? </label>
<div id="cid_69" class="form-input-wide" data-layout="half"> <input type="text" id="input_69" name="q69_howLong" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_69" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_92" data-css-selector="id_92"><label class="form-label form-label-top form-label-auto" id="label_92" aria-hidden="false"> Are you under 18?<span class="form-required">*</span> </label>
<div id="cid_92" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_92" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_92" class="form-radio validate[required]" id="input_92_0" name="q92_areYou" value="Yes" required=""><label id="label_input_92_0" for="input_92_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_92" class="form-radio validate[required]" id="input_92_1" name="q92_areYou" value="No" required=""><label id="label_input_92_1" for="input_92_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_93" data-css-selector="id_93"><label class="form-label form-label-top form-label-auto" id="label_93" aria-hidden="false"> Have you ever been convicted of a felony?<span class="form-required">*</span> </label>
<div id="cid_93" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_93" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_93" class="form-radio validate[required]" id="input_93_0" name="q93_haveYou" value="Yes" required=""><label id="label_input_93_0" for="input_93_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_93" class="form-radio validate[required]" id="input_93_1" name="q93_haveYou" value="No" required=""><label id="label_input_93_1" for="input_93_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_94" data-css-selector="id_94"><label class="form-label form-label-top form-label-auto" id="label_94" aria-hidden="false"> Have you ever been charged with a misdemeanor?<span class="form-required">*</span> </label>
<div id="cid_94" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_94" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_94" class="form-radio validate[required]" id="input_94_0" name="q94_haveYou94" value="Yes" required=""><label id="label_input_94_0" for="input_94_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_94" class="form-radio validate[required]" id="input_94_1" name="q94_haveYou94" value="No" required=""><label id="label_input_94_1" for="input_94_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_98" data-css-selector="id_98"><label class="form-label form-label-top form-label-auto" id="label_98" aria-hidden="false"> Have you ever served in the US Armed Forces?<span class="form-required">*</span> </label>
<div id="cid_98" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_98" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_98" class="form-radio validate[required]" id="input_98_0" name="q98_haveYou98" value="Yes" required=""><label id="label_input_98_0" for="input_98_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_98" class="form-radio validate[required]" id="input_98_1" name="q98_haveYou98" value="No" required=""><label id="label_input_98_1" for="input_98_1">No</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_fullname" id="id_100" data-css-selector="id_100"><label class="form-label form-label-top form-label-auto" id="label_100" for="first_100" aria-hidden="false"> If yes, which branch and when? </label>
<div id="cid_100" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_100" name="q100_ifYes100[first]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_100 given-name" size="10" data-component="first" aria-labelledby="label_100 sublabel_100_first" value=""><label class="form-sub-label" for="first_100" id="sublabel_100_first" style="min-height:13px">Branch</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_100" name="q100_ifYes100[last]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_100 family-name" size="15" data-component="last" aria-labelledby="label_100 sublabel_100_last" value=""><label class="form-sub-label" for="last_100" id="sublabel_100_last" style="min-height:13px">Dates Served</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_checkbox" id="id_96" data-css-selector="id_96"><label class="form-label form-label-top form-label-auto" id="label_96" aria-hidden="false"> Do you have Texas Driver's License or a State Issue Identification? (check all that apply)<span class="form-required">*</span> </label>
<div id="cid_96" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_96" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input type="checkbox" aria-describedby="label_96" class="form-checkbox validate[required]" id="input_96_0" name="q96_doYou96[]" value="Yes, I have a Texas Driver's License" required=""><label id="label_input_96_0" for="input_96_0">Yes, I have a Texas Driver's License</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input type="checkbox" aria-describedby="label_96" class="form-checkbox validate[required]" id="input_96_1" name="q96_doYou96[]" value="No, I do not have a Texas Driver's License" required=""><label id="label_input_96_1" for="input_96_1">No, I do not have a Texas Driver's License</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input type="checkbox" aria-describedby="label_96" class="form-checkbox validate[required]" id="input_96_2" name="q96_doYou96[]" value="Yes, I have a State Issue Identification" required=""><label id="label_input_96_2" for="input_96_2">Yes, I have a State Issue Identification</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input type="checkbox" aria-describedby="label_96" class="form-checkbox validate[required]" id="input_96_3" name="q96_doYou96[]" value="No, I do not have a State Issue Identifcation" required=""><label id="label_input_96_3" for="input_96_3">No, I do not have a State Issue Identifcation</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_66" data-css-selector="id_66"><label class="form-label form-label-top form-label-auto" id="label_66" for="input_66" aria-hidden="false"> Driver's License # </label>
<div id="cid_66" class="form-input-wide" data-layout="half"> <input type="text" id="input_66" name="q66_driversLicense" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_66" value=""> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_87" data-css-selector="id_87"><label class="form-label form-label-top form-label-auto" id="label_87" for="input_87" aria-hidden="false"> Driver's License State </label>
<div id="cid_87" class="form-input-wide" data-layout="half"> <input type="text" id="input_87" name="q87_driversLicense87" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_87" value=""> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_88" data-css-selector="id_88"><label class="form-label form-label-top form-label-auto" id="label_88" for="input_88" aria-hidden="false"> If no Driver's License, please provide another state issued identification/passport </label>
<div id="cid_88" class="form-input-wide" data-layout="half"> <input type="text" id="input_88" name="q88_ifNo" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_88" value=""> </div>
</li>
<li class="form-line" data-type="control_textarea" id="id_86" data-css-selector="id_86"><label class="form-label form-label-top form-label-auto" id="label_86" for="input_86" aria-hidden="false"> Do you have any Specialized Training? </label>
<div id="cid_86" class="form-input-wide" data-layout="full"> <textarea id="input_86" class="form-textarea custom-hint-group form-custom-hint" name="q86_doYou86" style="width:648px;height:163px" data-component="textarea" aria-labelledby="label_86" data-customhint="Type here..." customhinted="true" placeholder="Type here..." spellcheck="false"></textarea> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_97" data-css-selector="id_97"><label class="form-label form-label-top form-label-auto" id="label_97" for="input_97" aria-hidden="false"> Notable Licenses/Training </label>
