{"id":44,"date":"2012-09-07T22:55:47","date_gmt":"2012-09-08T03:55:47","guid":{"rendered":"https:\/\/acthomehealthservices.com\/wordpress\/?page_id=44"},"modified":"2024-10-22T00:09:50","modified_gmt":"2024-10-22T05:09:50","slug":"careers","status":"publish","type":"page","link":"https:\/\/acthomehealthservices.com\/dev\/careers\/","title":{"rendered":"Careers"},"content":{"rendered":"<p><section id=\"bt_section69eb79841bfda\"  class=\"boldSection btDivider topSemiSpaced bottomSemiSpaced btDarkSkin gutter inherit wBackground cover\" style=\"background-color:rgb(0,0,153);background-image:url('https:\/\/acthomehealthservices.com\/dev\/wp-content\/uploads\/2015\/12\/bgn-grad.png');\"><div class=\"port\"><div class=\"boldCell\"><div class=\"boldCellInner\"><div class=\"boldRow  \" ><div class=\"boldRowInner\"><div class=\"rowItem col-md-12 col-ms-12  btTextLeft animate animate-fadein animate-moveleft inherit\"  ><div class=\"rowItemContent\" ><div class=\"btClear btSeparator topExtraSmallSpaced noBorder\" ><hr><\/div><div class=\"btClear btSeparator topExtraSmallSpaced noBorder\" ><hr><\/div><header class=\"header btClear large  btNormalDash\" ><div class=\"dash\"><h2><span class=\"headline\">Careers<\/span><\/h2><\/div><\/header><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section id=\"bt_section69eb79841c1c4\"  class=\"boldSection topSpaced bottomSmallSpaced gutter inherit\" ><div class=\"port\"><div class=\"boldCell\"><div class=\"boldCellInner\"><div class=\"boldRow  \" ><div class=\"boldRowInner\"><div class=\"rowItem col-md-12 col-ms-12  btTextLeft animate animate-fadein animate-moveleft inherit\"  ><div class=\"rowItemContent\" ><div class=\"bpgPhoto btTextCenter\" ><div class=\"btImage\"><img decoding=\"async\" src=\"https:\/\/acthomehealthservices.com\/dev\/wp-content\/uploads\/2024\/10\/CAREERS-PHOTO-1.jpg\" alt=\"career\" title=\"career\"><\/div><\/div><div class=\"btClear btSeparator bottomSemiSpaced noBorder\" ><hr><\/div><\/div><\/div><\/div><\/div><div class=\"boldRow  \" ><div class=\"boldRowInner\"><div class=\"rowItem col-md-12 col-ms-12  btTextLeft animate animate-fadein inherit\"  ><div class=\"rowItemContent\" ><div class=\"btText\" ><\/p>\n<p><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script><\/p>\n<div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' 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id='gf_page_steps_6' class='gf_page_steps'>\n<div id='gf_step_6_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Application Form<\/span><\/div>\n<div id='gf_step_6_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Availability and Preferences<\/span><\/div>\n<div id='gf_step_6_3' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>HR Requirements<\/span><\/div>\n<\/div>\n<div class='gform-body gform_body'>\n<div id='gform_page_6_1' class='gform_page ' data-js='page-field-id-1' >\n<div class='gform_page_fields'>\n<ul id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below validation_below'>\n<li id=\"field_6_1\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_1\" >\n<p><strong>ACT HOME HEALTH SERVICES, INC. (ACT)<\/strong> is an Equal Employment Opportunity Employer. ACT complies with all federal, state and local laws that prohibit discrimination. Employment actions are made without regard to race, sex (including sexual orientation, gender identity, pregnancy), color, national origin, ancestry, religious creed, handicap, age or genetic information.<\/p>\n<\/li>\n<li id=\"field_6_2\" class=\"gfield gfield--type-name gfield--input-type-name gf_left_half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_2\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_complex ginput_container ginput_container--name no_prefix no_first_name no_middle_name has_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_6_2'>\n<p>                            <span id='input_6_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' ><br \/>\n                                                    <input type='text' name='input_2.6' id='input_6_2_6' value=''   aria-required='true'     \/><br \/>\n                                                    <label for='input_6_2_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label><br \/>\n                                                <\/span><\/p><\/div>\n<\/li>\n<li id=\"field_6_3\" class=\"gfield gfield--type-name gfield--input-type-name gf_right_half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_3\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_6_3'>\n<p>                            <span id='input_6_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' ><br \/>\n                                                    <input type='text' name='input_3.3' id='input_6_3_3' value=''   aria-required='true'     \/><br \/>\n                                                    <label for='input_6_3_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label><br \/>\n                                                <\/span><\/p><\/div>\n<\/li>\n<li id=\"field_6_4\" class=\"gfield gfield--type-name gfield--input-type-name gf_left_half field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_4\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Middle Initial<\/label>\n<div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_6_4'>\n<p>                            <span id='input_6_4_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' ><br \/>\n                                                    <input type='text' name='input_4.3' id='input_6_4_3' value=''   aria-required='false'     \/><br \/>\n                                                    <label for='input_6_4_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label><br \/>\n                                                <\/span><\/p><\/div>\n<\/li>\n<li id=\"field_6_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_5\" ><label class='gfield_label gform-field-label' for='input_6_5'>Mobile Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_phone'><input name='input_5' id='input_6_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div>\n<\/li>\n<li id=\"field_6_6\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_6\" ><label class='gfield_label gform-field-label' for='input_6_6'>Street  Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_6' id='input_6_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_7\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_7\" ><label class='gfield_label