{"id":3867,"date":"2018-01-05T15:39:24","date_gmt":"2018-01-05T23:39:24","guid":{"rendered":"https:\/\/www.darimart.com\/?page_id=3867"},"modified":"2018-05-01T12:02:40","modified_gmt":"2018-05-01T19:02:40","slug":"apply","status":"publish","type":"page","link":"https:\/\/www.darimart.com\/apply\/","title":{"rendered":"Apply"},"content":{"rendered":"\n                <div class='gf_browser_chrome gform_wrapper' id='gform_wrapper_2' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/wp-json\/wp\/v2\/pages\/3867'>\n                        <div class='gform_heading'>\n                            <span class='gform_description'>Thank you for showing an interest in working for Dari-Mart Stores. Dari-Mart is a local family based chain of 44 convenience grocery stores located in Lane, Linn and Benton Counties since 1965. We encourage and welcome you to apply and join our friendly, community based team. <br \/><br \/>\r\n\r\nBelow is an online application. Upon completion it will be automatically sent to the managers in charge of hiring to review and process.<br \/><br \/>\r\n\r\nDari-Mart is a drug free workplace. Beginning salary is $13.00\/hour. Benefits include employee assistance program at date of hire and paid time off after 91 days. Medical insurance, voluntary dental insurance, $20,000.00 life insurance, Long Term Disability insurance and 401(k) with matching funds after one year of employment. <br \/><br \/>\r\n\r\n<strong>Dari-Mart is An Equal Opportunity Employer and we look forward to receiving your application.<\/strong><br \/>\r\nDari-Mart Stores, Inc., provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Dari-Mart Stores, Inc., complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.<\/span>\n                        <\/div>\n                        <div class='gform_body'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below'><li id='field_2_1' class='gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_1' >Position Applied For<\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_2_1' type='text' value='' class='medium'  tabindex='1'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_3' class='gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_3' >Date of Application<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_3' id='input_2_3' type='text' value='' class='datepicker medium mdy datepicker_no_icon' tabindex='2'  \/>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_3' class='gform_hidden' value='https:\/\/www.darimart.com\/wp-content\/plugins\/gravityforms-master\/images\/calendar.png'\/><\/li><li id='field_2_4' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_2_4_3' >Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gfield_trigger_change' id='input_2_4'>\n                            \n                            <span id='input_2_4_3_container' class='name_first' >\n                                                    <input type='text' name='input_4.3' id='input_2_4_3' value='' aria-label='First name' tabindex='4'  aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_2_4_3' >First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_4_6_container' class='name_last' >\n                                                    <input type='text' name='input_4.6' id='input_2_4_6' value='' aria-label='Last name' tabindex='6'  aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_2_4_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id='field_2_85' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Are you over 18?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_85'><li class='gchoice_2_85_1'>\n\t\t\t\t\t\t\t\t<input name='input_85.1' type='checkbox'  value='Yes, I&#039;m 18 years or older.'  id='choice_2_85_1' tabindex='8'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_85_1' id='label_2_85_1'>Yes, I'm 18 years or older.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_2_83' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_83' >Your Email<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_83' id='input_2_83' type='email' value='' class='medium' tabindex='9'    aria-required=\"true\" aria-invalid=\"false\"\/>\n                        <\/div><\/li><li id='field_2_84' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_84' >Your Phone<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_84' id='input_2_84' type='tel' value='' class='medium' tabindex='10'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_5' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_2_5_1' >Address<span class='gfield_required'>*<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gfield_trigger_change' id='input_2_5' >\n                         <span class='ginput_full address_line_1' id='input_2_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_2_5_1' value='' tabindex='11'  \/>\n                                        <label for='input_2_5_1' id='input_2_5_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_2_5_2_container' >\n                                        <input type='text' name='input_5.2' id='input_2_5_2' value='' tabindex='12'  \/>\n                                        <label for='input_2_5_2' id='input_2_5_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_2_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_2_5_3' value='' tabindex='13'  \/>\n                                    <label