{"id":9,"date":"2013-07-24T09:44:13","date_gmt":"2013-07-24T09:44:13","guid":{"rendered":"http:\/\/kokuacare.com\/forms\/?page_id=9"},"modified":"2016-04-06T21:17:03","modified_gmt":"2016-04-06T21:17:03","slug":"job-appllication","status":"publish","type":"page","link":"http:\/\/kokuacare.com\/forms\/job-appllication\/","title":{"rendered":"Job Application"},"content":{"rendered":"<div class=\"visual-form-builder-container\">\n\t\t<form id=\"job-application-2\" class=\"visual-form-builder vfb-form-2  \" method=\"post\" enctype=\"multipart\/form-data\" action=\"\">\n\t\t<input type=\"hidden\" name=\"form_id\" value=\"2\" \/><fieldset class=\"vfb-fieldset vfb-fieldset-1 17    \" id=\"vfb-17-17\"><div class=\"vfb-legend\"><h3><\/h3><\/div><ul class=\"vfb-section vfb-section-1\"><li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-21-21\"><label for=\"vfb-21-21\" class=\"vfb-desc\"> <\/label><H2>Online Application for Employment \r\nwith Kokua Care <\/H2><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-all-fields-marked-with-red-asterisk-e280a2-are-required-22\"><label for=\"vfb-all-fields-marked-with-red-asterisk-e280a2-are-required-22\" class=\"vfb-desc\">All fields marked with red asterisk \u2022 are required <\/label><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-job-name-23\"><label for=\"vfb-job-name-23\" class=\"vfb-desc\">Job Name  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-23\" id=\"vfb-job-name-23\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-note-24\"><label for=\"vfb-note-24\" class=\"vfb-desc\">NOTE <\/label><a href=\"http:\/\/www.kokuacare.com\/job_posting.php\">If you don't know the job name click here to see all current jobs.<\/a><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-first-name-25\"><label for=\"vfb-first-name-25\" class=\"vfb-desc\">First Name  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-25\" id=\"vfb-first-name-25\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-middle-initial-26\"><label for=\"vfb-middle-initial-26\" class=\"vfb-desc\">Middle Initial <\/label><input type=\"text\" name=\"vfb-26\" id=\"vfb-middle-initial-26\" value=\"\" class=\"vfb-text  vfb-small   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-third  \" id=\"item-vfb-last-name-27\"><label for=\"vfb-last-name-27\" class=\"vfb-desc\">Last Name  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-27\" id=\"vfb-last-name-27\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-present-mailing-address-28\"><label for=\"vfb-present-mailing-address-28\" class=\"vfb-desc\">Present Mailing Address  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-28\" id=\"vfb-present-mailing-address-28\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-city-29\"><label for=\"vfb-city-29\" class=\"vfb-desc\">City  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-29\" id=\"vfb-city-29\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-state-30\"><label for=\"vfb-state-30\" class=\"vfb-desc\">State  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-30\" id=\"vfb-state-30\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-third  \" id=\"item-vfb-zip-code-32\"><label for=\"vfb-zip-code-32\" class=\"vfb-desc\">Zip Code  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-32\" id=\"vfb-zip-code-32\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-half  \" id=\"item-vfb-home-phone-33\"><label for=\"vfb-home-phone-33\" class=\"vfb-desc\">Home Phone  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-33\" id=\"vfb-home-phone-33\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-half  \" id=\"item-vfb-cell-phone-34\"><label for=\"vfb-cell-phone-34\" class=\"vfb-desc\">Cell Phone <\/label><input type=\"text\" name=\"vfb-34\" id=\"vfb-cell-phone-34\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-e-mail-address-35\"><label for=\"vfb-e-mail-address-35\" class=\"vfb-desc\">E-mail Address <\/label><input type=\"text\" name=\"vfb-35\" id=\"vfb-e-mail-address-35\" value=\"\" class=\"vfb-text  vfb-medium   email \" \/><\/li>\n<div class=\"vfb-section-div vfb-work-availability-36   \"><h4>Work Availability<\/h4><\/div><div class=\"vfb-clear\"><\/div><li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-37-37\"><label for=\"vfb-37-37\" class=\"vfb-desc\"> <\/label>Specify how many hours; for example 8 hours on Monday (just input the number only); you are available on each day.\r\nThe amount of work we can assign depends on your flexibility...<\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-sunday-40\"><label for=\"vfb-sunday-40\" class=\"vfb-desc\">Sunday <\/label><input type=\"text\" name=\"vfb-40\" id=\"vfb-sunday-40\" value=\"\" class=\"vfb-text  vfb-medium   number \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-monday-41\"><label for=\"vfb-monday-41\" class=\"vfb-desc\">Monday <\/label><input type=\"text\" name=\"vfb-41\" id=\"vfb-monday-41\" value=\"\" class=\"vfb-text  vfb-medium   number \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-third  \" id=\"item-vfb-tuesday-42\"><label for=\"vfb-tuesday-42\" class=\"vfb-desc\">Tuesday <\/label><input type=\"text\" name=\"vfb-42\" id=\"vfb-tuesday-42\" value=\"\" class=\"vfb-text  vfb-medium   number \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-wednesday-43\"><label for=\"vfb-wednesday-43\" class=\"vfb-desc\">Wednesday <\/label><input type=\"text\" name=\"vfb-43\" id=\"vfb-wednesday-43\" value=\"\" class=\"vfb-text  vfb-medium   number \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-thursday-44\"><label for=\"vfb-thursday-44\" class=\"vfb-desc\">Thursday <\/label><input type=\"text\" name=\"vfb-44\" id=\"vfb-thursday-44\" value=\"\" class=\"vfb-text  vfb-medium   number \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-third  \" id=\"item-vfb-friday-45\"><label for=\"vfb-friday-45\" class=\"vfb-desc\">Friday <\/label><input type=\"text\" name=\"vfb-45\" id=\"vfb-friday-45\" value=\"\" class=\"vfb-text  vfb-medium   number \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-saturday-46\"><label for=\"vfb-saturday-46\" class=\"vfb-desc\">Saturday <\/label><input type=\"text\" name=\"vfb-46\" id=\"vfb-saturday-46\" value=\"\" class=\"vfb-text  vfb-medium   number \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-what-areas-would-you-prefer-to-work-in-48\"><label for=\"vfb-what-areas-would-you-prefer-to-work-in-48\" class=\"vfb-desc\">What areas would you prefer to work in? <\/label>(Please check all areas you would consider. The amount of work we can assign depends on your flexibility.)