gform-field-label' for='input_6_7'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_7' id='input_6_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_105\" class=\"gfield gfield--type-select gfield--input-type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_105\" ><label class='gfield_label gform-field-label' for='input_6_105'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_select'><select name='input_105' id='input_6_105' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='AK' >AK<\/option><option value='AL' >AL<\/option><option value='AR' >AR<\/option><option value='AZ' >AZ<\/option><option value='CA' >CA<\/option><option value='CO' >CO<\/option><option value='CT' >CT<\/option><option value='DE' >DE<\/option><option value='FL' >FL<\/option><option value='GA' >GA<\/option><option value='HI' >HI<\/option><option value='IA' >IA<\/option><option value='ID' >ID<\/option><option value='IL' >IL<\/option><option value='IN' >IN<\/option><option value='KS' >KS<\/option><option value='KY' >KY<\/option><option value='LA' >LA<\/option><option value='MA' >MA<\/option><option value='MD' >MD<\/option><option value='ME' >ME<\/option><option value='MI' >MI<\/option><option value='MN' >MN<\/option><option value='MO' >MO<\/option><option value='MS' >MS<\/option><option value='MT' >MT<\/option><option value='NC' >NC<\/option><option value='ND' >ND<\/option><option value='NE' >NE<\/option><option value='NH' >NH<\/option><option value='NJ' >NJ<\/option><option value='NM' >NM<\/option><option value='NV' >NV<\/option><option value='NY' >NY<\/option><option value='OH' >OH<\/option><option value='OK' >OK<\/option><option value='OR' >OR<\/option><option value='PA' >PA<\/option><option value='RI' >RI<\/option><option value='SC' >SC<\/option><option value='SD' >SD<\/option><option value='TN' >TN<\/option><option value='TX' >TX<\/option><option value='UT' >UT<\/option><option value='VA' >VA<\/option><option value='VT' >VT<\/option><option value='WA' >WA<\/option><option value='WI' >WI<\/option><option value='WV' >WV<\/option><option value='WY' >WY<\/option><\/select><\/div>\n<\/li>\n<li id=\"field_6_8\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_8\" ><label class='gfield_label gform-field-label' for='input_6_8'>Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_8' id='input_6_8' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_9\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_9\" ><label class='gfield_label gform-field-label' for='input_6_9'>Other Phone<\/label>\n<div class='ginput_container ginput_container_phone'><input name='input_9' id='input_6_9' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div>\n<\/li>\n<li id=\"field_6_100\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_100\" ><label class='gfield_label gform-field-label' for='input_6_100'>Other Name under which you were employed<\/label>\n<div class='ginput_container ginput_container_text'><input name='input_100' id='input_6_100' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_11\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_11\" ><label class='gfield_label gform-field-label' for='input_6_11'>Position Applying For<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_11' id='input_6_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_12\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_12\" ><label class='gfield_label gform-field-label' for='input_6_12'>Acceptable  Salary Rate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_12' id='input_6_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_13\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_13\" ><label class='gfield_label gform-field-label' for='input_6_13'>Social Security Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_13' id='input_6_13' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_14\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_14\" ><label class='gfield_label gform-field-label' for='input_6_14'>How did you find out about ACT<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_14' id='input_6_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_15\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_15\" ><label class='gfield_label gform-field-label' for='input_6_15'>When can you start ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_15' id='input_6_15' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_16\" class=\"gfield gfield--type-email gfield--input-type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_16\" ><label class='gfield_label gform-field-label' for='input_6_16'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_email'>\n                            <input name='input_16' id='input_6_16' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div>\n<\/li>\n<li id=\"field_6_17\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_17\" >\n<h4>Emergency Contact <\/h4>\n<\/li>\n<li id=\"field_6_18\" class=\"gfield gfield--type-name gfield--input-type-name gf_left_half field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_18\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<\/label>\n<div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_6_18'>\n<p>                            <span id='input_6_18_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' ><br \/>\n                                                    <input type='text' name='input_18.3' id='input_6_18_3' value=''   aria-required='false'     \/><br \/>\n                                                    <label for='input_6_18_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label><br \/>\n                                                <\/span><\/p><\/div>\n<\/li>\n<li id=\"field_6_19\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_19\" ><label class='gfield_label gform-field-label' for='input_6_19'>Relationship<\/label>\n<div class='ginput_container ginput_container_text'><input name='input_19' id='input_6_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_20\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_20\" ><label class='gfield_label gform-field-label' for='input_6_20'>Address<\/label>\n<div class='ginput_container ginput_container_text'><input name='input_20' id='input_6_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_21\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_21\" ><label class='gfield_label gform-field-label' for='input_6_21'>Telephone<\/label>\n<div class='ginput_container ginput_container_phone'><input name='input_21' id='input_6_21' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div>\n<\/li>\n<li id=\"field_6_22\" class=\"gfield gfield--type-email gfield--input-type-email gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_22\" ><label class='gfield_label gform-field-label' for='input_6_22'>Emergency Email<\/label>\n<div class='ginput_container ginput_container_email'>\n                            <input name='input_22' id='input_6_22' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div>\n<\/li>\n<li id=\"field_6_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_23\" ><label class='gfield_label gform-field-label' for='input_6_23'>Are you a U.S Citizen or are you authorized to work in the U.S. ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_select'><select name='input_23' id='input_6_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div>\n<\/li>\n<li id=\"field_6_24\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_24\" >\n<p>Note : Verification of U.S. Citizenship or U.S. Employment Authorization will be required upon the commencement of your engagement. <\/p>\n<\/li>\n<\/ul>\n<fieldset class=\"gfieldset gform_fieldset_begin gform_fieldset \">\n<legend class=\"gfieldset-legend\">Education Section<\/legend>\n<ul class=\"gform_fields top_label form_sublabel_below description_below validation_below\">\n<li id=\"field_6_85\" class=\"gfield gfield--type-list gfield--input-type-list education-fields-listing gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_85\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Education and Training received<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><br \/>\n<style type=\"text\/css\">\n<p>\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons {\n\t\t\t\t\t\t\tvertical-align: middle !important;\n\t\t\t\t\t\t}<\/p>\n<p>\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img {\n\t\t\t\t\t\t\tbackground-color: transparent !important;\n\t\t\t\t\t\t\tbackground-position: 0 0;\n\t\t\t\t\t\t\tbackground-size: 16px 16px !important;\n\t\t\t\t\t\t\tbackground-repeat: no-repeat;\n\t\t\t\t\t\t\tborder: none !important;\n\t\t\t\t\t\t\twidth: 16px !important;\n\t\t\t\t\t\t\theight: 16px !important;\n\t\t\t\t\t\t\topacity: 0.5;\n\t\t\t\t\t\t\ttransition: opacity .5s ease-out;\n\t\t\t\t\t\t    -moz-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -webkit-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -o-transition: opacity .5s ease-out;\n\t\t\t\t\t\t}<\/p>\n<p>\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons a:hover img {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}<\/p>\n<\/style>\n<div class='ginput_container ginput_container_list ginput_list'>\n<table class='gfield_list gfield_list_container'>\n<colgroup>\n<col id='gfield_list_85_col_1' class='gfield_list_col_odd' \/>\n<col id='gfield_list_85_col_2' class='gfield_list_col_even' \/>\n<col id='gfield_list_85_col_3' class='gfield_list_col_odd' \/>\n<col id='gfield_list_85_col_4' class='gfield_list_col_even' \/>\n<col id='gfield_list_85_col_5' class='gfield_list_col_odd' \/>\n<col id='gfield_list_85_col_6' class='gfield_list_col_even' \/><\/colgroup>\n<thead>\n<tr>\n<th scope=\"col\">School\/Training<\/th>\n<th scope=\"col\">Dates Attended From<\/th>\n<th scope=\"col\">Dates Attended To<\/th>\n<th scope=\"col\">Graduated<\/th>\n<th scope=\"col\">Subjects Studied \/Degree Received<\/th>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class='gfield_list_row_odd gfield_list_group'>\n<td class='gfield_list_cell gfield_list_85_cell1' data-label='School\/Training'><input aria-invalid='false' aria-required=\"true\"  aria-label='School\/Training, Row 1' data-aria-label-template='School\/Training, Row {0}' type='text' name='input_85[]' value=''   \/><\/td>\n<td class='gfield_list_cell gfield_list_85_cell2' data-label='Dates Attended From'><input class='datepicker_with_icon datepicker mdy ' aria-invalid='false' aria-required=\"true\"  aria-label='Dates Attended From, Row 1' data-aria-label-template='Dates Attended From, Row {0}' type='text' name='input_85[]' value=''   \/><input id='gforms_calendar_icon_input_6_85_2' class='gform_hidden' type='hidden' value='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/calendar.png'  \/><\/td>\n<td class='gfield_list_cell gfield_list_85_cell3' data-label='Dates Attended To'><input class='datepicker_with_icon datepicker mdy ' aria-invalid='false' aria-required=\"true\"  aria-label='Dates Attended To, Row 1' data-aria-label-template='Dates Attended To, Row {0}' type='text' name='input_85[]' value=''   \/><input id='gforms_calendar_icon_input_6_85_3' class='gform_hidden' type='hidden' value='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/calendar.png'  \/><\/td>\n<td class='gfield_list_cell gfield_list_85_cell4' data-label='Graduated'><select title='Graduated'name='input_85[]'   aria-invalid='false' aria-required=\"true\"  aria-label='Graduated, Row 1' data-aria-label-template='Graduated, Row {0}'><option value='' ><\/option><option value='Yes ' >Yes <\/option><option value='No' >No<\/option><\/select><\/td>\n<td class='gfield_list_cell gfield_list_85_cell5' data-label='Subjects Studied \/Degree Received'><input aria-invalid='false' aria-required=\"true\"  aria-label='Subjects Studied \/Degree Received, Row 1' data-aria-label-template='Subjects Studied \/Degree Received, Row {0}' type='text' name='input_85[]' value=''   \/><\/td>\n<td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 4)' onkeypress='gformAddListItem(this, 4)'><img src='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 4)' onkeypress='gformDeleteListItem(this, 4)' style=\"visibility:hidden;\"><img src='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/li>\n<\/ul>\n<\/fieldset>\n<fieldset class=\"gfieldset gform_fieldset_begin gform_fieldset \">\n<legend class=\"gfieldset-legend\">Licensure Section<\/legend>\n<ul class=\"gform_fields top_label form_sublabel_below description_below validation_below\">\n<li id=\"field_6_88\" class=\"gfield gfield--type-list gfield--input-type-list education-fields-listing gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_88\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Licensure\/Certification Received<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_list ginput_list'>\n<table class='gfield_list gfield_list_container'>\n<colgroup>\n<col id='gfield_list_88_col_1' class='gfield_list_col_odd' \/>\n<col id='gfield_list_88_col_2' class='gfield_list_col_even' \/>\n<col id='gfield_list_88_col_3' class='gfield_list_col_odd' \/>\n<col id='gfield_list_88_col_4' class='gfield_list_col_even' \/>\n<col id='gfield_list_88_col_5' class='gfield_list_col_odd' \/>\n<col