for='input_2_5_3' id='input_2_5_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_2_5_4_container' >\n                                        <input type='text' name='input_5.4' id='input_2_5_4' value='' tabindex='15'    \/>\n                                        <label for='input_2_5_4' id='input_2_5_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_2_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_2_5_5' value='' tabindex='16'  \/>\n                                    <label for='input_2_5_5' id='input_2_5_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country' id='input_2_5_6_container' >\n                                        <select name='input_5.6' id='input_2_5_6' tabindex='17' ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select>\n                                        <label for='input_2_5_6' id='input_2_5_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_2_6' class='gfield gf_list_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Are you legally eligible to work in the U.S.?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_6'><li class='gchoice_2_6_0'><input name='input_6' type='radio' value='Yes'  id='choice_2_6_0' tabindex='18'    \/><label for='choice_2_6_0' id='label_2_6_0'>Yes<\/label><\/li><li class='gchoice_2_6_1'><input name='input_6' type='radio' value='No'  id='choice_2_6_1' tabindex='19'    \/><label for='choice_2_6_1' id='label_2_6_1'>No<\/label><\/li><\/ul><\/div><\/li><li id='field_2_7' class='gfield gf_list_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Have you previously worked for Dari-Mart?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_7'><li class='gchoice_2_7_0'><input name='input_7' type='radio' value='Yes'  id='choice_2_7_0' tabindex='20'  onclick='gf_apply_rules(2,[9]);' onkeypress='gf_apply_rules(2,[9]);'  \/><label for='choice_2_7_0' id='label_2_7_0'>Yes<\/label><\/li><li class='gchoice_2_7_1'><input name='input_7' type='radio' value='No'  id='choice_2_7_1' tabindex='21'  onclick='gf_apply_rules(2,[9]);' onkeypress='gf_apply_rules(2,[9]);'  \/><label for='choice_2_7_1' id='label_2_7_1'>No<\/label><\/li><\/ul><\/div><\/li><li id='field_2_9' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_9' >Date<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_2_9' type='text' value='' class='datepicker medium mdy datepicker_no_icon' tabindex='22'  \/>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_9' class='gform_hidden' value='https:\/\/www.darimart.com\/wp-content\/plugins\/gravityforms-master\/images\/calendar.png'\/><\/li><li id='field_2_10' class='gfield gf_list_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Do you have relatives working at this facility?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_10'><li class='gchoice_2_10_0'><input name='input_10' type='radio' value='Yes'  id='choice_2_10_0' tabindex='23'  onclick='gf_apply_rules(2,[11]);' onkeypress='gf_apply_rules(2,[11]);'  \/><label for='choice_2_10_0' id='label_2_10_0'>Yes<\/label><\/li><li class='gchoice_2_10_1'><input name='input_10' type='radio' value='No'  id='choice_2_10_1' tabindex='24'  onclick='gf_apply_rules(2,[11]);' onkeypress='gf_apply_rules(2,[11]);'  \/><label for='choice_2_10_1' id='label_2_10_1'>No<\/label><\/li><\/ul><\/div><\/li><li id='field_2_11' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_11' >Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_2_11' type='text' value='' class='medium'  tabindex='25'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_17' class='gfield gf_list_inline field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Where did you hear about this position?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_17'><li class='gchoice_2_17_1'>\n\t\t\t\t\t\t\t\t<input name='input_17.1' type='checkbox'  value='Newspaper'  id='choice_2_17_1' tabindex='26'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_1' id='label_2_17_1'>Newspaper<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_17_2'>\n\t\t\t\t\t\t\t\t<input name='input_17.2' type='checkbox'  value='Referred By'  id='choice_2_17_2' tabindex='27'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_2' id='label_2_17_2'>Referred By<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_17_3'>\n\t\t\t\t\t\t\t\t<input name='input_17.3' type='checkbox'  value='Other'  id='choice_2_17_3' tabindex='28'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_3' id='label_2_17_3'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_2_79' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>Availability<\/h2><\/li><li id='field_2_12' class='gfield gf_list_3col gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Mark all locations where you are interested in working<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_12'><li class='gchoice_2_12_1'>\n\t\t\t\t\t\t\t\t<input name='input_12.1' type='checkbox'  value='Any Location'  id='choice_2_12_1' tabindex='29'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1'>Any Location<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_2'>\n\t\t\t\t\t\t\t\t<input name='input_12.2' type='checkbox'  value='Eugene'  id='choice_2_12_2' tabindex='30'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_2' id='label_2_12_2'>Eugene<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_3'>\n\t\t\t\t\t\t\t\t<input name='input_12.3' type='checkbox'  value='Springfield'  id='choice_2_12_3' tabindex='31'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_3' id='label_2_12_3'>Springfield<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_4'>\n\t\t\t\t\t\t\t\t<input