<\/li>\n<li class=\"vfb-item vfb-item-checkbox  vfb-three-column   \" id=\"item-vfb-preferences-49\"><label for=\"vfb-preferences-49\" class=\"vfb-desc\">Preferences <\/label><div><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-0\" value=\"No Preference\" class=\"vfb-checkbox  \" checked='checked' \/><label for=\"vfb-preferences-49-0\" class=\"vfb-choice\">No Preference<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-1\" value=\"WEST: Waianae\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-1\" class=\"vfb-choice\">WEST: Waianae<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-2\" value=\"WEST: Makakilo\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-2\" class=\"vfb-choice\">WEST: Makakilo<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-3\" value=\"WEST: Kapolei\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-3\" class=\"vfb-choice\">WEST: Kapolei<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-4\" value=\"WEST: Ewa Beach\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-4\" class=\"vfb-choice\">WEST: Ewa Beach<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-5\" value=\"CENTRAL: Wahiawa\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-5\" class=\"vfb-choice\">CENTRAL: Wahiawa<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-6\" value=\"CENTRAL: Mililani\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-6\" class=\"vfb-choice\">CENTRAL: Mililani<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-7\" value=\"CENTRAL: Waipahu\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-7\" class=\"vfb-choice\">CENTRAL: Waipahu<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-8\" value=\"CENTRAL: Pearl City\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-8\" class=\"vfb-choice\">CENTRAL: Pearl City<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-9\" value=\"CENTRAL: Aiea\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-9\" class=\"vfb-choice\">CENTRAL: Aiea<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-10\" value=\"NORTH: Wailua\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-10\" class=\"vfb-choice\">NORTH: Wailua<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-11\" value=\"NORTH: Haleiwa\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-11\" class=\"vfb-choice\">NORTH: Haleiwa<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-12\" value=\"NORTH: Waimea\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-12\" class=\"vfb-choice\">NORTH: Waimea<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-13\" value=\"WINDWARD: Laie\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-13\" class=\"vfb-choice\">WINDWARD: Laie<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-14\" value=\"WINDWARD: Hauula\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-14\" class=\"vfb-choice\">WINDWARD: Hauula<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-15\" value=\"WINDWARD: Kaneohe\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-15\" class=\"vfb-choice\">WINDWARD: Kaneohe<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-16\" value=\"WINDWARD: Kailua\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-16\" class=\"vfb-choice\">WINDWARD: Kailua<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-17\" value=\"WINDWARD: Waimanalo\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-17\" class=\"vfb-choice\">WINDWARD: Waimanalo<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-18\" value=\"EAST: Hawaii Kai\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-18\" class=\"vfb-choice\">EAST: Hawaii Kai<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-19\" value=\"EAST: Niu Valley\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-19\" class=\"vfb-choice\">EAST: Niu Valley<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-20\" value=\"EAST: Aina Haina\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-20\" class=\"vfb-choice\">EAST: Aina Haina<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-21\" value=\"TOWN: Kalihi\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-21\" class=\"vfb-choice\">TOWN: Kalihi<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-22\" value=\"TOWN: Honolulu\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-22\" class=\"vfb-choice\">TOWN: Honolulu<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-23\" value=\"TOWN: Manoa\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-23\" class=\"vfb-choice\">TOWN: Manoa<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-24\" value=\"TOWN: Waikiki\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-24\" class=\"vfb-choice\">TOWN: Waikiki<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-49[]\" id=\"vfb-preferences-49-25\" value=\"TOWN: Kahala\" class=\"vfb-checkbox  \" \/><label for=\"vfb-preferences-49-25\" class=\"vfb-choice\">TOWN: Kahala<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-date-available-for-work-56\"><label for=\"vfb-date-available-for-work-56\" class=\"vfb-desc\">Date available for work: <\/label><\/li>\n<li class=\"vfb-item vfb-item-select   vfb-left-third  \" id=\"item-vfb-month-53\"><label for=\"vfb-month-53\" class=\"vfb-desc\">Month <\/label><select name=\"vfb-53\" id=\"vfb-month-53\" class=\"vfb-select  vfb-medium  \"><option value=\"January\">January<\/option><option value=\"February\">February<\/option><option value=\"March\">March<\/option><option value=\"April\">April<\/option><option value=\"May\">May<\/option><option value=\"June\">June<\/option><option value=\"July\">July<\/option><option value=\"August\">August<\/option><option