<div id="cid_97" class="form-input-wide" data-layout="half"> <input type="text" id="input_97" name="q97_notableLicensestraining" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_97" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_91" data-css-selector="id_91"><label class="form-label form-label-top form-label-auto" id="label_91" aria-hidden="false"> Gender<span class="form-required">*</span> </label>
<div id="cid_91" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_91" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_91" class="form-radio validate[required]" id="input_91_0" name="q91_gender" value="Male" required=""><label id="label_input_91_0" for="input_91_0">Male</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_91" class="form-radio validate[required]" id="input_91_1" name="q91_gender" value="Female" required=""><label id="label_input_91_1" for="input_91_1">Female</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_address" id="id_90" data-css-selector="id_90"><label class="form-label form-label-top form-label-auto" id="label_90" for="input_90_addr_line1" aria-hidden="false"> Physical Identification<span class="form-required">*</span> </label>
<div id="cid_90" class="form-input-wide jf-required" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_90_addr_line1" name="q90_physicalIdentification[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="section-input_90 address-line1" data-component="address_line_1" aria-labelledby="label_90 sublabel_90_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_90_addr_line1" id="sublabel_90_addr_line1" style="min-height:13px">Race</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_90_addr_line2" name="q90_physicalIdentification[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_90 address-line2" data-component="address_line_2" aria-labelledby="label_90 sublabel_90_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_90_addr_line2" id="sublabel_90_addr_line2" style="min-height:13px">Weight</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_90_city" name="q90_physicalIdentification[city]" class="form-textbox validate[required] form-address-city" data-defaultvalue="" autocomplete="section-input_90 address-level2" data-component="city" aria-labelledby="label_90 sublabel_90_city" required="" value="" maxlength="60"><label class="form-sub-label" for="input_90_city" id="sublabel_90_city" style="min-height:13px">Height (Feet & Inches)</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_90_state" name="q90_physicalIdentification[state]" class="form-textbox validate[required] form-address-state" data-defaultvalue="" autocomplete="section-input_90 address-level1" data-component="state" aria-labelledby="label_90 sublabel_90_state" required="" value="" maxlength="60"><label class="form-sub-label" for="input_90_state" id="sublabel_90_state" style="min-height:13px">Hair Color</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_90_postal" name="q90_physicalIdentification[postal]" class="form-textbox validate[required] form-address-postal" data-defaultvalue="" autocomplete="section-input_90 postal-code" data-component="zip" aria-labelledby="label_90 sublabel_90_postal" required="" value="" maxlength="20"><label class="form-sub-label" for="input_90_postal" id="sublabel_90_postal" style="min-height:13px">Eye Color</label></span></span></div>
</div>
</div>
</li>
<li id="cid_101" class="form-input-wide" data-type="control_head" data-css-selector="id_101">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_101" class="form-header" data-component="header">References</h2>
<div id="subHeader_101" class="form-subHeader">Give three personal references, not relatives or former employers.</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_102" data-css-selector="id_102"><label class="form-label form-label-top form-label-auto" id="label_102" for="input_102" aria-hidden="false"> Reference 1 (Name, Address, Phone #) </label>
<div id="cid_102" class="form-input-wide" data-layout="half"> <input type="text" id="input_102" name="q102_reference1" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_102" value=""> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_103" data-css-selector="id_103"><label class="form-label form-label-top form-label-auto" id="label_103" for="input_103" aria-hidden="false"> Reference 2 (Name, Address, Phone #) </label>
<div id="cid_103" class="form-input-wide" data-layout="half"> <input type="text" id="input_103" name="q103_reference2" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_103" value=""> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_104" data-css-selector="id_104"><label class="form-label form-label-top form-label-auto" id="label_104" for="input_104" aria-hidden="false"> Reference 3 (Name, Address, Phone #) </label>
<div id="cid_104" class="form-input-wide" data-layout="half"> <input type="text" id="input_104" name="q104_reference3" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_104" value=""> </div>
</li>
<li id="cid_81" class="form-input-wide" data-type="control_head" data-css-selector="id_81">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_81" class="form-header" data-component="header">Previous Experience</h2>
</div>
</div>
</li>
<li class="form-line" data-type="control_address" id="id_80" data-css-selector="id_80"><label class="form-label form-label-top form-label-auto" id="label_80" for="input_80_addr_line1" aria-hidden="false"> Previous Employer 1 </label>
<div id="cid_80" class="form-input-wide" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_80_addr_line1" name="q80_previousEmployer[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_80 address-line1" data-component="address_line_1" aria-labelledby="label_80 sublabel_80_addr_line1" value="" maxlength="100"><label class="form-sub-label" for="input_80_addr_line1" id="sublabel_80_addr_line1" style="min-height:13px">Dates Employed</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_80_addr_line2" name="q80_previousEmployer[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_80 address-line2" data-component="address_line_2" aria-labelledby="label_80 sublabel_80_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_80_addr_line2" id="sublabel_80_addr_line2" style="min-height:13px">Company Name</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_80_city" name="q80_previousEmployer[city]" class="form-textbox form-address-city" data-defaultvalue="" autocomplete="section-input_80 address-level2" data-component="city" aria-labelledby="label_80 sublabel_80_city" value="" maxlength="60"><label class="form-sub-label" for="input_80_city" id="sublabel_80_city" style="min-height:13px">Role/Title</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_80_state" name="q80_previousEmployer[state]" class="form-textbox form-address-state" data-defaultvalue="" autocomplete="section-input_80 address-level1" data-component="state" aria-labelledby="label_80 sublabel_80_state" value="" maxlength="60"><label class="form-sub-label" for="input_80_state" id="sublabel_80_state" style="min-height:13px">Location</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_80_postal" name="q80_previousEmployer[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_80 postal-code" data-component="zip" aria-labelledby="label_80 sublabel_80_postal" value="" maxlength="20"><label class="form-sub-label" for="input_80_postal" id="sublabel_80_postal" style="min-height:13px">Reason for Leaving</label></span></span></div>