name='input_12.4' type='checkbox'  value='Coburg'  id='choice_2_12_4' tabindex='32'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_4' id='label_2_12_4'>Coburg<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_5'>\n\t\t\t\t\t\t\t\t<input name='input_12.5' type='checkbox'  value='Junction City \/ Harrisburg'  id='choice_2_12_5' tabindex='33'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_5' id='label_2_12_5'>Junction City \/ Harrisburg<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_6'>\n\t\t\t\t\t\t\t\t<input name='input_12.6' type='checkbox'  value='Veneta'  id='choice_2_12_6' tabindex='34'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_6' id='label_2_12_6'>Veneta<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_7'>\n\t\t\t\t\t\t\t\t<input name='input_12.7' type='checkbox'  value='Cheshire\/Monroe'  id='choice_2_12_7' tabindex='35'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_7' id='label_2_12_7'>Cheshire\/Monroe<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_8'>\n\t\t\t\t\t\t\t\t<input name='input_12.8' type='checkbox'  value='Creswell \/ Cottage Grove'  id='choice_2_12_8' tabindex='36'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_8' id='label_2_12_8'>Creswell \/ Cottage Grove<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_9'>\n\t\t\t\t\t\t\t\t<input name='input_12.9' type='checkbox'  value='Pleasant Hill'  id='choice_2_12_9' tabindex='37'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_9' id='label_2_12_9'>Pleasant Hill<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_11'>\n\t\t\t\t\t\t\t\t<input name='input_12.11' type='checkbox'  value='Albany\/Corvallis'  id='choice_2_12_11' tabindex='38'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_11' id='label_2_12_11'>Albany\/Corvallis<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_12_12'>\n\t\t\t\t\t\t\t\t<input name='input_12.12' type='checkbox'  value='Brownsville'  id='choice_2_12_12' tabindex='39'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_12_12' id='label_2_12_12'>Brownsville<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_2_13' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_13' >On what date would you be available for work?<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_2_13' type='text' value='' class='medium'  tabindex='40'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_14' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><p><strong>Dari-Mart Stores are open from 5:00 am \u2013 11:00 pm (some to 12:00 midnight) 365 days per year:<\/strong><\/p><\/li><li id='field_2_15' class='gfield gf_list_inline gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Mornings:<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_15'><li class='gchoice_2_15_1'>\n\t\t\t\t\t\t\t\t<input name='input_15.1' type='checkbox'  value='Mon.'  id='choice_2_15_1' tabindex='41'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_15_1' id='label_2_15_1'>Mon.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_15_2'>\n\t\t\t\t\t\t\t\t<input name='input_15.2' type='checkbox'  value='Tues.'  id='choice_2_15_2' tabindex='42'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_15_2' id='label_2_15_2'>Tues.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_15_3'>\n\t\t\t\t\t\t\t\t<input name='input_15.3' type='checkbox'  value='Wed.'  id='choice_2_15_3' tabindex='43'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_15_3' id='label_2_15_3'>Wed.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_15_4'>\n\t\t\t\t\t\t\t\t<input name='input_15.4' type='checkbox'  value='Thu.'  id='choice_2_15_4' tabindex='44'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_15_4' id='label_2_15_4'>Thu.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_15_5'>\n\t\t\t\t\t\t\t\t<input name='input_15.5' type='checkbox'  value='Fri.'  id='choice_2_15_5' tabindex='45'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_15_5' id='label_2_15_5'>Fri.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_15_6'>\n\t\t\t\t\t\t\t\t<input name='input_15.6' type='checkbox'  value='Sat.'  id='choice_2_15_6' tabindex='46'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_15_6' id='label_2_15_6'>Sat.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_15_7'>\n\t\t\t\t\t\t\t\t<input name='input_15.7' type='checkbox'  value='Sun'  id='choice_2_15_7' tabindex='47'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_15_7' id='label_2_15_7'>Sun<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_2_16' class='gfield gf_list_inline gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Evenings:<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_16'><li class='gchoice_2_16_1'>\n\t\t\t\t\t\t\t\t<input name='input_16.1' type='checkbox'  value='Mon.'  id='choice_2_16_1' tabindex='48'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_16_1' id='label_2_16_1'>Mon.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_16_2'>\n\t\t\t\t\t\t\t\t<input name='input_16.2' type='checkbox'  value='Tues.'  id='choice_2_16_2' tabindex='49'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_16_2' id='label_2_16_2'>Tues.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_16_3'>\n\t\t\t\t\t\t\t\t<input name='input_16.3' type='checkbox'  value='Wed.'  id='choice_2_16_3' tabindex='50'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_16_3' id='label_2_16_3'>Wed.