value=\"September\">September<\/option><option value=\"October\">October<\/option><option value=\"November\">November<\/option><option value=\"December\">December<\/option><\/select><\/li>\n<li class=\"vfb-item vfb-item-select   vfb-middle-third  \" id=\"item-vfb-day-54\"><label for=\"vfb-day-54\" class=\"vfb-desc\">Day <\/label><select name=\"vfb-54\" id=\"vfb-day-54\" class=\"vfb-select  vfb-medium  \"><option value=\"1\">1<\/option><option value=\"2\" selected='selected'>2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><option value=\"13\">13<\/option><option value=\"14\">14<\/option><option value=\"15\">15<\/option><option value=\"16\">16<\/option><option value=\"17\">17<\/option><option value=\"18\">18<\/option><option value=\"19\">19<\/option><option value=\"20\">20<\/option><option value=\"21\">21<\/option><option value=\"22\">22<\/option><option value=\"23\">23<\/option><option value=\"24\">24<\/option><option value=\"25\">25<\/option><option value=\"26\">26<\/option><option value=\"27\">27<\/option><option value=\"28\">28<\/option><option value=\"29\">29<\/option><option value=\"30\">30<\/option><option value=\"31\">31<\/option><\/select><\/li>\n<li class=\"vfb-item vfb-item-select   vfb-right-third  \" id=\"item-vfb-year-55\"><label for=\"vfb-year-55\" class=\"vfb-desc\">Year <\/label><select name=\"vfb-55\" id=\"vfb-year-55\" class=\"vfb-select  vfb-medium  \"><option value=\"2016\" selected='selected'>2016<\/option><option value=\"2017\">2017<\/option><option value=\"2018\">2018<\/option><\/select><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-other-skills-57\"><label for=\"vfb-other-skills-57\" class=\"vfb-desc\">Other Skills: <\/label><input type=\"text\" name=\"vfb-57\" id=\"vfb-other-skills-57\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-professional-licenses-58\"><label for=\"vfb-professional-licenses-58\" class=\"vfb-desc\">Professional Licenses: <\/label><input type=\"text\" name=\"vfb-58\" id=\"vfb-professional-licenses-58\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<div class=\"vfb-section-div vfb-educational-background-50   \"><h4>Educational Background<\/h4><\/div><div class=\"vfb-clear\"><\/div><li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-high-school-64\"><label for=\"vfb-high-school-64\" class=\"vfb-desc\">High School: <\/label><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-schoolcitystate-60\"><label for=\"vfb-schoolcitystate-60\" class=\"vfb-desc\">School;City;State <\/label><input type=\"text\" name=\"vfb-60\" id=\"vfb-schoolcitystate-60\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-degreecertificate-61\"><label for=\"vfb-degreecertificate-61\" class=\"vfb-desc\">Degree\/Certificate <\/label><input type=\"text\" name=\"vfb-61\" id=\"vfb-degreecertificate-61\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-checkbox   vfb-right-third  \" id=\"item-vfb-graduated-63\"><label for=\"vfb-graduated-63\" class=\"vfb-desc\">Graduated? <\/label><div><span><input type=\"checkbox\" name=\"vfb-63[]\" id=\"vfb-graduated-63-0\" value=\"Yes\" class=\"vfb-checkbox  \" \/><label for=\"vfb-graduated-63-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-63[]\" id=\"vfb-graduated-63-1\" value=\"No\" class=\"vfb-checkbox  \" checked='checked' \/><label for=\"vfb-graduated-63-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-college-77\"><label for=\"vfb-college-77\" class=\"vfb-desc\">College <\/label><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-schoolcitystate-68\"><label for=\"vfb-schoolcitystate-68\" class=\"vfb-desc\">School;City;State <\/label><input type=\"text\" name=\"vfb-68\" id=\"vfb-schoolcitystate-68\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-degreecertificate-71\"><label for=\"vfb-degreecertificate-71\" class=\"vfb-desc\">Degree\/Certificate <\/label><input type=\"text\" name=\"vfb-71\" id=\"vfb-degreecertificate-71\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-checkbox   vfb-right-third  \" id=\"item-vfb-graduated-74\"><label for=\"vfb-graduated-74\" class=\"vfb-desc\">Graduated? <\/label><div><span><input type=\"checkbox\" name=\"vfb-74[]\" id=\"vfb-graduated-74-0\" value=\"Yes\" class=\"vfb-checkbox  \" \/><label for=\"vfb-graduated-74-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-74[]\" id=\"vfb-graduated-74-1\" value=\"No\" class=\"vfb-checkbox  \" checked='checked' \/><label for=\"vfb-graduated-74-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-nursing-school-76\"><label for=\"vfb-nursing-school-76\" class=\"vfb-desc\">Nursing School: <\/label><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-schoolcitystate-67\"><label for=\"vfb-schoolcitystate-67\" class=\"vfb-desc\">School;City;State <\/label><input type=\"text\" name=\"vfb-67\" id=\"vfb-schoolcitystate-67\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-degreecertificate-70\"><label for=\"vfb-degreecertificate-70\" class=\"vfb-desc\">Degree\/Certificate <\/label><input type=\"text\" name=\"vfb-70\" id=\"vfb-degreecertificate-70\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-checkbox   vfb-right-third  \" id=\"item-vfb-graduated-73\"><label for=\"vfb-graduated-73\" class=\"vfb-desc\">Graduated <\/label><div><span><input type=\"checkbox\" name=\"vfb-73[]\" id=\"vfb-graduated-73-0\" value=\"Yes\" class=\"vfb-checkbox  \" \/><label for=\"vfb-graduated-73-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-73[]\" id=\"vfb-graduated-73-1\" value=\"No\" class=\"vfb-checkbox  \" checked='checked' \/><label for=\"vfb-graduated-73-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-technical-training-75\"><label for=\"vfb-technical-training-75\" class=\"vfb-desc\">Technical Training: <\/label><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-schoolcitystate-66\"><label for=\"vfb-schoolcitystate-66\" class=\"vfb-desc\">School;City;State <\/label><input type=\"text\" name=\"vfb-66\" id=\"vfb-schoolcitystate-66\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-degreecertificate-69\"><label for=\"vfb-degreecertificate-69\" class=\"vfb-desc\">Degree\/Certificate <\/label><input