id='gfield_list_88_col_6' class='gfield_list_col_even' \/><\/colgroup>\n<thead>\n<tr>\n<th scope=\"col\">State<\/th>\n<th scope=\"col\">License\/Certification Number<\/th>\n<th scope=\"col\">Dates of Original Issue<\/th>\n<th scope=\"col\">Renewal Date<\/th>\n<th scope=\"col\">Expiration Date<\/th>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class='gfield_list_row_odd gfield_list_group'>\n<td class='gfield_list_cell gfield_list_88_cell1' data-label='State'><input aria-invalid='false' aria-required=\"true\"  aria-label='State, Row 1' data-aria-label-template='State, Row {0}' type='text' name='input_88[]' value=''   \/><\/td>\n<td class='gfield_list_cell gfield_list_88_cell2' data-label='License\/Certification Number'><input aria-invalid='false' aria-required=\"true\"  aria-label='License\/Certification Number, Row 1' data-aria-label-template='License\/Certification Number, Row {0}' type='text' name='input_88[]' value=''   \/><\/td>\n<td class='gfield_list_cell gfield_list_88_cell3' data-label='Dates of Original Issue'><input class='datepicker_with_icon datepicker mdy ' aria-invalid='false' aria-required=\"true\"  aria-label='Dates of Original Issue, Row 1' data-aria-label-template='Dates of Original Issue, Row {0}' type='text' name='input_88[]' value=''   \/><input id='gforms_calendar_icon_input_6_88_3' class='gform_hidden' type='hidden' value='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/calendar.png'  \/><\/td>\n<td class='gfield_list_cell gfield_list_88_cell4' data-label='Renewal Date'><input class='datepicker_with_icon datepicker mdy ' aria-invalid='false' aria-required=\"true\"  aria-label='Renewal Date, Row 1' data-aria-label-template='Renewal Date, Row {0}' type='text' name='input_88[]' value=''   \/><input id='gforms_calendar_icon_input_6_88_4' class='gform_hidden' type='hidden' value='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/calendar.png'  \/><\/td>\n<td class='gfield_list_cell gfield_list_88_cell5' data-label='Expiration Date'><input class='datepicker_with_icon datepicker mdy ' aria-invalid='false' aria-required=\"true\"  aria-label='Expiration Date, Row 1' data-aria-label-template='Expiration Date, Row {0}' type='text' name='input_88[]' value=''   \/><input id='gforms_calendar_icon_input_6_88_5' class='gform_hidden' type='hidden' value='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/calendar.png'  \/><\/td>\n<td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 4)' onkeypress='gformAddListItem(this, 4)'><img src='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 4)' onkeypress='gformDeleteListItem(this, 4)' style=\"visibility:hidden;\"><img src='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/li>\n<\/ul>\n<\/fieldset>\n<fieldset class=\"gfieldset gform_fieldset_begin gform_fieldset \">\n<legend class=\"gfieldset-legend\">Employment Section<\/legend>\n<ul class=\"gform_fields top_label form_sublabel_below description_below validation_below\">\n<li id=\"field_6_99\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_99\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Employment History<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_list ginput_list'>\n<table class='gfield_list gfield_list_container'>\n<colgroup>\n<col id='gfield_list_99_col_1' class='gfield_list_col_odd' \/>\n<col id='gfield_list_99_col_2' class='gfield_list_col_even' \/>\n<col id='gfield_list_99_col_3' class='gfield_list_col_odd' \/>\n<col id='gfield_list_99_col_4' class='gfield_list_col_even' \/>\n<col id='gfield_list_99_col_5' class='gfield_list_col_odd' \/>\n<col id='gfield_list_99_col_6' class='gfield_list_col_even' \/>\n<col id='gfield_list_99_col_7' class='gfield_list_col_odd' \/><\/colgroup>\n<thead>\n<tr>\n<th scope=\"col\">Dates of Employed From<\/th>\n<th scope=\"col\">Dates of Employed To<\/th>\n<th scope=\"col\">Employer&#039;s Name\/Supervisior&#039;s Name<\/th>\n<th scope=\"col\">Employer&#039;s Address\/Phone #<\/th>\n<th scope=\"col\">Reason for Leaving<\/th>\n<th scope=\"col\">Position Held<\/th>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class='gfield_list_row_odd gfield_list_group'>\n<td class='gfield_list_cell gfield_list_99_cell1' data-label='Dates of Employed From'><input class='datepicker_with_icon datepicker mdy ' aria-invalid='false' aria-required=\"true\"  aria-label='Dates of Employed From, Row 1' data-aria-label-template='Dates of Employed From, Row {0}' type='text' name='input_99[]' value=''   \/><input id='gforms_calendar_icon_input_6_99_1' class='gform_hidden' type='hidden' value='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/calendar.png'  \/><\/td>\n<td class='gfield_list_cell gfield_list_99_cell2' data-label='Dates of Employed To'><input class='datepicker_with_icon datepicker mdy ' aria-invalid='false' aria-required=\"true\"  aria-label='Dates of Employed To, Row 1' data-aria-label-template='Dates of Employed To, Row {0}' type='text' name='input_99[]' value=''   \/><input id='gforms_calendar_icon_input_6_99_2' class='gform_hidden' type='hidden' value='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/calendar.png'  \/><\/td>\n<td class='gfield_list_cell gfield_list_99_cell3' data-label='Employer&#039;s Name\/Supervisior&#039;s Name'><input aria-invalid='false' aria-required=\"true\"  aria-label='Employer&#039;s Name\/Supervisior&#039;s Name, Row 1' data-aria-label-template='Employer&#039;s Name\/Supervisior&#039;s Name, Row {0}' type='text' name='input_99[]' value=''   \/><\/td>\n<td class='gfield_list_cell gfield_list_99_cell4' data-label='Employer&#039;s Address\/Phone #'><input aria-invalid='false' aria-required=\"true\"  aria-label='Employer&#039;s Address\/Phone #, Row 1' data-aria-label-template='Employer&#039;s Address\/Phone #, Row {0}' type='text' name='input_99[]' value=''   \/><\/td>\n<td class='gfield_list_cell gfield_list_99_cell5' data-label='Reason for Leaving'><input aria-invalid='false' aria-required=\"true\"  aria-label='Reason for Leaving, Row 1' data-aria-label-template='Reason for Leaving, Row {0}' type='text' name='input_99[]' value=''   \/><\/td>\n<td class='gfield_list_cell gfield_list_99_cell6' data-label='Position Held'><input aria-invalid='false' aria-required=\"true\"  aria-label='Position Held, Row 1' data-aria-label-template='Position Held, Row {0}' type='text' name='input_99[]' value=''   \/><\/td>\n<td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 4)' onkeypress='gformAddListItem(this, 4)'><img src='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 4)' onkeypress='gformDeleteListItem(this, 4)' style=\"visibility:hidden;\"><img src='https:\/\/acthomehealthservices.com\/dev\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/li>\n<\/ul>\n<\/fieldset>\n<ul class=\"gform_fields top_label form_sublabel_below description_below validation_below\">\n<li id=\"field_6_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_44\" >\n<p>Information provided in response to these questions will not necessarily bar engagement with ACT if the answers to questions 1,2 or 4 are &#8220;YES&#8221;.Please give full details on a separate sheet.