</div>
</div>
</li>
<li class="form-line" data-type="control_address" id="id_83" data-css-selector="id_83"><label class="form-label form-label-top form-label-auto" id="label_83" for="input_83_addr_line1" aria-hidden="false"> Previous Employer 2 </label>
<div id="cid_83" class="form-input-wide" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_83_addr_line1" name="q83_previousEmployer83[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_83 address-line1" data-component="address_line_1" aria-labelledby="label_83 sublabel_83_addr_line1" value="" maxlength="100"><label class="form-sub-label" for="input_83_addr_line1" id="sublabel_83_addr_line1" style="min-height:13px">Dates Employed</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_83_addr_line2" name="q83_previousEmployer83[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_83 address-line2" data-component="address_line_2" aria-labelledby="label_83 sublabel_83_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_83_addr_line2" id="sublabel_83_addr_line2" style="min-height:13px">Company Name</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_83_city" name="q83_previousEmployer83[city]" class="form-textbox form-address-city" data-defaultvalue="" autocomplete="section-input_83 address-level2" data-component="city" aria-labelledby="label_83 sublabel_83_city" value="" maxlength="60"><label class="form-sub-label" for="input_83_city" id="sublabel_83_city" style="min-height:13px">Role/Title</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_83_state" name="q83_previousEmployer83[state]" class="form-textbox form-address-state" data-defaultvalue="" autocomplete="section-input_83 address-level1" data-component="state" aria-labelledby="label_83 sublabel_83_state" value="" maxlength="60"><label class="form-sub-label" for="input_83_state" id="sublabel_83_state" style="min-height:13px">Location</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_83_postal" name="q83_previousEmployer83[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_83 postal-code" data-component="zip" aria-labelledby="label_83 sublabel_83_postal" value="" maxlength="20"><label class="form-sub-label" for="input_83_postal" id="sublabel_83_postal" style="min-height:13px">Reason for Leaving</label></span></span></div>
</div>
</div>
</li>
<li class="form-line" data-type="control_address" id="id_84" data-css-selector="id_84"><label class="form-label form-label-top form-label-auto" id="label_84" for="input_84_addr_line1" aria-hidden="false"> Previous Employer 3 </label>
<div id="cid_84" class="form-input-wide" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_84_addr_line1" name="q84_previousEmployer84[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_84 address-line1" data-component="address_line_1" aria-labelledby="label_84 sublabel_84_addr_line1" value="" maxlength="100"><label class="form-sub-label" for="input_84_addr_line1" id="sublabel_84_addr_line1" style="min-height:13px">Dates Employed</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_84_addr_line2" name="q84_previousEmployer84[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_84 address-line2" data-component="address_line_2" aria-labelledby="label_84 sublabel_84_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_84_addr_line2" id="sublabel_84_addr_line2" style="min-height:13px">Company Name</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_84_city" name="q84_previousEmployer84[city]" class="form-textbox form-address-city" data-defaultvalue="" autocomplete="section-input_84 address-level2" data-component="city" aria-labelledby="label_84 sublabel_84_city" value="" maxlength="60"><label class="form-sub-label" for="input_84_city" id="sublabel_84_city" style="min-height:13px">Role/Title</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_84_state" name="q84_previousEmployer84[state]" class="form-textbox form-address-state" data-defaultvalue="" autocomplete="section-input_84 address-level1" data-component="state" aria-labelledby="label_84 sublabel_84_state" value="" maxlength="60"><label class="form-sub-label" for="input_84_state" id="sublabel_84_state" style="min-height:13px">Location</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_84_postal" name="q84_previousEmployer84[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_84 postal-code" data-component="zip" aria-labelledby="label_84 sublabel_84_postal" value="" maxlength="20"><label class="form-sub-label" for="input_84_postal" id="sublabel_84_postal" style="min-height:13px">Reason for Leaving</label></span></span></div>
</div>
</div>
</li>
<li class="form-line" data-type="control_address" id="id_85" data-css-selector="id_85"><label class="form-label form-label-top form-label-auto" id="label_85" for="input_85_addr_line1" aria-hidden="false"> Previous Employer 4 </label>
<div id="cid_85" class="form-input-wide" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_85_addr_line1" name="q85_previousEmployer85[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_85 address-line1" data-component="address_line_1" aria-labelledby="label_85 sublabel_85_addr_line1" value="" maxlength="100"><label class="form-sub-label" for="input_85_addr_line1" id="sublabel_85_addr_line1" style="min-height:13px">Dates Employed</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_85_addr_line2" name="q85_previousEmployer85[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_85 address-line2" data-component="address_line_2" aria-labelledby="label_85 sublabel_85_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_85_addr_line2" id="sublabel_85_addr_line2" style="min-height:13px">Company Name</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_85_city" name="q85_previousEmployer85[city]" class="form-textbox form-address-city" data-defaultvalue="" autocomplete="section-input_85 address-level2" data-component="city" aria-labelledby="label_85 sublabel_85_city" value="" maxlength="60"><label class="form-sub-label" for="input_85_city" id="sublabel_85_city" style="min-height:13px">Role/Title</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_85_state" name="q85_previousEmployer85[state]" class="form-textbox form-address-state" data-defaultvalue="" autocomplete="section-input_85 address-level1" data-component="state" aria-labelledby="label_85 sublabel_85_state" value="" maxlength="60"><label class="form-sub-label" for="input_85_state" id="sublabel_85_state" style="min-height:13px">Location</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_85_postal" name="q85_previousEmployer85[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_85 postal-code" data-component="zip" aria-labelledby="label_85 sublabel_85_postal" value="" maxlength="20"><label class="form-sub-label" for="input_85_postal" id="sublabel_85_postal" style="min-height:13px">Reason for Leaving</label></span></span></div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_82" data-css-selector="id_82">
<div id="cid_82" class="form-input-wide" data-layout="full">
<div id="text_82" class="form-html" data-component="text" tabindex="0">
<p>I certify that all information provided by me on this information sheet is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.</p>
<p>I understand that I will work as an INDEPENDENT CONTRACTOR which means that either I or this company can terminate the contract relationship at any time for any reason not prohibited by statute. I hereby acknowledge that I have read and understand the above statements.</p>
<p>Please review your information for accuracy.</p>