type=\"text\" name=\"vfb-69\" id=\"vfb-degreecertificate-69\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-checkbox   vfb-right-third  \" id=\"item-vfb-graduated-72\"><label for=\"vfb-graduated-72\" class=\"vfb-desc\">Graduated? <\/label><div><span><input type=\"checkbox\" name=\"vfb-72[]\" id=\"vfb-graduated-72-0\" value=\"Yes\" class=\"vfb-checkbox  \" \/><label for=\"vfb-graduated-72-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"checkbox\" name=\"vfb-72[]\" id=\"vfb-graduated-72-1\" value=\"No\" class=\"vfb-checkbox  \" checked='checked' \/><label for=\"vfb-graduated-72-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<div class=\"vfb-section-div vfb-employment-history-78   \"><h4>Employment History<\/h4><\/div><div class=\"vfb-clear\"><\/div><li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-instructions-79\"><label for=\"vfb-instructions-79\" class=\"vfb-desc\">Instructions <\/label>Include information pertaining to patient care, starting with the most recent.<\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-employer-1-80\"><label for=\"vfb-employer-1-80\" class=\"vfb-desc\">Employer 1 <\/label><input type=\"text\" name=\"vfb-80\" id=\"vfb-employer-1-80\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-job-title-84\"><label for=\"vfb-job-title-84\" class=\"vfb-desc\">Job Title <\/label><input type=\"text\" name=\"vfb-84\" id=\"vfb-job-title-84\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-work-city-87\"><label for=\"vfb-work-city-87\" class=\"vfb-desc\">Work City <\/label><input type=\"text\" name=\"vfb-87\" id=\"vfb-work-city-87\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-work-state-90\"><label for=\"vfb-work-state-90\" class=\"vfb-desc\">Work State <\/label><input type=\"text\" name=\"vfb-90\" id=\"vfb-work-state-90\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-third  \" id=\"item-vfb-telephone-93\"><label for=\"vfb-telephone-93\" class=\"vfb-desc\">Telephone <\/label><input type=\"text\" name=\"vfb-93\" id=\"vfb-telephone-93\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-date   vfb-left-half  \" id=\"item-vfb-date-started-96\"><label for=\"vfb-date-started-96\" class=\"vfb-desc\">Date Started: <\/label><input type=\"text\" name=\"vfb-96\" id=\"vfb-date-started-96\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  \" \/><\/li>\n<li class=\"vfb-item vfb-item-date   vfb-right-half  \" id=\"item-vfb-date-ended-105\"><label for=\"vfb-date-ended-105\" class=\"vfb-desc\">Date Ended: <\/label><input type=\"text\" name=\"vfb-105\" id=\"vfb-date-ended-105\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-reason-for-leaving-101\"><label for=\"vfb-reason-for-leaving-101\" class=\"vfb-desc\">Reason For Leaving <\/label><input type=\"text\" name=\"vfb-101\" id=\"vfb-reason-for-leaving-101\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-employer-2-83\"><label for=\"vfb-employer-2-83\" class=\"vfb-desc\">Employer 2 <\/label><input type=\"text\" name=\"vfb-83\" id=\"vfb-employer-2-83\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-110-110\"><label for=\"vfb-110-110\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-job-title-86\"><label for=\"vfb-job-title-86\" class=\"vfb-desc\">Job Title <\/label><input type=\"text\" name=\"vfb-86\" id=\"vfb-job-title-86\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-work-city-89\"><label for=\"vfb-work-city-89\" class=\"vfb-desc\">Work City <\/label><input type=\"text\" name=\"vfb-89\" id=\"vfb-work-city-89\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-work-state-92\"><label for=\"vfb-work-state-92\" class=\"vfb-desc\">Work State <\/label><input type=\"text\" name=\"vfb-92\" id=\"vfb-work-state-92\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-third  \" id=\"item-vfb-telephone-95\"><label for=\"vfb-telephone-95\" class=\"vfb-desc\">Telephone <\/label><input type=\"text\" name=\"vfb-95\" id=\"vfb-telephone-95\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-date   vfb-left-half  \" id=\"item-vfb-date-started-103\"><label for=\"vfb-date-started-103\" class=\"vfb-desc\">Date Started: <\/label><input type=\"text\" name=\"vfb-103\" id=\"vfb-date-started-103\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  \" \/><\/li>\n<li class=\"vfb-item vfb-item-date   vfb-right-half  \" id=\"item-vfb-date-ended-97\"><label for=\"vfb-date-ended-97\" class=\"vfb-desc\">Date Ended: <\/label><input type=\"text\" name=\"vfb-97\" id=\"vfb-date-ended-97\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-reason-for-leaving-107\"><label for=\"vfb-reason-for-leaving-107\" class=\"vfb-desc\">Reason For Leaving <\/label><input type=\"text\" name=\"vfb-107\" id=\"vfb-reason-for-leaving-107\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-113-113\"><label for=\"vfb-113-113\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-employer-3-82\"><label for=\"vfb-employer-3-82\" class=\"vfb-desc\">Employer 3 <\/label><input type=\"text\" name=\"vfb-82\" id=\"vfb-employer-3-82\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-job-title-85\"><label for=\"vfb-job-title-85\" class=\"vfb-desc\">Job Title <\/label><input type=\"text\" name=\"vfb-85\" id=\"vfb-job-title-85\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-third  \" id=\"item-vfb-work-city-88\"><label for=\"vfb-work-city-88\" class=\"vfb-desc\">Work City <\/label><input type=\"text\" name=\"vfb-88\" id=\"vfb-work-city-88\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-middle-third  \" id=\"item-vfb-work-state-91\"><label for=\"vfb-work-state-91\" class=\"vfb-desc\">Work State <\/label><input type=\"text\" name=\"vfb-91\" id=\"vfb-work-state-91\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-third  \" id=\"item-vfb-telephone-94\"><label for=\"vfb-telephone-94\" class=\"vfb-desc\">Telephone <\/label><input type=\"text\" name=\"vfb-94\" id=\"vfb-telephone-94\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-date   vfb-left-half  \" id=\"item-vfb-date-started-102\"><label for=\"vfb-date-started-102\" class=\"vfb-desc\">Date Started: <\/label><input