<\/p>\n<h4>Questions<\/h4>\n<\/li>\n<li id=\"field_6_45\" class=\"gfield gfield--type-select gfield--input-type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_45\" ><label class='gfield_label gform-field-label' for='input_6_45'>1. Has your clinical license to practice in any jurisdiction ever been limited, suspended or revoked?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_select'><select name='input_45' id='input_6_45' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='YES' >YES<\/option><option value='NO' >NO<\/option><option value='N\/A' >N\/A<\/option><\/select><\/div>\n<\/li>\n<li id=\"field_6_46\" class=\"gfield gfield--type-select gfield--input-type-select gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_46\" ><label class='gfield_label gform-field-label' for='input_6_46'>2. Have your clinical privileges ever been suspended, diminished, revoked or not renewed?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_select'><select name='input_46' id='input_6_46' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='YES' >YES<\/option><option value='NO' >NO<\/option><option value='N\/A' >N\/A<\/option><\/select><\/div>\n<\/li>\n<li id=\"field_6_47\" class=\"gfield gfield--type-select gfield--input-type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_47\" ><label class='gfield_label gform-field-label' for='input_6_47'>3. Do you have the ability to perform all essential job functions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_select'><select name='input_47' id='input_6_47' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='YES' >YES<\/option><option value='NO' >NO<\/option><\/select><\/div>\n<\/li>\n<li id=\"field_6_48\" class=\"gfield gfield--type-select gfield--input-type-select gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_48\" ><label class='gfield_label gform-field-label' for='input_6_48'>4. If engaged by ACT, will you consent to a physical examination?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_select'><select name='input_48' id='input_6_48' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='YES' >YES<\/option><option value='NO' >NO<\/option><\/select><\/div>\n<\/li>\n<li id=\"field_6_49\" class=\"gfield gfield--type-select gfield--input-type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_49\" ><label class='gfield_label gform-field-label' for='input_6_49'>5. Where you in the United States Armed Forces?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_select'><select name='input_49' id='input_6_49' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='YES' >YES<\/option><option value='NO' >NO<\/option><\/select><\/div>\n<\/li>\n<li id=\"field_6_75\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_75\" ><label class='gfield_label gform-field-label' for='input_6_75'>Upload Resume<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_75' id='input_6_75' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_75\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_75'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_75'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_107\" class=\"gfield gfield--type-captcha gfield--input-type-captcha field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_107\" ><label class='gfield_label gform-field-label' for='input_6_107'>CAPTCHA<\/label>\n<div id='input_6_107' class='ginput_container ginput_recaptcha' data-sitekey='6Lf1bw8UAAAAACYvcSqcRAxREHq8NGDNt8xwl0py'  data-theme='light' data-tabindex='0'  data-badge=''><\/div>\n<\/li>\n<\/ul><\/div>\n<div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_6_50' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_6\").val(\"2\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_6\").val(\"2\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); } ' \/>\n                    <\/div>\n<\/p><\/div>\n<div id='gform_page_6_2' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n<div class='gform_page_fields'>\n<ul id='gform_fields_6_2' class='gform_fields top_label form_sublabel_below description_below validation_below'>\n<li id=\"field_6_51\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_51\" >\n<h4>Skills, Availability and Preferences<\/h4>\n<\/li>\n<li id=\"field_6_101\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_101\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Skills<\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_6_101'>\n<li class='gchoice gchoice_6_101_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.1' type='checkbox'  value='5'  id='choice_6_101_1'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_101_1' id='label_6_101_1' class='gform-field-label gform-field-label--type-inline'>Trache<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_101_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.2' type='checkbox'  value='6'  id='choice_6_101_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_101_2' id='label_6_101_2' class='gform-field-label gform-field-label--type-inline'>Trache &amp; Vent<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_101_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.3' type='checkbox'  value='9'  id='choice_6_101_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_101_3' id='label_6_101_3' class='gform-field-label gform-field-label--type-inline'>G Tube<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_101_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.4' type='checkbox'  value='10'  id='choice_6_101_4'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_101_4' id='label_6_101_4' class='gform-field-label gform-field-label--type-inline'>NGT<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_101_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.5' type='checkbox'  value='7'  id='choice_6_101_5'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_101_5' id='label_6_101_5' class='gform-field-label gform-field-label--type-inline'>CPAP\/BIPAP<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_6_104\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_104\" ><label