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_16_4'>\n\t\t\t\t\t\t\t\t<input name='input_16.4' type='checkbox'  value='Thu.'  id='choice_2_16_4' tabindex='51'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_16_4' id='label_2_16_4'>Thu.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_16_5'>\n\t\t\t\t\t\t\t\t<input name='input_16.5' type='checkbox'  value='Fri.'  id='choice_2_16_5' tabindex='52'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_16_5' id='label_2_16_5'>Fri.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_16_6'>\n\t\t\t\t\t\t\t\t<input name='input_16.6' type='checkbox'  value='Sat.'  id='choice_2_16_6' tabindex='53'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_16_6' id='label_2_16_6'>Sat.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_16_7'>\n\t\t\t\t\t\t\t\t<input name='input_16.7' type='checkbox'  value='Sun'  id='choice_2_16_7' tabindex='54'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_16_7' id='label_2_16_7'>Sun<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_2_23' class='gfield large gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_2_23_shim' >Education<span class='gfield_required'>*<\/span><\/label><style type=\"text\/css\">\n\n\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}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img.add_list_item,\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img.delete_list_item {\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}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img.add_list_item:hover,\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img.delete_list_item:hover {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\t<\/style><div class='ginput_container ginput_container_list ginput_list'><input type='text' id='input_2_23_shim' style='position:absolute;left:-999em;' onfocus='jQuery( \"#field_2_23 table tr td:first-child input\" ).focus();' \/><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_23_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_23_col_2' class='gfield_list_col_even' \/><col id='gfield_list_23_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_23_col_4' class='gfield_list_col_even' \/><col id='gfield_list_23_col_5' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th>Institution Name<\/th><th>City, State<\/th><th>Years Attended<\/th><th>List Diploma or Degree<\/th><th>&nbsp;<\/th><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_23_cell1' data-label='Institution Name'><input type='text' name='input_23[]' value='' tabindex='55' \/><\/td><td class='gfield_list_cell gfield_list_23_cell2' data-label='City, State'><input type='text' name='input_23[]' value='' tabindex='56' \/><\/td><td class='gfield_list_cell gfield_list_23_cell3' data-label='Years Attended'><input type='text' name='input_23[]' value='' tabindex='57' \/><\/td><td class='gfield_list_cell gfield_list_23_cell4' data-label='List Diploma or Degree'><input type='text' name='input_23[]' value='' tabindex='58' \/><\/td><td class='gfield_list_icons'>   <img src='https:\/\/www.darimart.com\/wp-content\/plugins\/gravityforms-master\/images\/list-add.svg' class='add_list_item '  title='Add another row' alt='Add a new row' onclick='gformAddListItem(this, 6)' onkeypress='gformAddListItem(this, 6)' style='cursor:pointer;' tabindex='59'\/>   <img src='https:\/\/www.darimart.com\/wp-content\/plugins\/gravityforms-master\/images\/list-remove.svg' class='delete_list_item'  title='Remove this row' alt='Remove this row' onclick='gformDeleteListItem(this, 6)' onkeypress='gformDeleteListItem(this, 6)' style='cursor:pointer; visibility:hidden;' tabindex='60'\/><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id='field_2_24' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_24' >Please describe specialized training or skills that you have that are relevant to this position:<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_2_24' class='textarea medium' tabindex='61'   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_2_81' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Do you have employment history?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_81'><li class='gchoice_2_81_0'><input name='input_81' type='radio' value='Yes'  id='choice_2_81_0' tabindex='62'  onclick='gf_apply_rules(2,[27,27,28,29,64,33,62,61,60,38,35,57,56,28,64,33,62,61,60,38,35,57,56,65,65,31,63,34,36,37,59,58,32,39,31,63,34,36,37,59,58,32,39]);' onkeypress='gf_apply_rules(2,[27,27,28,29,64,33,62,61,60,38,35,57,56,28,64,33,62,61,60,38,35,57,56,65,65,31,63,34,36,37,59,58,32,39,31,63,34,36,37,59,58,32,39]);'  \/><label for='choice_2_81_0' id='label_2_81_0'>Yes<\/label><\/li><li class='gchoice_2_81_1'><input name='input_81' type='radio' value='No'  id='choice_2_81_1' tabindex='63'  onclick='gf_apply_rules(2,[27,27,28,29,64,33,62,61,60,38,35,57,56,28,64,33,62,61,60,38,35,57,56,65,65,31,63,34,36,37,59,58,32,39,31,63,34,36,37,59,58,32,39]);' onkeypress='gf_apply_rules(2,[27,27,28,29,64,33,62,61,60,38,35,57,56,28,64,33,62,61,60,38,35,57,56,65,65,31,63,34,36,37,59,58,32,39,31,63,34,36,37,59,58,32,39]);'  \/><label for='choice_2_81_1' id='label_2_81_1'>No<\/label><\/li><\/ul><\/div><\/li><li id='field_2_27' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>Most Recent Employer<\/h2><\/li><li id='field_2_28' class='gfield gf_list_inline gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Are you presently working for this employer?