<p>I have reviewed all my information, and all is complete and correct.</p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_3" data-css-selector="id_3"><label class="form-label form-label-top form-label-auto" id="label_3" for="input_3" aria-hidden="false"> Signature<span class="form-required">*</span> </label>
<div id="cid_3" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_3" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_3" data-width="310" data-height="114" data-id="3" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_3" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q3_signature" class="output4" id="input_3">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li id="cid_57" class="form-input-wide" data-type="control_head" data-css-selector="id_57">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_57" class="form-header" data-component="header">Background Check Disclosure & Authorization to Release Information</h2>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_56" data-css-selector="id_56">
<div id="cid_56" class="form-input-wide" data-layout="full">
<div id="text_56" class="form-html" data-component="text" tabindex="0">
<p>As part of AllStar Security Group, we perform a hiring background and investigation, we may obtain consumer reports or prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not limited to, credit information reports, criminal history reports, and driving history records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681u) as amended, before we can seek such records, we must have written permission to obtain the information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your Rights Under the Fair Credit Reporting Act.</p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_fullname" id="id_70" data-css-selector="id_70"><label class="form-label form-label-top form-label-extended form-label-auto" id="label_70" for="first_70" aria-hidden="false"> Name<span class="form-required">*</span> </label>
<div id="cid_70" class="form-input-wide jf-required" data-layout="full">
<div data-wrapper-react="true" class="extended"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_70" name="q70_name[first]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_70 given-name" size="10" data-component="first" aria-labelledby="label_70 sublabel_70_first" required="" value=""><label class="form-sub-label" for="first_70" id="sublabel_70_first" style="min-height:13px">First Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="middle"><input type="text" id="middle_70" name="q70_name[middle]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_70 additional-name" size="10" data-component="middle" aria-labelledby="label_70 sublabel_70_middle" required="" value=""><label class="form-sub-label" for="middle_70" id="sublabel_70_middle" style="min-height:13px">Middle Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_70" name="q70_name[last]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_70 family-name" size="15" data-component="last" aria-labelledby="label_70 sublabel_70_last" required="" value=""><label class="form-sub-label" for="last_70" id="sublabel_70_last" style="min-height:13px">Last Name</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_datetime" id="id_67" data-css-selector="id_67"><label class="form-label form-label-top form-label-auto" id="label_67" for="lite_mode_67" aria-hidden="false"> Date of Birth<span class="form-required">*</span> </label>
<div id="cid_67" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[required, limitDate]" id="month_67" name="q67_dateOf67[month]" size="2" data-maxlength="2" data-age="" maxlength="2" value="" required="" autocomplete="off" aria-labelledby="label_67 sublabel_67_month" inputmode="numeric"><span class="date-separate" aria-hidden="true"> -</span><label class="form-sub-label" for="month_67" id="sublabel_67_month" style="min-height:13px">Month</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[required, limitDate]" id="day_67" name="q67_dateOf67[day]" size="2" data-maxlength="2" data-age="" maxlength="2" value="" required="" autocomplete="off" aria-labelledby="label_67 sublabel_67_day" inputmode="numeric"><span class="date-separate" aria-hidden="true"> -</span><label class="form-sub-label" for="day_67" id="sublabel_67_day" style="min-height:13px">Day</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[required, limitDate]" id="year_67" name="q67_dateOf67[year]" size="4" data-maxlength="4" data-age="" maxlength="4" value="" required="" autocomplete="off" aria-labelledby="label_67 sublabel_67_year"><label class="form-sub-label" for="year_67" id="sublabel_67_year" style="min-height:13px">Year</label></span></div><span class="form-sub-label-container" style="vertical-align:top"><input type="text" class="form-textbox validate[required, limitDate, validateLiteDate]" id="lite_mode_67" size="12" data-maxlength="12" data-age="" value="" required="" data-format="mmddyyyy" data-seperator="-" placeholder="MM-DD-YYYY" data-placeholder="MM-DD-YYYY" autocomplete="off" aria-labelledby="label_67 sublabel_67_litemode" inputmode="numeric"><img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_67_pick" src="https://cdn.jotfor.ms/images/calendar.png" data-component="datetime" aria-hidden="false" data-allow-time="No" data-version="v2" aria-label="Choose Date" role="button" tabindex="0" aria-haspopup="dialog" aria-expanded="false"><label class="form-sub-label" for="lite_mode_67" id="sublabel_67_litemode" style="min-height:13px">Date</label></span>
</div>
</div>
</li>
<li id="cid_75" class="form-input-wide" data-type="control_head" data-css-selector="id_75">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_75" class="form-header" data-component="header">Addresses</h2>
<div id="subHeader_75" class="form-subHeader">Include current address and any other addresses used for the PAST SEVEN YEARS</div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_textbox" id="id_73" data-css-selector="id_73"><label class="form-label form-label-top form-label-auto" id="label_73" for="input_73" aria-hidden="false"> Current Address (include street, apt, city, state, zip code)<span class="form-required">*</span> </label>
<div id="cid_73" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_73" name="q73_currentAddress" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_73" required="" value=""> </div>
</li>
<li class="form-line" data-type="control_fullname" id="id_74" data-css-selector="id_74"><label class="form-label form-label-top form-label-auto" id="label_74" for="first_74" aria-hidden="false"> Previous Address 1 </label>
<div id="cid_74" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_74" name="q74_previousAddress[first]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_74 given-name" size="10" data-component="first" aria-labelledby="label_74 sublabel_74_first" value=""><label class="form-sub-label" for="first_74" id="sublabel_74_first" style="min-height:13px">(street, city, apt, state, zip code)</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_74" name="q74_previousAddress[last]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_74 family-name" size="15" data-component="last" aria-labelledby="label_74 sublabel_74_last" value=""><label class="form-sub-label" for="last_74" id="sublabel_74_last" style="min-height:13px">Dates of Residence</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_fullname" id="id_76" data-css-selector="id_76"><label class="form-label form-label-top form-label-auto" id="label_76" for="first_76" aria-hidden="false"> Previous Address 2 </label>
