File: /var/www/html/wpcurated/wp-content/themes/curatedbkk/apply-career.php
<?php
/* Template Name: Apply Career */
get_header();
// Fetch the career_id from the query string
$career_id = isset($_GET['career_id']) ? intval($_GET['career_id']) : 0;
// Fetch the post details using the ID
if ($career_id && get_post($career_id)) {
// Set up post data
$post = get_post($career_id);
setup_postdata($post);
}
?>
<section class="sub-bnr apply-banner">
<div class="container custom-container">
<div class="content-area">
<div class="title"><?php echo get_the_title($career_id); ?></div>
<div class="tag"><?php echo get_field('location', $career_id); ?></div>
</div>
</div>
<div class="bnt-txt-btm">
<img src="<?php echo get_template_directory_uri(); ?>/img/service-detail-bnr-txt.png" alt="">
</div>
</section>
<div class="apply-outer-wrap">
<div class="container custom-container">
<div class="show-more-button">
<button class="btn">Show More</button>
</div>
</div>
<div class="container custom-container section1" style="display: none;">
<div class="row row-align">
<div class="col-md-12">
<p class="para"><?php echo get_field('job_description', $career_id); ?>
</p>
</div>
</div>
<div class="row row-align">
<div class="col-md-12">
<div class="content">
<h2 class="sub-head">Key <span>Responsibilities:</span></h2>
<?php $responsibilities = get_field('responsibilities', $career_id); echo wp_kses_post($responsibilities); ?>
</div>
</div>
<!-- <div class="col-md-6">
<figure class="img">
<img src="<?php echo get_template_directory_uri(); ?>/img/ap-1.png" alt="">
</figure>
</div> -->
</div>
<div class="row row-align">
<div class="col-md-6">
<div class="box-listing">
<h2 class="sub-head">Qualifications <span>Required:</span></h2>
<?php $qualifications = get_field('qualifications', $career_id); echo wp_kses_post($qualifications); ?>
</div>
</div>
<div class="col-md-6">
<div class="box-listing">
<h2 class="sub-head">What <span>We Offer:</span></h2>
<?php $offer = get_field('offer', $career_id); echo wp_kses_post($offer); ?>
</div>
</div>
</div>
</div>
</div>
<section class="form-sec">
<div class="container custom-container">
<div class="form-outer">
<div class="top-sec">
<div class="form-title">
How to <span>Apply:</span>
</div>
<div class="form-content">
Qualified candidates are invited to submit 3 references, a CV, cover letter, and three
professional references detailing their experience and suitability for the role.
</div>
<div class="form-content">
Applications should be sent to <a href="">deoliveira@curatedmh.com</a>
</div>
<div class="form-content">
Curated Mental Health is an equal opportunity employer, committed to fostering a diverse and
inclusive workplace. We encourage all qualified individuals to apply, regardless of race,
ethnicity, gender, sexual orientation, age, disability, or any other protected status under
applicable laws in New York State. We prioritize creating an environment that promotes
diversity, equity, and inclusion.
</div>
</div>
<div class="form-inner">
<form id="customForm" data-parsley-validate>
<div class="form-header">
<div class="apply-title">Apply for <span class="light-blue">Job</span></div>
<div class="sub-sec">Required <span>*</span></div>
</div>
<div class="formfield-section">
<div class="row mb-3">
<div class="col-md-6">
<label class="form-label">First Name <span>*</span></label>
<input type="text" class="form-control" placeholder="Enter First Name" name="first_name"
required data-parsley-required-message="First Name is required.">
</div>
<div class="col-md-6">
<label class="form-label">Last Name <span>*</span></label>
<input type="text" class="form-control" placeholder="Enter Last Name" name="last_name"
required data-parsley-required-message="Last Name is required.">
</div>
</div>
<div class="row mb-3">
<div class="col-md-6">
<label class="form-label">Email ID <span>*</span></label>
<input type="email" class="form-control" placeholder="Enter Email ID" name="email" required data-parsley-required-message="Email ID is required.">
</div>
<div class="col-md-6">
<label class="form-label">Phone Number <span>*</span></label>
<input
type="tel"
class="form-control"
placeholder="Enter Phone Number"
name="phone_number"
required
data-parsley-required-message="Phone Number is required."