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_28'><li class='gchoice_2_28_0'><input name='input_28' type='radio' value='Yes'  id='choice_2_28_0' tabindex='64'  onclick='gf_apply_rules(2,[29]);' onkeypress='gf_apply_rules(2,[29]);'  \/><label for='choice_2_28_0' id='label_2_28_0'>Yes<\/label><\/li><li class='gchoice_2_28_1'><input name='input_28' type='radio' value='No'  id='choice_2_28_1' tabindex='65'  onclick='gf_apply_rules(2,[29]);' onkeypress='gf_apply_rules(2,[29]);'  \/><label for='choice_2_28_1' id='label_2_28_1'>No<\/label><\/li><\/ul><\/div><\/li><li id='field_2_29' class='gfield gf_list_inline gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >May we contact them?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_29'><li class='gchoice_2_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_2_29_0' tabindex='66'    \/><label for='choice_2_29_0' id='label_2_29_0'>Yes<\/label><\/li><li class='gchoice_2_29_1'><input name='input_29' type='radio' value='No'  id='choice_2_29_1' tabindex='67'    \/><label for='choice_2_29_1' id='label_2_29_1'>No<\/label><\/li><\/ul><\/div><\/li><li id='field_2_64' class='gfield gf_half_left gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_64' >Company<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_2_64' type='text' value='' class='medium'  tabindex='68'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_33' class='gfield gf_half_right gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_33' >Type of Business<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_2_33' type='text' value='' class='medium'  tabindex='69'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_62' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_2_62_1' >Address<span class='gfield_required'>*<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gfield_trigger_change' id='input_2_62' >\n                         <span class='ginput_full address_line_1' id='input_2_62_1_container' >\n                                        <input type='text' name='input_62.1' id='input_2_62_1' value='' tabindex='70'  \/>\n                                        <label for='input_2_62_1' id='input_2_62_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_2_62_2_container' >\n                                        <input type='text' name='input_62.2' id='input_2_62_2' value='' tabindex='71'  \/>\n                                        <label for='input_2_62_2' id='input_2_62_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_2_62_3_container' >\n                                    <input type='text' name='input_62.3' id='input_2_62_3' value='' tabindex='72'  \/>\n                                    <label for='input_2_62_3' id='input_2_62_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_2_62_4_container' >\n                                        <input type='text' name='input_62.4' id='input_2_62_4' value='' tabindex='74'    \/>\n                                        <label for='input_2_62_4' id='input_2_62_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_2_62_5_container' >\n                                    <input type='text' name='input_62.5' id='input_2_62_5' value='' tabindex='75'  \/>\n                                    <label for='input_2_62_5' id='input_2_62_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country' id='input_2_62_6_container' >\n                                        <select name='input_62.6' id='input_2_62_6' tabindex='76' ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select>\n                                        <label for='input_2_62_6' id='input_2_62_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_2_61' class='gfield gf_half_left field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_61' >Your Title<\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_2_61' type='text' value='' class='medium'  tabindex='77'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_60' class='gfield gf_half_right field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_60' >Employed Time (from\/to):<\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_2_60' type='text' value='' class='medium'  tabindex='78'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_38' class='gfield gf_half_left field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_38' >Supervisor<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_2_38' type='text' value='' class='medium'  tabindex='79'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_35' class='gfield gf_half_right field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_35' >Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_35' id='input_2_35' type='tel' value='' class='medium' tabindex='80'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_57' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_57' >Job Duties<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_57' id='input_2_57' class='textarea medium' tabindex='81'    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_2_56' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_56' >Reason for Leaving<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_56' id='input_2_56' class='textarea medium' tabindex='82'    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_2_65' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>Additional Employer<\/h2><\/li><li