<div id="cid_76" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_76" name="q76_previousAddress76[first]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_76 given-name" size="10" data-component="first" aria-labelledby="label_76 sublabel_76_first" value=""><label class="form-sub-label" for="first_76" id="sublabel_76_first" style="min-height:13px">(street, city, apt, state, zip code)</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_76" name="q76_previousAddress76[last]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_76 family-name" size="15" data-component="last" aria-labelledby="label_76 sublabel_76_last" value=""><label class="form-sub-label" for="last_76" id="sublabel_76_last" style="min-height:13px">Dates of Residence</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_fullname" id="id_77" data-css-selector="id_77"><label class="form-label form-label-top form-label-auto" id="label_77" for="first_77" aria-hidden="false"> Previous Address 3 </label>
<div id="cid_77" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_77" name="q77_previousAddress77[first]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_77 given-name" size="10" data-component="first" aria-labelledby="label_77 sublabel_77_first" value=""><label class="form-sub-label" for="first_77" id="sublabel_77_first" style="min-height:13px">(street, city, apt, state, zip code)</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_77" name="q77_previousAddress77[last]" class="form-textbox" data-defaultvalue="" autocomplete="section-input_77 family-name" size="15" data-component="last" aria-labelledby="label_77 sublabel_77_last" value=""><label class="form-sub-label" for="last_77" id="sublabel_77_last" style="min-height:13px">Dates of Residence</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_58" data-css-selector="id_58">
<div id="cid_58" class="form-input-wide" data-layout="full">
<div id="text_58" class="form-html" data-component="text" tabindex="0">
<p>I do hereby authorize verification of all information in my employment application from all sources of employment, education, motor vehicle, financial history, criminal history, personal character, and worker's compensation records in compliance with ADA, labor and wage records, etc. or any part thereof, and authorize any duly authorized agent to obtain, whether the said records are public or private, and including those which may be deemed to be privileged or confidential in nature and I release all persons from liability on account of such disclosures, information appearing on this suitability for employment. I certify that I have made true, correct, and complete answers and statements on my employment application, any supplements to it and interview in the knowledge that they will be relied upon in considering my application for employment. I agree to provide additional information that may be requested to process my employment application. I authorize without reservation any part or agency connected to furnish the above-mentioned information. This authorization is valid during the course of my employment to the extent permitted by law.</p>
<p><br>I hereby do authorize you to contact my current employer for Employment and Reference Verification. (This will authorize immediate inquiries to the Human Resources Department and to any listed supervisors or references in the Employment/References section of your application.)</p>
<p><br>I have the right, upon proper identification, to request the nature and substance of all information into files on me at the time of my request, including sources of information, and the recipients of any reports on me which has been previously furnished within the two year period preceding my request.</p>
<p><br>I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in any interviews, will be sufficient grounds for rejection of employment and my discharge after employment.</p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_4" data-css-selector="id_4"><label class="form-label form-label-top form-label-auto" id="label_4" for="input_4" aria-hidden="false"> Signature<span class="form-required">*</span> </label>
<div id="cid_4" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_4" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_4" data-width="310" data-height="114" data-id="4" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_4" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q4_signature4" class="output4" id="input_4">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li id="cid_52" class="form-input-wide" data-type="control_head" data-css-selector="id_52">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_52" class="form-header" data-component="header">Agreement and Consent to Drug and/or Alcohol Testing</h2>
<div id="subHeader_52" class="form-subHeader">Pre-employment drug screening is required and will be scheduled by a company representative.</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_55" data-css-selector="id_55">
<div id="cid_55" class="form-input-wide" data-layout="full">
<div id="text_55" class="form-html" data-component="text" tabindex="0">
<p>I hereby agree, upon a request made under the drug/alcohol testing policy of Allstar Security Group, to submit to a drug or alcohol test and to furnigh a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy, or if I otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorize and give full permission to have the Company and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally, I authorize the Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test.</p>
<p><br>I understand that only duly-authorized Company officers, employees, and agents will have access to information furnished or obtained in connection with the test; that they will maintain and protect the confidentiality of such information to the greatest extent possible; and that they will share such information only to the extent necessary to make employment decisions and to respond to inquiries or notices from government entities.</p>
<p><br>l will hold harmless the Company, its company physician, and any testing laboratory the Company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if a Company or laboratory representative makes en error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the Company, its company physician, and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above. </p>
<p>This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered.</p>
<p>I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN AND/OR ALCOHOL TEST UNDER THIS POLICY WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT, AND I AGREE TO SUBMIT TO ANY SUCH TEST.</p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_5" data-css-selector="id_5"><label class="form-label form-label-top form-label-auto" id="label_5" for="input_5" aria-hidden="false"> Signature<span class="form-required">*</span> </label>
<div id="cid_5" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_5" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_5" data-width="310" data-height="114" data-id="5" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_5" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q5_signature5" class="output4" id="input_5">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li id="cid_46" class="form-input-wide" data-type="control_head" data-css-selector="id_46">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_46" class="form-header" data-component="header">Background Information Questions</h2>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_35" data-css-selector="id_35"><label class="form-label form-label-top form-label-auto" id="label_35" aria-hidden="false"> 1. Have you ever been convicted, in any jurisdiction, of a felony level offense?<span class="form-required">*</span> </label>