data-parsley-type="digits"
data-parsley-type-message="Please enter a valid phone number.">
</div>
</div>
<div class="row mb-3">
<div class="col-12">
<label class="form-label">Location (City) </label>
<input type="text" class="form-control" placeholder="Enter Location" name="location">
</div>
</div>
<div class="mb-3">
<label class="form-label">Resume/CV <span>*</span></label>
<div class="custom-file-upload">
<input
type="file"
id="resume"
name="resume"
required
data-parsley-required-message="Resume/CV is required."
data-parsley-errors-container="#resume-errors">
<div class="upload-inner">
<div class="upload-ico">
<img src="<?php echo get_template_directory_uri(); ?>/img/upload-ico.png" alt="upload">
</div>
<div class="contents">
<p class="txt" id="file-display">
Drag and Drop file here <span>Choose File</span>
</p>
<p class="file-types">File types: pdf, doc, docx, txt, rtf</p>
</div>
</div>
<!-- Error container for Parsley -->
</div>
<div id="resume-errors" class="parsley-error"></div>
</div>
<script>
document.getElementById('resume').addEventListener('change', function (event) {
const fileInput = event.target;
const fileDisplay = document.getElementById('file-display');
if (fileInput.files.length > 0) {
const fileName = fileInput.files[0].name;
fileDisplay.innerHTML = `Uploaded: <span>${fileName}</span>`;
} else {
fileDisplay.innerHTML = 'Drag and Drop file here <span>Choose File</span>';
}
});
</script>
<div class="cover-letter-sec">
<label for="cover_letter" class="form-label">Cover Letter </label>
<div class="custom-file-upload">
<input type="file" id="cover-letter" name="cover_letter">
<div class="upload-inner">
<div class="upload-ico">
<img src="<?php echo get_template_directory_uri(); ?>/img/upload-ico.png" alt="upload">
</div>
<div class="contents">
<p class="txt" id="cover-letter-display">
Drag and Drop file here <span>Choose File</span>
</p>
<p class="file-types">File types: pdf, doc, docx, txt, rtf</p>
</div>
</div>
</div>
</div>
<script>
document.getElementById('cover-letter').addEventListener('change', function (event) {
const fileInput = event.target;
const fileDisplay = document.getElementById('cover-letter-display');
if (fileInput.files.length > 0) {
const fileName = fileInput.files[0].name;
fileDisplay.innerHTML = `Uploaded: <span>${fileName}</span>`;
} else {
fileDisplay.innerHTML = 'Drag and Drop file here <span>Choose File</span>';
}
});
</script>
<div class="row mb-3 location">
<div class="col-12">
<label class="form-label">LinkedIn Profile </label>
<input type="text" class="form-control" placeholder="Enter LinkedIn Profile"
name="linkedin_profile" >
</div>
</div>
<!-- Questions with Radio Buttons -->
<div class="mb-3 radio-qust">
<label class="form-label">Do you have your Medical Assistant Certification/Diploma?
<span>*</span></label>
<div>
<div class="form-check form-check-inline">
<input
class="form-check-input"
type="radio"
name="medical_certification"
id="medical_cert_yes"
value="yes"
required
data-parsley-required="true"
data-parsley-required-message="Please select an option."
data-parsley-errors-container="#medical-cert-error">
<label class="form-check-label" for="medical_cert_yes">Yes</label>
</div>
<div class="form-check form-check-inline">
<input
class="form-check-input"
type="radio"
name="medical_certification"
id="medical_cert_no"
value="no">
<label class="form-check-label" for="medical_cert_no">No</label>
</div>
<!-- Error container for Parsley -->
<div id="medical-cert-error" style="color: red; font-size: 1em;"></div>
</div>
</div>
<div class="mb-3 radio-qust">
<label class="form-label">Can you work the following hours & shift: Full Time 40 hour work
week (4 x 10's - four 10 hour days) with occasional availability to stay after 5pm for
closing shifts? <span>*</span></label>
<div>
<div class="form-check form-check-inline">
<input
class="form-check-input"
type="radio"
name="work_hours"
id="work_hours_yes"
value="Yes"
required
data-parsley-required="true"
data-parsley-required-message="Please select an option."