type=\"text\" name=\"vfb-102\" id=\"vfb-date-started-102\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  \" \/><\/li>\n<li class=\"vfb-item vfb-item-date   vfb-right-half  \" id=\"item-vfb-date-ended-104\"><label for=\"vfb-date-ended-104\" class=\"vfb-desc\">Date Ended: <\/label><input type=\"text\" name=\"vfb-104\" id=\"vfb-date-ended-104\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-reason-for-leaving-106\"><label for=\"vfb-reason-for-leaving-106\" class=\"vfb-desc\">Reason For Leaving <\/label><input type=\"text\" name=\"vfb-106\" id=\"vfb-reason-for-leaving-106\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-112-112\"><label for=\"vfb-112-112\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-may-we-call-your-employers-108\"><label for=\"vfb-may-we-call-your-employers-108\" class=\"vfb-desc\">May we call your employers?: <\/label><div><span><input type=\"radio\" name=\"vfb-108\" id=\"vfb-may-we-call-your-employers-108-0\" value=\"Yes\" class=\"vfb-radio  \" checked='checked' \/><label for=\"vfb-may-we-call-your-employers-108-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-108\" id=\"vfb-may-we-call-your-employers-108-1\" value=\"No\" class=\"vfb-radio  \" \/><label for=\"vfb-may-we-call-your-employers-108-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-if-no-please-explain-109\"><label for=\"vfb-if-no-please-explain-109\" class=\"vfb-desc\">If no please explain: <\/label><input type=\"text\" name=\"vfb-109\" id=\"vfb-if-no-please-explain-109\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-please-describe-your-most-recent-hospital-home-care-or-medical-related-experience-118\"><label for=\"vfb-please-describe-your-most-recent-hospital-home-care-or-medical-related-experience-118\" class=\"vfb-desc\">Please describe your most recent hospital, home care, or medical related experience:  <\/label><div><textarea name=\"vfb-118\" id=\"vfb-please-describe-your-most-recent-hospital-home-care-or-medical-related-experience-118\" class=\"vfb-textarea  vfb-large   \"><\/textarea><\/div><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-117-117\"><label for=\"vfb-117-117\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<div class=\"vfb-section-div vfb-questionnaire-119   \"><h4>Questionnaire:<\/h4><\/div><div class=\"vfb-clear\"><\/div><li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-120-120\"><label for=\"vfb-120-120\" class=\"vfb-desc\"> <\/label>All questions in this questionaire are required to be answered.<\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-have-you-ever-been-convicted-122\"><label for=\"vfb-have-you-ever-been-convicted-122\" class=\"vfb-desc\">Have you ever been convicted\u2026,  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><input type=\"radio\" name=\"vfb-122\" id=\"vfb-have-you-ever-been-convicted-122-0\" value=\"Yes\" class=\"vfb-radio  required \" \/><label for=\"vfb-have-you-ever-been-convicted-122-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-122\" id=\"vfb-have-you-ever-been-convicted-122-1\" value=\"No\" class=\"vfb-radio  required \" \/><label for=\"vfb-have-you-ever-been-convicted-122-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-if-yes-please-explain-121\"><label for=\"vfb-if-yes-please-explain-121\" class=\"vfb-desc\">if yes, please explain: <\/label><input type=\"text\" name=\"vfb-121\" id=\"vfb-if-yes-please-explain-121\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-141-141\"><label for=\"vfb-141-141\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-have-you-been-fired-in-the-last-ten-years-127\"><label for=\"vfb-have-you-been-fired-in-the-last-ten-years-127\" class=\"vfb-desc\">Have you been fired in the last ten years?  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><input type=\"radio\" name=\"vfb-127\" id=\"vfb-have-you-been-fired-in-the-last-ten-years-127-0\" value=\"Yes\" class=\"vfb-radio  required \" checked='checked' \/><label for=\"vfb-have-you-been-fired-in-the-last-ten-years-127-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-127\" id=\"vfb-have-you-been-fired-in-the-last-ten-years-127-1\" value=\"No\" class=\"vfb-radio  required \" \/><label for=\"vfb-have-you-been-fired-in-the-last-ten-years-127-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-if-yes-please-explain-134\"><label for=\"vfb-if-yes-please-explain-134\" class=\"vfb-desc\">if yes, please explain: <\/label><input type=\"text\" name=\"vfb-134\" id=\"vfb-if-yes-please-explain-134\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-115-115\"><label for=\"vfb-115-115\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-have-you-been-employed-or-attended-school-using-any-other-name-126\"><label for=\"vfb-have-you-been-employed-or-attended-school-using-any-other-name-126\" class=\"vfb-desc\">Have you been employed or attended school using any other name?  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><input type=\"radio\" name=\"vfb-126\" id=\"vfb-have-you-been-employed-or-attended-school-using-any-other-name-126-0\" value=\"Yes\" class=\"vfb-radio  required \" checked='checked' \/><label for=\"vfb-have-you-been-employed-or-attended-school-using-any-other-name-126-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-126\" id=\"vfb-have-you-been-employed-or-attended-school-using-any-other-name-126-1\" value=\"No\" class=\"vfb-radio  required \" \/><label for=\"vfb-have-you-been-employed-or-attended-school-using-any-other-name-126-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-if-yes-please-explain-133\"><label for=\"vfb-if-yes-please-explain-133\" class=\"vfb-desc\">if yes, please explain: <\/label><input type=\"text\" name=\"vfb-133\" id=\"vfb-if-yes-please-explain-133\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-111-111\"><label for=\"vfb-111-111\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-do-you-have-the-legal-right-to-be-employed-in-the-united-states-125\"><label for=\"vfb-do-you-have-the-legal-right-to-be-employed-in-the-united-states-125\" class=\"vfb-desc\">Do you have the legal right to be employed in the United States?  