<div id="cid_35" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_35" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_35" class="form-radio validate[required]" id="input_35_0" name="q35_areYou35" value="Yes - Less than 10 years since completing my sentence or probationary period." required=""><label id="label_input_35_0" for="input_35_0">Yes - Less than 10 years since completing my sentence or probationary period.</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_35" class="form-radio validate[required]" id="input_35_1" name="q35_areYou35" value="Yes - More than 10 years since completing my sentence or probationary period." required=""><label id="label_input_35_1" for="input_35_1">Yes - More than 10 years since completing my sentence or probationary period.</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_35" class="form-radio validate[required]" id="input_35_2" name="q35_areYou35" value="No" required=""><label id="label_input_35_2" for="input_35_2">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_47" data-css-selector="id_47"><label class="form-label form-label-top form-label-auto" id="label_47" aria-hidden="false"> 2. Have you ever been convicted, in any jurisdiction, of a Class A or equivalent misdemeanor?<span class="form-required">*</span> </label>
<div id="cid_47" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_47" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_47" class="form-radio validate[required]" id="input_47_0" name="q47_2Have" value="Yes - Less than 5 years since completing my sentence or probationary period." required=""><label id="label_input_47_0" for="input_47_0">Yes - Less than 5 years since completing my sentence or probationary period.</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_47" class="form-radio validate[required]" id="input_47_1" name="q47_2Have" value="Yes - More than 5 years since completing my sentence or probationary period." required=""><label id="label_input_47_1" for="input_47_1">Yes - More than 5 years since completing my sentence or probationary period.</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_47" class="form-radio validate[required]" id="input_47_2" name="q47_2Have" value="No" required=""><label id="label_input_47_2" for="input_47_2">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_48" data-css-selector="id_48"><label class="form-label form-label-top form-label-auto" id="label_48" aria-hidden="false"> 3. Have you, within the last 5 years, been convicted, in any jurisdiction, of a Class B misdemeanor or equivalent offense?<span class="form-required">*</span> </label>
<div id="cid_48" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_48" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_48" class="form-radio validate[required]" id="input_48_0" name="q48_3Have" value="Yes" required=""><label id="label_input_48_0" for="input_48_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_48" class="form-radio validate[required]" id="input_48_1" name="q48_3Have" value="No" required=""><label id="label_input_48_1" for="input_48_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_36" data-css-selector="id_36"><label class="form-label form-label-top form-label-auto" id="label_36" aria-hidden="false"> 4. Are you currently charged with, or under indictment for, a felony, or Class A misdemeanor?<span class="form-required">*</span> </label>
<div id="cid_36" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_36" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_36" class="form-radio validate[required]" id="input_36_0" name="q36_areYou36" value="Yes" required=""><label id="label_input_36_0" for="input_36_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_36" class="form-radio validate[required]" id="input_36_1" name="q36_areYou36" value="No" required=""><label id="label_input_36_1" for="input_36_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_37" data-css-selector="id_37"><label class="form-label form-label-top form-label-auto" id="label_37" aria-hidden="false"> 5. Are you currently charged with a Class B misdemeanor?<span class="form-required">*</span> </label>
<div id="cid_37" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_37" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_37" class="form-radio validate[required]" id="input_37_0" name="q37_areYou37" value="Yes" required=""><label id="label_input_37_0" for="input_37_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_37" class="form-radio validate[required]" id="input_37_1" name="q37_areYou37" value="No" required=""><label id="label_input_37_1" for="input_37_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_38" data-css-selector="id_38"><label class="form-label form-label-top form-label-auto" id="label_38" aria-hidden="false"> 6. Have you ever been found by a court to be incompetent by reason of mental defect?<span class="form-required">*</span> </label>
<div id="cid_38" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_38" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_38" class="form-radio validate[required]" id="input_38_0" name="q38_areYou38" value="Yes" required=""><label id="label_input_38_0" for="input_38_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_38" class="form-radio validate[required]" id="input_38_1" name="q38_areYou38" value="No" required=""><label id="label_input_38_1" for="input_38_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_40" data-css-selector="id_40"><label class="form-label form-label-top form-label-auto" id="label_40" aria-hidden="false"> 7. Were you discharged from the military?<span class="form-required">*</span> </label>
<div id="cid_40" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_40" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_40" class="form-radio validate[required]" id="input_40_0" name="q40_areYou40" value="Yes - I must submit a copy of my DD-214." required=""><label id="label_input_40_0" for="input_40_0">Yes - I must submit a copy of my DD-214.</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_40" class="form-radio validate[required]" id="input_40_1" name="q40_areYou40" value="Yes - I received a dishonorable discharge, a bod conduct discharge, or an other than honorable discharge, from Armed Forces. I must submit a copy of my DD-214." required=""><label id="label_input_40_1" for="input_40_1">Yes - I received a dishonorable discharge, a bod conduct discharge, or an other than honorable discharge, from Armed Forces. I must submit a copy of my DD-214.</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_40" class="form-radio validate[required]" id="input_40_2" name="q40_areYou40" value="No" required=""><label id="label_input_40_2" for="input_40_2">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_41" data-css-selector="id_41"><label class="form-label form-label-top form-label-auto" id="label_41" aria-hidden="false"> 8. Are you required to register as a sex offender, in Texas or any other State?<span class="form-required">*</span> </label>
<div id="cid_41" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_41" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_41" class="form-radio validate[required]" id="input_41_0" name="q41_8Are" value="Yes" required=""><label id="label_input_41_0" for="input_41_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_41" class="form-radio validate[required]" id="input_41_1" name="q41_8Are" value="No" required=""><label id="label_input_41_1" for="input_41_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_42" data-css-selector="id_42"><label class="form-label form-label-top form-label-auto" id="label_42" aria-hidden="false"> 9. Have you been diagnosed by a licensed physician as suffering from a psychiatric disorder or condition that causes or is likely to cause substantial impairment in judgment, mood, perception, impulse control, or intellectual ability? (See Texas Occupations Code 1702.163 (d), (e) & (f).<span class="form-required">*</span> </label>