data-parsley-errors-container="#work-hours-error">
<label class="form-check-label" for="work_hours_yes">Yes</label>
</div>
<div class="form-check form-check-inline">
<input
class="form-check-input"
type="radio"
name="work_hours"
id="work_hours_no"
value="No">
<label class="form-check-label" for="work_hours_no">No</label>
</div>
<!-- Error container for Parsley -->
<div id="work-hours-error" style="color: red; font-size: 1em;"></div>
</div>
</div>
<div class="mb-3 radio-sec radio-qust">
<label class="form-label">Will you need sponsorship to continue or extend your current work
authorization status? <span>*</span></label>
<div>
<div class="form-check form-check-inline">
<input
class="form-check-input"
type="radio"
name="sponsorship"
id="sponsorship_yes"
value="Yes"
required
data-parsley-required="true"
data-parsley-required-message="Please select an option."
data-parsley-errors-container="#sponsorship-error">
<label class="form-check-label" for="sponsorship_yes">Yes</label>
</div>
<div class="form-check form-check-inline">
<input
class="form-check-input"
type="radio"
name="sponsorship"
id="sponsorship_no"
value="No">
<label class="form-check-label" for="sponsorship_no">No</label>
</div>
<!-- Error container for Parsley -->
<div id="sponsorship-error" style="color: red; font-size: 1em;"></div>
</div>
</div>
<div class="checkbox-sec">
<div class="sub-content">
<span class="bold">U.S. Standard Demographic Questions</span> We invite applicants to share their demographic
background. If you choose to complete this survey, your responses may be used to
identify areas of improvement in our hiring process.
</div>
<!-- Checkbox Question -->
<div class="mb-3">
<div class="chk-inner">
<label class="form-label">How would you describe your gender identity? (mark all
that apply)</label>
<div class="check-box-inner">
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="gender_identity[]"
id="gender_man" value="Man">
<label class="form-check-label" for="gender_man">Man</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="gender_identity[]"
id="gender_self_describe" value="I prefer to
self-describe">
<label class="form-check-label" for="gender_self_describe">I prefer to
self-describe</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="gender_identity[]"
id="gender_non_binary" value="Non-binary">
<label class="form-check-label"
for="gender_non_binary">Non-binary</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="gender_identity[]"
id="gender_women" value="I don't wish to
answer">
<label class="form-check-label" for="gender_women">I don't wish to
answer</label>
</div>
</div>
</div>
</div>
<div class="chk-inner">
<label class="form-label">How would you describe your racial/ethnic background?
(mark all that apply)</label>
<div class="check-box-inner">
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racial1" value="Black or of African
descent">
<label class="form-check-label" for="racial1">Black or of African
descent</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia2" value="Middle
Eastern or North African">
<label class="form-check-label" for="racia2">Middle
Eastern or North African</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia3" value="Native
Hawaiian or Pacific Islander">
<label class="form-check-label" for="racia3">Native
Hawaiian or Pacific Islander</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia4" value="I prefer to
self-describe">
<label class="form-check-label" for="racia4">I prefer to
self-describe</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia5" value="East
Asian">
<label class="form-check-label" for="racia5">East
Asian</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia6" value="South Asian">
<label class="form-check-label" for="racia6">South Asian</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia7" value="Southeast
Asian">
<label class="form-check-label" for="racia7">Southeast
Asian</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia8" value="I don't wish to
answer">
<label class="form-check-label" for="racia8">I don't wish to
answer</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia9" value="Hispanic, Latinx
or of Spanish Origin">
<label class="form-check-label" for="racia9">Hispanic, Latinx
or of Spanish Origin</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia10" value="Indigenous,
American Indian or Alaska Native">
<label class="form-check-label" for="racia10">Indigenous,
American Indian or Alaska Native</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="racial[]"
id="racia11" value="White or Europeanr">
<label class="form-check-label" for="racia11">
White or Europeanr</label>
</div>
</div>
</div>
</div>
<div class="chk-inner">
<label class="form-label">How would you describe your sexual orientation? (mark all
that apply)</label>
<div class="check-box-inner">