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label>(If hired, you will be required to provide identification to prove eligibility for employment):<\/label><\/span><span><input type=\"radio\" name=\"vfb-125\" id=\"vfb-do-you-have-the-legal-right-to-be-employed-in-the-united-states-125-0\" value=\"Yes\" class=\"vfb-radio  required \" \/><label for=\"vfb-do-you-have-the-legal-right-to-be-employed-in-the-united-states-125-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-125\" id=\"vfb-do-you-have-the-legal-right-to-be-employed-in-the-united-states-125-1\" value=\"No\" class=\"vfb-radio  required \" checked='checked' \/><label for=\"vfb-do-you-have-the-legal-right-to-be-employed-in-the-united-states-125-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-114-114\"><label for=\"vfb-114-114\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-have-you-ever-been-convicted-pled-guilty-or-no-contest-or-forfeited-bond-on-bail-for-any-crime-other-than-traffic-violations-124\"><label for=\"vfb-have-you-ever-been-convicted-pled-guilty-or-no-contest-or-forfeited-bond-on-bail-for-any-crime-other-than-traffic-violations-124\" class=\"vfb-desc\">Have you ever been convicted, pled guilty or no contest, or forfeited bond on bail for any crime other than traffic violations? : <\/label><div><span><input type=\"radio\" name=\"vfb-124\" id=\"vfb-have-you-ever-been-convicted-pled-guilty-or-no-contest-or-forfeited-bond-on-bail-for-any-crime-other-than-traffic-violations-124-0\" value=\"Yes\" class=\"vfb-radio  \" \/><label for=\"vfb-have-you-ever-been-convicted-pled-guilty-or-no-contest-or-forfeited-bond-on-bail-for-any-crime-other-than-traffic-violations-124-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-124\" id=\"vfb-have-you-ever-been-convicted-pled-guilty-or-no-contest-or-forfeited-bond-on-bail-for-any-crime-other-than-traffic-violations-124-1\" value=\"No\" class=\"vfb-radio  \" checked='checked' \/><label for=\"vfb-have-you-ever-been-convicted-pled-guilty-or-no-contest-or-forfeited-bond-on-bail-for-any-crime-other-than-traffic-violations-124-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-if-yes-please-explain-132\"><label for=\"vfb-if-yes-please-explain-132\" class=\"vfb-desc\">if yes, please explain: <\/label><input type=\"text\" name=\"vfb-132\" id=\"vfb-if-yes-please-explain-132\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-116-116\"><label for=\"vfb-116-116\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-as-a-caregiver-you-may-be-required-to-manually-lift-or-transfer-a-patient-the-average-weight-may-be-70-lbs-will-you-be-able-to-do-that-if-no-please-explain-123\"><label for=\"vfb-as-a-caregiver-you-may-be-required-to-manually-lift-or-transfer-a-patient-the-average-weight-may-be-70-lbs-will-you-be-able-to-do-that-if-no-please-explain-123\" class=\"vfb-desc\">As a caregiver, you may be required to manually lift or transfer a patient. The average weight may be 70 lbs. Will you be able to do that? If no, please explain  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><input type=\"radio\" name=\"vfb-123\" id=\"vfb-as-a-caregiver-you-may-be-required-to-manually-lift-or-transfer-a-patient-the-average-weight-may-be-70-lbs-will-you-be-able-to-do-that-if-no-please-explain-123-0\" value=\"Yes\" class=\"vfb-radio  required \" \/><label for=\"vfb-as-a-caregiver-you-may-be-required-to-manually-lift-or-transfer-a-patient-the-average-weight-may-be-70-lbs-will-you-be-able-to-do-that-if-no-please-explain-123-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-123\" id=\"vfb-as-a-caregiver-you-may-be-required-to-manually-lift-or-transfer-a-patient-the-average-weight-may-be-70-lbs-will-you-be-able-to-do-that-if-no-please-explain-123-1\" value=\"No\" class=\"vfb-radio  required \" \/><label for=\"vfb-as-a-caregiver-you-may-be-required-to-manually-lift-or-transfer-a-patient-the-average-weight-may-be-70-lbs-will-you-be-able-to-do-that-if-no-please-explain-123-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-if-yes-please-explain-131\"><label for=\"vfb-if-yes-please-explain-131\" class=\"vfb-desc\">if yes, please explain: <\/label><input type=\"text\" name=\"vfb-131\" id=\"vfb-if-yes-please-explain-131\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-144-144\"><label for=\"vfb-144-144\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-do-you-have-any-employment-restrictions-resulting-from-a-non-compete-or-confidentiality-agreement-135\"><label for=\"vfb-do-you-have-any-employment-restrictions-resulting-from-a-non-compete-or-confidentiality-agreement-135\" class=\"vfb-desc\">Do you have any employment restrictions resulting from a non-compete or confidentiality agreement?  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><input type=\"radio\" name=\"vfb-135\" id=\"vfb-do-you-have-any-employment-restrictions-resulting-from-a-non-compete-or-confidentiality-agreement-135-0\" value=\"Yes\" class=\"vfb-radio  required \" \/><label for=\"vfb-do-you-have-any-employment-restrictions-resulting-from-a-non-compete-or-confidentiality-agreement-135-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-135\" id=\"vfb-do-you-have-any-employment-restrictions-resulting-from-a-non-compete-or-confidentiality-agreement-135-1\" value=\"No\" class=\"vfb-radio  required \" \/><label for=\"vfb-do-you-have-any-employment-restrictions-resulting-from-a-non-compete-or-confidentiality-agreement-135-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-if-yes-please-explain-130\"><label for=\"vfb-if-yes-please-explain-130\" class=\"vfb-desc\">if yes, please explain: <\/label><input type=\"text\" name=\"vfb-130\" id=\"vfb-if-yes-please-explain-130\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-143-143\"><label for=\"vfb-143-143\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-are-you-willing-and-able-to-drive-for-our-clients-using-their-car-136\"><label for=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-their-car-136\" class=\"vfb-desc\">Are you willing and able to drive for our clients using their car?   <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><input type=\"radio\" name=\"vfb-136\" id=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-their-car-136-0\" value=\"Yes\" class=\"vfb-radio  required \" \/><label for=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-their-car-136-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-136\" id=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-their-car-136-1\" value=\"No\" class=\"vfb-radio  required \" \/><label for=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-their-car-136-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-are-you-willing-and-able-to-drive-for-our-clients-using-our-car-137\"><label for=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-our-car-137\" class=\"vfb-desc\">Are you willing and able to drive for our clients using our car?   <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><input type=\"radio\" name=\"vfb-137\" id=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-our-car-137-0\" value=\"Yes\" class=\"vfb-radio  required \" \/><label for=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-our-car-137-0\" class=\"vfb-choice\">Yes<\/label><\/span><span><input type=\"radio\" name=\"vfb-137\" id=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-our-car-137-1\" value=\"No\" class=\"vfb-radio  required \" \/><label for=\"vfb-are-you-willing-and-able-to-drive-for-our-clients-using-our-car-137-1\" class=\"vfb-choice\">No<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-if-yes-please-please-provide-insurance-information-129\"><label for=\"vfb-if-yes-please-please-provide-insurance-information-129\" class=\"vfb-desc\">if yes, please please provide insurance information: <\/label><input type=\"text\" name=\"vfb-129\" id=\"vfb-if-yes-please-please-provide-insurance-information-129\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-142-142\"><label for=\"vfb-142-142\" class=\"vfb-desc\"> <\/label><hr><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-how-did-you-hear-about-us-138\"><label for=\"vfb-how-did-you-hear-about-us-138\" class=\"vfb-desc\">How did you hear about us? <\/label><input type=\"text\" name=\"vfb-138\" id=\"vfb-how-did-you-hear-about-us-138\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<div class=\"vfb-section-div vfb-what-would-do-professional-response-section-139   \"><h4>What Would Do? Professional Response Section<\/h4><\/div><div class=\"vfb-clear\"><\/div><li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-140-140\"><label for=\"vfb-140-140\" class=\"vfb-desc\"> <\/label>Please answer the following questions to the best of your knowledge.<\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-1-145\"><label for=\"vfb-question-1-145\" class=\"vfb-desc\">Question #1  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\">You are with a client who has mild dementia and their care-plan states that they should not be left alone. The client tells you to leave 15 minutes before her spouse plans to be home. <\/b>She insists that she will be fine, and becomes agitated when you tell her that you need to stay until her husband returns. What would you do? <\/span><\/label><\/span><textarea name=\"vfb-145\" id=\"vfb-question-1-145\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-2-159\"><label for=\"vfb-question-2-159\" class=\"vfb-desc\">Question # 2  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\"> Your client has high blood pressure medication that is only to be taken if his diastolic pressure is over 100. His blood pressure is 146\/82. Do you give him his medication?<\/span><\/label><\/span><textarea name=\"vfb-159\" id=\"vfb-question-2-159\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-3-152\"><label for=\"vfb-question-3-152\" class=\"vfb-desc\">Question #3  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\">Your client asks you to work outside of your normally scheduled hours, and wants to pay you in cash.\r\n<\/b>What would you do?<\/span><\/label><\/span><textarea name=\"vfb-152\" id=\"vfb-question-3-152\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-4-151\"><label for=\"vfb-question-4-151\" class=\"vfb-desc\">Question #4  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\">Your client, Mrs. Kauhane has some old jewelry that she wants to give to you. She insists that her children do not want the jewelry, and because you have been so kind to her, she wants you to have it. What do you do? <\/span><\/label><\/span><textarea name=\"vfb-151\" id=\"vfb-question-4-151\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-5-150\"><label for=\"vfb-question-5-150\" class=\"vfb-desc\">Question #5  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\">A client that you only visit once a week has some redness around the tailbone area. This client is not very mobile,and usually spends his day sitting in a recliner, watching TV all day. What would you do?<\/span><\/label><\/span><textarea name=\"vfb-150\" id=\"vfb-question-5-150\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-6-149\"><label for=\"vfb-question-6-149\" class=\"vfb-desc\">Question #6  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\"> Your client is bed bound, and has had a BM. You have changed his Depends, and now are preparing to give him \r\na bed bath. As per Universal Precaution Guidelines, what should you do before giving him his bath, or performing any \r\nother personal care or ADL\u2019s? <\/span><\/label><\/span><textarea name=\"vfb-149\" id=\"vfb-question-6-149\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-7-148\"><label for=\"vfb-question-7-148\" class=\"vfb-desc\">Question #7  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\"> Your client has a cold, but refuses to take his cough syrup. What do you do? <\/span><\/label><\/span><textarea name=\"vfb-148\" id=\"vfb-question-7-148\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-8-147\"><label for=\"vfb-question-8-147\" class=\"vfb-desc\">Question #8  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\">Your client slipped and fell while you were on shift. What do you do? <\/span><\/label><\/span><textarea name=\"vfb-147\" id=\"vfb-question-8-147\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-textarea    \" id=\"item-vfb-question-9-146\"><label for=\"vfb-question-9-146\" class=\"vfb-desc\">Question #9  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label><span style=\"font-size:14px;\">Your client has diabetes and is on insulin. You have been trained to take his blood sugar, and when you test his BS, it is unusually low. What do you do?