<div id="cid_42" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_42" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_42" class="form-radio validate[required]" id="input_42_0" name="q42_9Have" value="Yes" required=""><label id="label_input_42_0" for="input_42_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_42" class="form-radio validate[required]" id="input_42_1" name="q42_9Have" value="No" required=""><label id="label_input_42_1" for="input_42_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_43" data-css-selector="id_43"><label class="form-label form-label-top form-label-auto" id="label_43" aria-hidden="false"> 10. Are you currently restricted under a court protective order or subject to a restraining order affecting the spousal relationship, other than a restraining order solely affecting property interests, including any court order restraining your conduct as to an intimate partner?<span class="form-required">*</span> </label>
<div id="cid_43" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_43" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_43" class="form-radio validate[required]" id="input_43_0" name="q43_10Are" value="Yes" required=""><label id="label_input_43_0" for="input_43_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_43" class="form-radio validate[required]" id="input_43_1" name="q43_10Are" value="No" required=""><label id="label_input_43_1" for="input_43_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_44" data-css-selector="id_44"><label class="form-label form-label-top form-label-auto" id="label_44" aria-hidden="false"> 11. Federal law prohibits the Department from issuing a license to anyone who is ineligible to work in the U.S. Are you a non-citizen?<span class="form-required">*</span> </label>
<div id="cid_44" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_44" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_44" class="form-radio validate[required]" id="input_44_0" name="q44_11Federal" value="Yes" required=""><label id="label_input_44_0" for="input_44_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_44" class="form-radio validate[required]" id="input_44_1" name="q44_11Federal" value="Yes - I must submit documentation of my federal employment authorization or a copy of my permanent resident card." required=""><label id="label_input_44_1" for="input_44_1">Yes - I must submit documentation of my federal employment authorization or a copy of my permanent resident card.</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_44" class="form-radio validate[required]" id="input_44_2" name="q44_11Federal" value="No" required=""><label id="label_input_44_2" for="input_44_2">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_39" data-css-selector="id_39"><label class="form-label form-label-top form-label-auto" id="label_39" aria-hidden="false"> 12. Have you been convicted in any court of a misdemeanor offense involving domestic violence?<span class="form-required">*</span> </label>
<div id="cid_39" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_39" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_39" class="form-radio validate[required]" id="input_39_0" name="q39_12Have" value="Yes" required=""><label id="label_input_39_0" for="input_39_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_39" class="form-radio validate[required]" id="input_39_1" name="q39_12Have" value="No" required=""><label id="label_input_39_1" for="input_39_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_34" data-css-selector="id_34"><label class="form-label form-label-top form-label-auto" id="label_34" aria-hidden="false"> 13. Are you an unlawful user of a controlled substance or addicted to any controlled substances?<span class="form-required">*</span> </label>
<div id="cid_34" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_34" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_34" class="form-radio validate[required]" id="input_34_0" name="q34_13Are" value="Yes" required=""><label id="label_input_34_0" for="input_34_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_34" class="form-radio validate[required]" id="input_34_1" name="q34_13Are" value="No" required=""><label id="label_input_34_1" for="input_34_1">No</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_9" data-css-selector="id_9"><label class="form-label form-label-top form-label-auto" id="label_9" for="input_9" aria-hidden="false"> Initial (acknowledgment of Background Information questions review)<span class="form-required">*</span> </label>
<div id="cid_9" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_9" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_9" data-width="310" data-height="114" data-id="9" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_9" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q9_initialacknowledgment" class="output4" id="input_9">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li id="cid_45" class="form-input-wide" data-type="control_head" data-css-selector="id_45">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_45" class="form-header" data-component="header">Background Questionnaire Acknowledgements</h2>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_62" data-css-selector="id_62">
<div id="cid_62" class="form-input-wide" data-layout="full">
<div id="text_62" class="form-html" data-component="text" tabindex="0">
<p><strong> I understand that all fees submitted to Private Security are non-refundable, are nontransferable and that, in accordance with Administrative Rule 35.23, I will have 90 days from the date of notice of a deficiency, to turn in all required documentation, supplemental information and/or fees or this application will be abandoned and I will be required to reapply.</strong></p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_6" data-css-selector="id_6"><label class="form-label form-label-top form-label-auto" id="label_6" for="input_6" aria-hidden="false"> Initial<span class="form-required">*</span> </label>
<div id="cid_6" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_6" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_6" data-width="310" data-height="114" data-id="6" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_6" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q6_initial" class="output4" id="input_6">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_63" data-css-selector="id_63">
<div id="cid_63" class="form-input-wide" data-layout="full">
<div id="text_63" class="form-html" data-component="text" tabindex="0">
<p><strong>I verify that the information proved is true and correct, and I understand that this is an official Government record and that any false statement made on this document or any other supplement provided to DPS may result in criminal prosecution.</strong></p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_7" data-css-selector="id_7"><label class="form-label form-label-top form-label-auto" id="label_7" for="input_7" aria-hidden="false"> Initial<span class="form-required">*</span> </label>
<div id="cid_7" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_7" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_7" data-width="310" data-height="114" data-id="7" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_7" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q7_initial7" class="output4" id="input_7">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_64" data-css-selector="id_64">