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="orientation[]"
id="orientation1" value="Asexual">
<label class="form-check-label" for="orientation1">Asexual</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="orientation[]"
id="orientation2" value="Heterosexual">
<label class="form-check-label"
for="orientation2">Heterosexual</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="orientation[]"
id="orientation3" value="I prefer to
self-describe">
<label class="form-check-label" for="orientation3">I prefer to
self-describe</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="orientation[]"
id="orientation4" value="Bisexual and/or
pansexual">
<label class="form-check-label" for="orientation4">Bisexual and/or
pansexual</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="orientation[]"
id="orientation5" value="Lesbian">
<label class="form-check-label" for="orientation5">Lesbian</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="orientation[]"
id="orientation6" value="I don't wish to
answer">
<label class="form-check-label" for="orientation6">I don't wish to
answer</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="orientation[]"
id="orientation7" value="Gay">
<label class="form-check-label" for="orientation7">Gay</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="orientation[]"
id="orientation8" value="Queer">
<label class="form-check-label" for="orientation8">Queer</label>
</div>
</div>
</div>
</div>
<div class="chk-inner">
<label class="form-label">Do you identify as transgender? (Select one)</label>
<div class="check-box-inner">
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="identify[]"
id="identify1" value="Yes">
<label class="form-check-label" for="identify1">Yes
</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="identify[]"
id="identify2" value="No">
<label class="form-check-label" for="identify2">No</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="identify[]"
id="identify3" value="I don't wish to
answer">
<label class="form-check-label" for="identify3">I don't wish to
answer</label>
</div>
</div>
</div>
</div>
<div class="chk-inner">
<label class="form-label"> Do you have a disability or chronic condition (physical,
visual, auditory, cognitive, mental, emotional, or other) that
substantially limits one or more of your major life activities, including
mobility, communication (seeing, hearing,
speaking), and learning? (Select one)</label>
<div class="check-box-inner">
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="chronic_condition[]"
id="chronic_condition1" value="Yes">
<label class="form-check-label" for="chronic_condition1">Yes
</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="chronic_condition[]"
id="chronic_condition2" value="No">
<label class="form-check-label" for="chronic_condition2">No</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="chronic_condition[]"
id="chronic_condition3" value="I don't wish to
answer">
<label class="form-check-label" for="chronic_condition3">I don't wish to
answer</label>
</div>
</div>
</div>
</div>
<div class="chk-inner">
<label class="form-label"> Are you a veteran or active member of the United States
Armed Forces? (Select one)</label>
<div class="check-box-inner">
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="armed_forces[]"
id="armed_forces1" value="Yes, I am a veteran or
active member">
<label class="form-check-label" for="armed_forces1">Yes, I am a veteran or
active member
</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="armed_forces[]"
id="armed_forces2" value="I don't wish to answer">
<label class="form-check-label" for="armed_forces2">I don't wish to answer
</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="armed_forces[]"
id="armed_forces3" value="I prefer to
self-describe">
<label class="form-check-label" for="armed_forces3">I prefer to
self-describe</label>
</div>
</div>
<div class="boxes">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="armed_forces[]"
id="armed_forces4" value="No, I am not a
veteran or active member">
<label class="form-check-label" for="armed_forces4">No, I am not a
veteran or active member</label>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="border"></div>
<div class="form-content-section-wrap">
<div class="row">
<div class="col-12">
<h2 class="sub-head">
Voluntary <span>Self-Identification</span>
</h2>
<p class="para">For government reporting purposes, we ask candidates to respond to the
below self-identification survey. Completion of the form is entirely voluntary.
Whatever your decision, it will not be considered in the hiring process or
thereafter. Any information that you do provide will be recorded and maintained in a
confidential file.</p>
<p class="para">As set forth in Tia’s Equal Employment Opportunity policy, we do not
discriminate on the basis of any protected group status under any applicable law.