<\/span><\/label><\/span><textarea name=\"vfb-146\" id=\"vfb-question-9-146\" class=\"vfb-textarea  vfb-medium  required  \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-agreement-155\"><label for=\"vfb-agreement-155\" class=\"vfb-desc\">Agreement <\/label>Agreement:\r\nPlease read the following statements carefully and indicate you have done so by entering your name and today's date in the fields below: <BR> <BR>\r\n \t \r\n<Blockquote>\"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release providers of reference information, as well as Kokua Care LLC ufrom all liability for any damage that may result from utilization of such information.\" <\/blockquote><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-half  \" id=\"item-vfb-name-first-and-last-156\"><label for=\"vfb-name-first-and-last-156\" class=\"vfb-desc\">Name: First and Last  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-156\" id=\"vfb-name-first-and-last-156\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-half  \" id=\"item-vfb-date-today-157\"><label for=\"vfb-date-today-157\" class=\"vfb-desc\">Date Today:  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-157\" id=\"vfb-date-today-157\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-instructions-158\"><label for=\"vfb-instructions-158\" class=\"vfb-desc\">Instructions <\/label><table width=\"100%\" border=\"0\" align=\"center\" cellpadding=\"0\" cellspacing=\"0\">\r\n  <tbody>\r\n    <tr align=\"left\">\r\n      <td height=\"30\" colspan=\"2\">All documents below must be provided before being interviewed with our company.<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"20\" colspan=\"2\">\u00a0<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"30\" colspan=\"2\"><ul>\r\n        <li>Current CPR card<\/li>\r\n        <li>Current First Aid card<\/li>\r\n        <li>Current TB clearance<\/li>\r\n        <li>Professional License (if applicable) (RN, LPN, CNA certificate)<\/li>\r\n      <\/ul><\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"20\">\u00a0<\/td>\r\n      <td>\u00a0<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"30\" colspan=\"2\">If you are offered a position with Kokua Care proof of work eligibility must be presented.<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"20\">\u00a0<\/td>\r\n      <td>\u00a0<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"30\" colspan=\"2\"><ul>\r\n        <li>Identifying Document (i.e. driver's license or ID card)<\/li>\r\n        <li>Employment Eligibility (i.e. US Social Security card<\/li>\r\n      <\/ul><\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"20\">\u00a0<\/td>\r\n      <td>\u00a0<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"30\" colspan=\"2\">You will be placed on conditional employment with our company until the following background checks have been completed.<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"20\">\u00a0<\/td>\r\n      <td>\u00a0<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"30\" colspan=\"2\"><ul>\r\n        <li>Original Criminal Abstract<\/li>\r\n        <li>Original Driving Abstract (only if you drive)<\/li>\r\n        <li>Adult Protective Services (APS) Central Registry Check<\/li>\r\n        <li>Child Welfare Services (CWS) Central Registry Check<\/li>\r\n      <\/ul><\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"20\">\u00a0<\/td>\r\n      <td>\u00a0<\/td>\r\n    <\/tr>\r\n    <tr align=\"left\">\r\n      <td height=\"30\" colspan=\"2\"><em><strong>Thank you for your interest in Kokua Care<\/strong><\/em><\/td>\r\n    <\/tr>\r\n  <\/tbody>\r\n<\/table><\/li>\n<\/ul><br \/><\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-2 verification  \" id=\"vfb-verification-18\"><div class=\"vfb-legend\"><h3>Verification<\/h3><\/div><ul class=\"vfb-section vfb-section-2\"><li class=\"vfb-item vfb-item-secret\"><label for=\"vfb-please-enter-any-two-digits-with-no-spaces-example-12-19\" class=\"vfb-desc\">Please enter any two digits with no spaces (Example: 12) <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"hidden\" name=\"_vfb-secret\" value=\"vfb-19\" \/><input type=\"text\" name=\"vfb-19\" id=\"vfb-please-enter-any-two-digits-with-no-spaces-example-12-19\" value=\"\" class=\"vfb-text  vfb-medium  required  {digits:true,maxlength:2,minlength:2} \" \/><li style=\"display:none;\"><label for=\"vfb-spam\">This box is for spam protection - <strong>please leave it blank<\/strong><\/label><div><input name=\"vfb-spam\" id=\"vfb-spam\" \/><\/div><\/li><li class=\"vfb-item vfb-item-submit\" id=\"vfb-submit-20\">\n\t\t\t\t\t<input type=\"submit\" name=\"visual-form-builder-submit\" id=\"sendmail\" value=\"Submit\" class=\"vfb-submit \" \/>\n\t\t\t\t\t<\/li><\/ul>\n\t\t <\/fieldset><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-9","page","type-page","status-publish","hentry","entry","override"],"_links":{"self":[{"href":"http:\/\/kokuacare.com\/forms\/wp-json\/wp\/v2\/pages\/9","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/kokuacare.com\/forms\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/kokuacare.com\/forms\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/kokuacare.com\/forms\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/kokuacare.com\/forms\/wp-json\/wp\/v2\/comments?post=9"}],"version-history":[{"count":3,"href":"http:\/\/kokuacare.com\/forms\/wp-json\/wp\/v2\/pages\/9\/revisions"}],"predecessor-version":[{"id":141,"href":"http:\/\/kokuacare.com\/forms\/wp-json\/wp\/v2\/pages\/9\/revisions\/141"}],"wp:attachment":[{"href":"http:\/\/kokuacare.com\/forms\/wp-json\/wp\/v2\/media?parent=9"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}