<div id="cid_64" class="form-input-wide" data-layout="full">
<div id="text_64" class="form-html" data-component="text" tabindex="0">
<p><strong>I understand, any pending charges or conviction referred to above require the submission of the appropriate court documentation, with this application. Failure to report an arrest or conviction, late found by a fingerprint search, may result in denial or revocation of a license based on the material misstatement of fact in this application.</strong></p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_8" data-css-selector="id_8"><label class="form-label form-label-top form-label-auto" id="label_8" for="input_8" aria-hidden="false"> Initial<span class="form-required">*</span> </label>
<div id="cid_8" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_8" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_8" data-width="310" data-height="114" data-id="8" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_8" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q8_initial8" class="output4" id="input_8">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_65" data-css-selector="id_65">
<div id="cid_65" class="form-input-wide" data-layout="full">
<div id="text_65" class="form-html" data-component="text" tabindex="0">
<p><strong>I acknowledge I have review the eligibility criteria of Texas Occupations Code 1702.113 and the definition of 'conviction' provided in 1702.371. In addition, I acknowledge I have reviewed the disqualifying offenses listed in Texas Administration Code 35.4.</strong></p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_32" data-css-selector="id_32"><label class="form-label form-label-top form-label-auto" id="label_32" for="input_32" aria-hidden="false"> Initial<span class="form-required">*</span> </label>
<div id="cid_32" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_32" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_32" data-width="310" data-height="114" data-id="32" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_32" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q32_initial32" class="output4" id="input_32">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_61" data-css-selector="id_61">
<div id="cid_61" class="form-input-wide" data-layout="full">
<div id="text_61" class="form-html" data-component="text" tabindex="0">
<p><strong>I, as the renewing employee, have completed the required minimum hours of Department approved Continuing Education (CE) credits necessary for renewal of my registration.</strong></p>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_signature" id="id_33" data-css-selector="id_33"><label class="form-label form-label-top form-label-auto" id="label_33" for="input_33" aria-hidden="false"> Initial<span class="form-required">*</span> </label>
<div id="cid_33" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_33" class="signature-pad-wrapper">
<div data-wrapper-react="true">
<!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
<div id="sig_pad_33" data-width="310" data-height="114" data-id="33" data-required="true" class="pad validate[required]" aria-description="Use your pointer or touch input to draw your signature." aria-labelledby="label_33" tabindex="0"><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas class="jSignature" width="310" style="margin: 0px; padding: 0px; border: none; height: 114px; width: 310px; touch-action: none; background-color: rgb(255, 255, 255);" height="114"></canvas><div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1.5em !important; margin-bottom:1.5em !important; position: relative;"></div></div><input type="hidden" name="q33_initial33" class="output4" id="input_33">
</div>
<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span></aside>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_60" data-css-selector="id_60">
<div id="cid_60" class="form-input-wide" data-layout="full">
<div id="text_60" class="form-html" data-component="text" tabindex="0">
<p><strong>I understand my application for renewal may be denied if I am either in default of a student loan or delinquent in the payment of child support (Texas Education Code, Chapter 57 or Texas Family Code, Chapter 232).</strong></p>
</div>
</div>
</li>
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<p><strong>I certify that all information I provided in relation to this criminal history record check is true and accurate. I authorize the Texas Department of Public Safety (DPS) to access Texas and Federal criminal history record information that pertains to me and disseminate that information to the designated Authorized Agency or Qualified Entity with which I am or am seeking to be employed or to serve as a volunteer, through the DPS Fingerprint-based Applicant Clearinghouse of Texas and as authorized by Texas Government Code Chapter 411 and any other applicable State of Federal statute or policy. I authorize the Texas Department of Public safety to submit my fingerprints and other application information to the FBI to disclose potentially pertinent information to the DPS during the processing of this application and for as long hereafter as may be relevant to the activity for which this application is being submitted. I understand that the FBI may also retain my fingerprints and other applicant information in the FBI's permanent collection of fingerprints and related information, where all such data will be subject to comparisons against other submissions received by the FBI and to further disseminations by the FBI as may be authorized under the Privacy Act of 1974 (5 USC 553a). I understand my fingerprints will be searched by and against civil, criminal and latent fingerprints in the Next Generation Identifications (NGI) system. I understand that I am entitled to obtain a copy of any criminal history record check and challenge the accuracy and completeness of the information before a final determination is made by the Qualified Entity. I also understand the Qualified Entity may deny me access to children, the elderly, or individuals with disabilities until the criminal history record check is completed. If a need arises to challenge the FBI response, you many contact the agency that submitted the information to the FBI, or you may send a written challenge request to the FBI's Criminal Justice Information Service (CJIS) Division at the FBI CJIS Division, Attention Correspondence Group, 1000 Custer Hollow Rd, Clarksburg, WV 26306.</strong></p>
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<div class="validate[multipleUpload]"><div class="qq-uploader"><div class="qq-upload-drop-area" style="display: none;"><span>Drop files here to upload</span></div><div class="qq-upload-button " aria-hidden="true" style="position: relative; overflow: hidden; direction: ltr;">Browse Files<div class="jfUpload-heading forDesktop">Drag and drop files here</div>
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Drag and drop files here" tabindex="0"><input multiple="multiple" class="fileupload-input" id="input_53" type="file" name="file" aria-labelledby="label_53" aria-hidden="true" tabindex="-1"></div><label class="form-sub-label" aria-hidden="true" for="input_53" id="sublabel_53"></label><span style="display:none" class="multipleFileUploadLabels cancelText">Cancel</span><span style="display:none" class="multipleFileUploadLabels ofText">of</span><ul class="qq-upload-list" aria-label="Uploaded files"></ul></div></div>
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