</p>
</div>
</div>
<div class="row select-row">
<div class="col-md-6">
<div class="seclect-wrap">
<label class="form-label">Gender</label>
<select class="form-select" name="gender">
<option elected="selected">Select Gender</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
<option value="Decline To Self Identify">Decline To Self Identify</option>
</select>
</div>
</div>
<div class="col-md-6">
<div class="seclect-wrap">
<label class="form-label">Are you Hispanic/Latino? </label>
<select class="form-select" name="hispanic">
<option selected> Please Select</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
<option value="Decline To Self Identify">Decline To Self Identify</option>
</select>
</div>
</div>
<div class="col-12">
<div class="btn-wrap">
<a class="btn" href="https://boards.cdn.greenhouse.io/docs/RaceEthnicityDefinitions.pdf" target="_blank">
<span>Race & Ethnicity Definitions</span>
<svg class="icon" viewBox="0 0 16 15" fill="none"
xmlns="http://www.w3.org/2000/svg">
<path d="M15 7.369H1m14 0-6 5.684m6-5.684L9 1.684" stroke="#fff"
stroke-width="2" stroke-linecap="round" stroke-linejoin="round"></path>
</svg>
</a>
</div>
</div>
</div>
<div class="row">
<div class="col-12">
<p class="para">If you believe you belong to any of the categories of protected veterans
listed below, please indicate by making the appropriate selection. As a government
contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA),
we request this information in order to measure the effectiveness of the outreach
and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of
protected categories is as follows:</p>
<p class="para">A "disabled veteran" is one of the following: a veteran of the U.S.
military, ground, naval or air service who is entitled to compensation (or who but
for the receipt of military retired pay would be entitled to compensation) under
laws administered by the Secretary of Veterans Affairs; or a person who was
discharged or released from active duty because of a service-connected disability.
</p>
<p class="para">A "recently separated veteran" means any veteran during the three-year
period beginning on the date of such veteran's discharge or release from active duty
in the U.S. military, ground, naval, or air service.</p>
<p class="para">An "active duty wartime or campaign badge veteran" means a veteran who
served on active duty in the U.S. military, ground, naval or air service during a
war, or in a campaign or expedition for which a campaign badge has been authorized
under the laws administered by the Department of Defense.</p>
<p class="para">An "Armed forces service medal veteran" means a veteran who, while
serving on active duty in the U.S. military, ground, naval or air service,
participated in a United States military operation for which an Armed Forces service
medal was awarded pursuant to Executive Order 12985.</p>
</div>
</div>
<div class="row select-row">
<div class="col-12">
<div class="seclect-wrap">
<label class="form-label">Veteran Status</label>
<select class="form-select" name="veteran">
<option value="0" selected="selected">Please Select</option>
<option value="I am not a protected veteran">I am not a protected veteran</option>
<option value="I identify as one or more of the classifications of a protected veteran">I identify as one or more of the classifications of a protected veteran</option>