class='gfield_label gform-field-label' for='input_6_104'>Other skills<\/label>\n<div class='ginput_container ginput_container_text'><input name='input_104' id='input_6_104' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div>\n<\/li>\n<li id=\"field_6_52\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_52\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Day Preference<\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_6_52'>\n<li class='gchoice gchoice_6_52_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.1' type='checkbox'  value='2'  id='choice_6_52_1'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_52_1' id='label_6_52_1' class='gform-field-label gform-field-label--type-inline'>Monday<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_52_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.2' type='checkbox'  value='3'  id='choice_6_52_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_52_2' id='label_6_52_2' class='gform-field-label gform-field-label--type-inline'>Tuesday<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_52_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.3' type='checkbox'  value='4'  id='choice_6_52_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_52_3' id='label_6_52_3' class='gform-field-label gform-field-label--type-inline'>Wednesday<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_52_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.4' type='checkbox'  value='5'  id='choice_6_52_4'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_52_4' id='label_6_52_4' class='gform-field-label gform-field-label--type-inline'>Thursday<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_52_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.5' type='checkbox'  value='6'  id='choice_6_52_5'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_52_5' id='label_6_52_5' class='gform-field-label gform-field-label--type-inline'>Friday<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_52_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.6' type='checkbox'  value='7'  id='choice_6_52_6'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_52_6' id='label_6_52_6' class='gform-field-label gform-field-label--type-inline'>Saturday<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_52_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.7' type='checkbox'  value='1'  id='choice_6_52_7'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_52_7' id='label_6_52_7' class='gform-field-label gform-field-label--type-inline'>Sunday<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_6_76\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_76\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Shift Preference<\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_6_76'>\n<li class='gchoice gchoice_6_76_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.1' type='checkbox'  value='Day'  id='choice_6_76_1'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_76_1' id='label_6_76_1' class='gform-field-label gform-field-label--type-inline'>Day Time Shift<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_76_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.2' type='checkbox'  value='Evening'  id='choice_6_76_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_76_2' id='label_6_76_2' class='gform-field-label gform-field-label--type-inline'>Evening Shift<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_76_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.3' type='checkbox'  value='Overnight'  id='choice_6_76_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_76_3' id='label_6_76_3' class='gform-field-label gform-field-label--type-inline'>Overnight Shift<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_76_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.4' type='checkbox'  value='24More'  id='choice_6_76_4'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_76_4' id='label_6_76_4' class='gform-field-label gform-field-label--type-inline'>More than 24 hrs\/week<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_76_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.5' type='checkbox'  value='24Less'  id='choice_6_76_5'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_76_5' id='label_6_76_5' class='gform-field-label gform-field-label--type-inline'>24 hrs or less\/week<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_6_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_53\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Patient Preference<\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_6_53'>\n<li class='gchoice gchoice_6_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='Male'  id='choice_6_53_1'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_53_1' id='label_6_53_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='Female'  id='choice_6_53_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_53_2' id='label_6_53_2' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_53_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.3' type='checkbox'  value='Pediatric'  id='choice_6_53_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_53_3' id='label_6_53_3' class='gform-field-label gform-field-label--type-inline'>Pediatric<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_53_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.4' type='checkbox'  value='Adult'  id='choice_6_53_4'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_53_4' id='label_6_53_4' class='gform-field-label gform-field-label--type-inline'>Adult<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_6_54\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_54\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Location Preference<\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_6_54'>\n<li class='gchoice gchoice_6_54_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.1' type='checkbox'  value='Northeast Philadelphia'  id='choice_6_54_1'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_1' id='label_6_54_1' class='gform-field-label gform-field-label--type-inline'>Northeast Philadelphia<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_54_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.2' type='checkbox'  value='North Philadelphia'  id='choice_6_54_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_2' id='label_6_54_2' class='gform-field-label gform-field-label--type-inline'>North Philadelphia<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_54_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.3' type='checkbox'  