<option value="I don't wish to answer">I don't wish to answer</option>
</select>
</div>
</div>
</div>
</div>
<div class="form-content-section-wrap">
<div class="row">
<div class="col-12">
<h2 class="sub-head">
Voluntary <span>Self-Identification of Disability</span>
</h2>
<div class="id-wrap">
<div class="row">
<div class="col-md-5 left-col">
<div class="id-content">
<svg viewBox="0 0 57 57" fill="none" xmlns="http://www.w3.org/2000/svg">
<circle cx="28.5" cy="28.5" r="28" fill="white" stroke="#BDD9FF" />
<path
d="M36.107 23.7504V37.6465C36.107 38.393 35.5 39 34.7535 39H22.252C21.5055 39 20.8984 38.393 20.8984 37.6465V19.3535C20.8984 18.607 21.5055 18 22.252 18H30.3566L36.107 23.7504Z"
fill="#014CB2" />
<path d="M25.6719 28.5703H32.3902V29.4357H25.6719V28.5703Z"
fill="white" />
<path
d="M24.1441 29.4846C24.4114 29.4846 24.6281 29.2679 24.6281 29.0006C24.6281 28.7333 24.4114 28.5166 24.1441 28.5166C23.8768 28.5166 23.6602 28.7333 23.6602 29.0006C23.6602 29.2679 23.8768 29.4846 24.1441 29.4846Z"
fill="white" />
<path d="M25.6719 31.0312H32.3902V31.8967H25.6719V31.0312Z"
fill="white" />
<path
d="M24.1441 31.9455C24.4114 31.9455 24.6281 31.7288 24.6281 31.4615C24.6281 31.1942 24.4114 30.9775 24.1441 30.9775C23.8768 30.9775 23.6602 31.1942 23.6602 31.4615C23.6602 31.7288 23.8768 31.9455 24.1441 31.9455Z"
fill="white" />
<path d="M25.6719 33.4922H32.3902V34.3576H25.6719V33.4922Z"
fill="white" />
<path
d="M24.1441 34.4064C24.4114 34.4064 24.6281 34.1898 24.6281 33.9225C24.6281 33.6552 24.4114 33.4385 24.1441 33.4385C23.8768 33.4385 23.6602 33.6552 23.6602 33.9225C23.6602 34.1898 23.8768 34.4064 24.1441 34.4064Z"
fill="white" />
<path opacity="0.19"
d="M31.1406 23.5535L36.1076 27.5771V23.7996L33.2898 22.1631L31.1406 23.5535Z"
fill="black" />
<path
d="M36.1098 23.7504H31.7129C30.9664 23.7504 30.3594 23.1434 30.3594 22.3969V18L36.1098 23.7504Z"
fill="#ABCFFF" />
</svg>
<div class="txt">
Form CC-305
<span>Page 1 of 1</span>
</div>
</div>
</div>
<div class="col-md-7">
<div class="id-content">
<svg viewBox="0 0 57 57" fill="none" xmlns="http://www.w3.org/2000/svg">
<circle cx="28.5" cy="28.5" r="28" fill="white" stroke="#BDD9FF" />
<path
d="M23.9676 21.3009V19.7471C23.9676 19.3387 24.3063 19 24.7146 19C25.123 19 25.4617 19.3387 25.4617 19.7471V21.2412H31.9362V19.7471C31.9362 19.3387 32.2749 19 32.6833 19C33.0917 19 33.4303 19.3387 33.4303 19.7471V21.3009C36.1198 21.55 37.4246 23.1537 37.6238 25.5343C37.6438 25.8232 37.4047 26.0622 37.1258 26.0622H20.2721C19.9833 26.0622 19.7442 25.8132 19.7741 25.5343C19.9733 23.1537 21.2782 21.55 23.9676 21.3009Z"
fill="#014CB2" />
<path
d="M20.7307 27.5557H36.668C37.2158 27.5557 37.6641 28.0039 37.6641 28.5518V34.6876C37.6641 37.6759 36.1699 39.668 32.6837 39.668H24.715C21.2287 39.668 19.7346 37.6759 19.7346 34.6876V28.5518C19.7346 28.0039 20.1828 27.5557 20.7307 27.5557ZM31.4784 35.8929C31.5282 35.9327 31.578 35.9825 31.6278 36.0124C31.6876 36.0522 31.7473 36.0821 31.8071 36.1021C31.8669 36.1319 31.9266 36.1519 31.9864 36.1618C32.0561 36.1718 32.1159 36.1817 32.1856 36.1817C32.3151 36.1817 32.4446 36.1519 32.5641 36.1021C32.6936 36.0523 32.7932 35.9825 32.8928 35.8929C33.0721 35.7036 33.1817 35.4446 33.1817 35.1857C33.1817 34.9267 33.0721 34.6677 32.8928 34.4784C32.7932 34.3888 32.6936 34.3191 32.5641 34.2693C32.3848 34.1896 32.1856 34.1697 31.9864 34.2095C31.9266 34.2195 31.8669 34.2394 31.8071 34.2693C31.7473 34.2892 31.6876 34.3191 31.6278 34.3589L31.4784 34.4784C31.2991 34.6677 31.1895 34.9267 31.1895 35.1857C31.1895 35.4446 31.2991 35.7036 31.4784 35.8929ZM31.4784 32.4066C31.6677 32.5859 31.9266 32.6955 32.1856 32.6955C32.4446 32.6955 32.7036 32.5859 32.8928 32.4066C33.0721 32.2173 33.1817 31.9584 33.1817 31.6994C33.1817 31.4404 33.0721 31.1814 32.8928 30.9922C32.6139 30.7133 32.1757 30.6236 31.8071 30.783C31.6776 30.8328 31.568 30.9025 31.4784 30.9922C31.2991 31.1814 31.1895 31.4404 31.1895 31.6994C31.1895 31.9584 31.2991 32.2173 31.4784 32.4066ZM27.9921 35.8929C28.1814 36.0722 28.4403 36.1817 28.6993 36.1817C28.9583 36.1817 29.2173 36.0722 29.4065 35.8929C29.5858 35.7036 29.6954 35.4446 29.6954 35.1857C29.6954 34.9267 29.5858 34.6677 29.4065 34.4784C29.038 34.1099 28.3607 34.1099 27.9921 34.4784C27.8128 34.6677 27.7032 34.9267 27.7032 35.1857C27.7032 35.4446 27.8128 35.7036 27.9921 35.8929ZM27.9921 32.4066C28.0419 32.4464 28.0917 32.4863 28.1415 32.5261C28.2013 32.566 28.2611 32.5958 28.3208 32.6158C28.3806 32.6457 28.4403 32.6656 28.5001 32.6755C28.5698 32.6855 28.6296 32.6955 28.6993 32.6955C28.9583 32.6955 29.2173 32.5859 29.4065 32.4066C29.5858 32.2173 29.6954 31.9584 29.6954 31.6994C29.6954 31.4404 29.5858 31.1814 29.4065 30.9922C29.3169 30.9025 29.2073 30.8328 29.0778 30.783C28.7093 30.6236 28.271 30.7133 27.9921 30.9922C27.8128 31.1814 27.7032 31.4404 27.7032 31.6994C27.7032 31.9584 27.8128 32.2173 27.9921 32.4066ZM24.5058 35.8929C24.6951 36.0722 24.9541 36.1817 25.213 36.1817C25.472 36.1817 25.731 36.0722 25.9203 35.8929C26.0996 35.7036 26.2091 35.4446 26.2091 35.1857C26.2091 34.9267 26.0996 34.6677 25.9203 34.4784C25.5517 34.1099 24.8744 34.1099 24.5058 34.4784C24.3265 34.6677 24.217 34.9267 24.217 35.1857C24.217 35.4446 24.3265 35.7036 24.5058 35.8929ZM24.5058 32.4066C24.5556 32.4464 24.6054 32.4863 24.6552 32.5261C24.715 32.566 24.7748 32.5958 24.8345 32.6158C24.8943 32.6457 24.9541 32.6656 25.0138 32.6755C25.0836 32.6855 25.1533 32.6955 25.213 32.6955C25.472 32.6955 25.731 32.5859 25.9203 32.4066C26.0996 32.2173 26.2091 31.9584 26.2091 31.6994C26.2091 31.4404 26.0996 31.1814 25.9203 30.9922C25.8207 30.9025 25.721 30.8328 25.5916 30.783C25.4123 30.7033 25.213 30.6834 25.0138 30.7232C24.9541 30.7332 24.8943 30.7531 24.8345 30.783C24.7748 30.8029 24.715 30.8328 24.6552 30.8726C24.6054 30.9125 24.5556 30.9523 24.5058 30.9922C24.3265 31.1814 24.217 31.4404 24.217 31.6994C24.217 31.9584 24.3265 32.2173 24.5058 32.4066Z"
fill="#014CB2" />
</svg>
<div class="txt">
OMB Control Number 1250-0005
<span>Expires 04/30/2026</span>
</div>
</div>
</div>
</div>
</div>
<h3 class="sub-sub-head">Why are you being asked to complete this form?</h3>
<p class="para">We are a federal contractor or subcontractor. The law requires us to
provide equal employment opportunity to qualified people with disabilities. We have
a goal of having at least 7% of our workers as people with disabilities. The law
says we must measure our progress towards this goal. To do this, we must ask
applicants and employees if they have a disability or have ever had one. People can
become disabled, so we need to ask this question at least every five years.</p>
<p class="para">Completing this form is voluntary, and we hope that you will choose to
do so. Your answer is confidential. No one who makes hiring decisions will see it.