value='West Philadelphia'  id='choice_6_54_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_3' id='label_6_54_3' class='gform-field-label gform-field-label--type-inline'>West Philadelphia<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_54_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.4' type='checkbox'  value='South Philadelphia'  id='choice_6_54_4'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_4' id='label_6_54_4' class='gform-field-label gform-field-label--type-inline'>South Philadelphia<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_54_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.5' type='checkbox'  value='Southwest Philadelphia'  id='choice_6_54_5'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_5' id='label_6_54_5' class='gform-field-label gform-field-label--type-inline'>Southwest Philadelphia<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_54_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.6' type='checkbox'  value='Montgomery County'  id='choice_6_54_6'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_6' id='label_6_54_6' class='gform-field-label gform-field-label--type-inline'>Montgomery County<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_54_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.7' type='checkbox'  value='Bucks County'  id='choice_6_54_7'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_7' id='label_6_54_7' class='gform-field-label gform-field-label--type-inline'>Bucks County<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_54_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.8' type='checkbox'  value='Delaware County'  id='choice_6_54_8'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_8' id='label_6_54_8' class='gform-field-label gform-field-label--type-inline'>Delaware County<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_54_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.9' type='checkbox'  value='Chester County'  id='choice_6_54_9'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_9' id='label_6_54_9' class='gform-field-label gform-field-label--type-inline'>Chester County<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_6_55\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_55\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Allergies<\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_6_55'>\n<li class='gchoice gchoice_6_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='Dogs'  id='choice_6_55_1'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_1' id='label_6_55_1' class='gform-field-label gform-field-label--type-inline'>Dogs<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_55_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.2' type='checkbox'  value='Cats'  id='choice_6_55_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_2' id='label_6_55_2' class='gform-field-label gform-field-label--type-inline'>Cats<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_6_55_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.3' type='checkbox'  value='Smoke'  id='choice_6_55_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_3' id='label_6_55_3' class='gform-field-label gform-field-label--type-inline'>Smoke<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<\/ul><\/div>\n<div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_6_56' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_6\").val(\"1\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_6\").val(\"1\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_6_56' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_6\").val(\"3\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_6\").val(\"3\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); } ' \/>\n                    <\/div>\n<\/p><\/div>\n<div id='gform_page_6_3' class='gform_page' data-js='page-field-id-56' style='display:none;'>\n<div class='gform_page_fields'>\n<ul id='gform_fields_6_3' class='gform_fields top_label form_sublabel_below description_below validation_below'>\n<li id=\"field_6_57\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_57\" >\n<h4>HR REQUIREMENTS:<\/h4>\n<\/li>\n<li id=\"field_6_103\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_103\" >\n<h6>Please bring the following current original documents for verification 1..11<\/h6>\n<\/li>\n<li id=\"field_6_58\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_58\" ><label class='gfield_label gform-field-label' for='input_6_58'>1) Driver\u2019s License and\/or State ID and\/or Passport<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_58' id='input_6_58' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_58\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_58'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_58'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_59\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_59\" ><label class='gfield_label gform-field-label' for='input_6_59'>2) Social Security Card<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_59' id='input_6_59' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_59\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_59'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_59'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_60\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_60\" ><label class='gfield_label gform-field-label' for='input_6_60'>3) State Nursing License for RNs and LPNs<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_60' id='input_6_60' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_60\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_60'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_60'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_61\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_61\" ><label class='gfield_label gform-field-label' for='input_6_61'>4) CNA Certification  for CNAs and  for Home Health Aide (certificate showing at least 75 hours of HHA training)<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_61' id='input_6_61' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_61\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_61'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_61'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_62\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_62\" ><label class='gfield_label gform-field-label' for='input_6_62'>5) CPR Certificate<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_62' id='input_6_62' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_62\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_62'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_62'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_63\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_63\" ><label class='gfield_label gform-field-label' for='input_6_63'>6) Criminal Background check<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_63' id='input_6_63' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_63\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_63'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_63'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_77\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_77\" ><label class='gfield_label gform-field-label' for='input_6_77'>7) Child Abuse Clearance<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_77' id='input_6_77' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_77\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_77'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_77'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_64\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_64\" ><label class='gfield_label gform-field-label' for='input_6_64'>8) FBI Fingerprint<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_64' id='input_6_64' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_64\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_64'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_64'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_78\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_78\" ><label class='gfield_label gform-field-label' for='input_6_78'>9) If applicable: Car insurance and Car registration<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_78' id='input_6_78' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_78\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_78'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_78'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_65\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_65\" ><label class='gfield_label gform-field-label' for='input_6_65'>10) Professional Liability Insurance Certificate<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_65' id='input_6_65' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_65\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_65'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_65'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_66\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_66\" ><label class='gfield_label gform-field-label' for='input_6_66'>11) If applying as an LLC or corporation \u2013 IRS letter ( SS-4) stating the LLC or Corporation name with Employer Identification Number(EID)<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_66' id='input_6_66' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_66\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_66'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_66'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_67\" class=\"gfield gfield--type-html gfield--input-type-html list_style_set gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_67\" >\n<ul>\n<li>Upon review of submitted clearances, you might be required to get more current clearances if clearances submitted does not comply with date requirements.<\/li>\n<li>Upon review, you might be asked to secure or upgrade to a different insurance.<\/li>\n<\/ul>\n<\/li>\n<li id=\"field_6_68\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_68\" >\n<h4> Medical Requirements<\/h4>\n<\/li>\n<li id=\"field_6_102\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_102\" >\n<h6>Please bring the following current original documents for verification 1..5<\/h6>\n<\/li>\n<li id=\"field_6_69\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_69\" ><label class='gfield_label gform-field-label' for='input_6_69'>1) Current physical examination<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_69' id='input_6_69' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_69\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_69'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_69'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_70\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_70\" ><label class='gfield_label gform-field-label' for='input_6_70'>2) TB Test or Chest Xray<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_70' id='input_6_70' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_70\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_70'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_70'><\/div>\n<\/div>\n<\/li>\n<\/ul>\n<\/fieldset>\n<ul class=\"gform_fields top_label form_sublabel_below description_below validation_below\">\n<li id=\"field_6_71\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_71\" ><label class='gfield_label gform-field-label' for='input_6_71'>3) Hepatitis B Vaccination Certificate<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_71' id='input_6_71' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_71\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_71'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_71'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_72\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_72\" ><label class='gfield_label gform-field-label' for='input_6_72'>4) Rubella Vaccination or Screening Test<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_72' id='input_6_72' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_72\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_72'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_72'><\/div>\n<\/div>\n<\/li>\n<\/ul>\n<\/fieldset>\n<ul class=\"gform_fields top_label form_sublabel_below description_below validation_below\">\n<li id=\"field_6_73\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_73\" ><label class='gfield_label gform-field-label' for='input_6_73'>5) Completed Medical History Form (form provided by ACT)<\/label>\n<div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_73' id='input_6_73' type='file' class='medium' aria-describedby=\"gfield_upload_rules_6_73\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_73'>Max. file size: 512 MB.<\/span><\/p>\n<div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_73'><\/div>\n<\/div>\n<\/li>\n<li id=\"field_6_106\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description 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