Your decision to complete the form and your answer will not harm you in any way. If
you want to learn more about the law or this form, visit the U.S. Department of
Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at
www.dol.gov/ofccp.</p>
<h3 class="sub-sub-head">How do you know if you have a disability?</h3>
<p class="para">A disability is a condition that substantially limits one or more of
your “major life activities.” If you have or have ever had such a condition, you are
a person with a disability. Disabilities include, but are not limited to:</p>
</div>
</div>
<div class="row">
<div class="col-md-6">
<ul class="listing">
<li>Alcohol or other substance use disorder (not currently using drugs illegally)
</li>
<li>Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis,
HIV/AIDS</li>
<li>Blind or low vision</li>
<li>Cancer (past or present)</li>
<li>Cardiovascular or heart disease</li>
<li>Celiac disease</li>
<li>Cerebral palsy</li>
<li>Deaf or serious difficulty hearing</li>
<li>Diabetes</li>
<li>Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or
congenital disorders</li>
<li>Epilepsy or other seizure disorder</li>
<li>Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel
syndrome</li>
</ul>
</div>
<div class="col-md-6">
<ul class="listing">
<li>Intellectual or developmental disability</li>
<li>Mental health conditions, for example, depression, bipolar disorder, anxiety
disorder, schizophrenia, PTSD</li>
<li>Missing limbs or partially missing limbs</li>
<li>Mobility impairment, benefiting from the use of a wheelchair, scooter, walker,
leg brace(s) and/or other supports</li>
<li>Nervous system condition, for example, migraine headaches, Parkinson’s disease,
multiple sclerosis (MS)</li>
<li>Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD),
autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities</li>
<li>Partial or complete paralysis (any cause)</li>
<li>Pulmonary or respiratory conditions, for example, tuberculosis, asthma,
emphysema</li>
<li>Short stature (dwarfism)</li>
<li>Traumatic brain injury</li>
</ul>
</div>
</div>
<div class="row select-row">
<div class="col-12">
<div class="seclect-wrap">
<label class="form-label">Disability Status</label>
<select class="form-select" name="disability_status">
<option value="0" selected="selected">Please Select</option>
<option value="Yes, I have a disability, or have had one in the past">Yes, I have a disability, or have had one in the past</option>
<option value="No, I do not have a disability and have not had one in the past">No, I do not have a disability and have not had one in the past</option>
<option value="I do not want to answer">I do not want to answer</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<p class="para">PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of
1995 no persons are required to respond to a collection of information unless such
collection displays a valid OMB control number. This survey should take about 5
minutes to complete.</p>
</div>
</div>
</div>
<div class="powered-wrap">
<div class="row align-row">
<div class="col-md-6">
</div>
<div class="col-md-6">
<div class="btn-wrap">
<div id="successAlert" class="alert alert-success" role="alert" style="text-align: center;display:none;"></div>
<div id="dangerAlert" class="alert alert-danger" role="alert" style="text-align: center;display:none;"></div>
</div>
</div>
</div>
<div class="row align-row">
<div class="col-md-6">
<div class="txt">Powered by <a href='#'>NEX-Forms</a></div>
</div>
<div class="col-md-6">
<div class="btn-wrap">
<button class="btn apply-btn" type="submit">
<span>Submit Application</span>
<svg class="icon" viewBox="0 0 16 15" fill="none"
xmlns="http://www.w3.org/2000/svg">
<path d="M15 7.369H1m14 0-6 5.684m6-5.684L9 1.684" stroke="#fff"
stroke-width="2" stroke-linecap="round" stroke-linejoin="round"></path>
</svg>
</button>
</div>
</div>
</div>
</div>
</form>
</div>
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</section>
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