id='field_2_31' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_31' >Company<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_2_31' type='text' value='' class='medium'  tabindex='83'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_63' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_63' >Type of Business<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_2_63' type='text' value='' class='medium'  tabindex='84'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_34' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_2_34_1' >Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gfield_trigger_change' id='input_2_34' >\n                         <span class='ginput_full address_line_1' id='input_2_34_1_container' >\n                                        <input type='text' name='input_34.1' id='input_2_34_1' value='' tabindex='85'  \/>\n                                        <label for='input_2_34_1' id='input_2_34_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_2_34_2_container' >\n                                        <input type='text' name='input_34.2' id='input_2_34_2' value='' tabindex='86'  \/>\n                                        <label for='input_2_34_2' id='input_2_34_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_2_34_3_container' >\n                                    <input type='text' name='input_34.3' id='input_2_34_3' value='' tabindex='87'  \/>\n                                    <label for='input_2_34_3' id='input_2_34_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_2_34_4_container' >\n                                        <input type='text' name='input_34.4' id='input_2_34_4' value='' tabindex='89'    \/>\n                                        <label for='input_2_34_4' id='input_2_34_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_2_34_5_container' >\n                                    <input type='text' name='input_34.5' id='input_2_34_5' value='' tabindex='90'  \/>\n                                    <label for='input_2_34_5' id='input_2_34_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country' id='input_2_34_6_container' >\n                                        <select name='input_34.6' id='input_2_34_6' tabindex='91' ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select>\n                                        <label for='input_2_34_6' id='input_2_34_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_2_36' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_36' >Your Title<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_2_36' type='text' value='' class='medium'  tabindex='92'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_37' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_37' >Employed Time (from\/to):<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_2_37' type='text' value='' class='medium'  tabindex='93'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_59' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_59' >Supervisor<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_2_59' type='text' value='' class='medium'  tabindex='94'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_58' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_58' >Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_58' id='input_2_58' type='tel' value='' class='medium' tabindex='95'    aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_32' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_32' >Job Duties<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_2_32' class='textarea medium' tabindex='96'    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_2_39' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_39' >Reason for Leaving<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_39' id='input_2_39' class='textarea medium' tabindex='97'    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_2_76' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>JOB RELATED BACKGROUND<\/h2><\/li><li id='field_2_71' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Most of our positions requires standing for long periods of time, bending, twisting, lifting up to 30 lbs., are you physically able to perform this job safely and without a significant risk of substantial harm to yourself or others?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_71'><li class='gchoice_2_71_0'><input name='input_71' type='radio' value='Yes'  id='choice_2_71_0' tabindex='98'  onclick='gf_apply_rules(2,[72]);' onkeypress='gf_apply_rules(2,[72]);'  \/><label for='choice_2_71_0' id='label_2_71_0'>Yes<\/label><\/li><li class='gchoice_2_71_1'><input name='input_71' type='radio' value='No'  id='choice_2_71_1' tabindex='99'  onclick='gf_apply_rules(2,[72]);' onkeypress='gf_apply_rules(2,[72]);'  \/><label for='choice_2_71_1' id='label_2_71_1'>No<\/label><\/li><\/ul><\/div><div class='gfield_description'>Note you may answer YES to the question above if you can perform all essential functions of the job with or without reasonable accommodations. The Company will provide to the best of its ability reasonable accommodation to any person with a disability.<\/div><\/li><li id='field_2_72' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_72' >If No, Explain<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_72' id='input_2_72' class='textarea medium' tabindex='100'   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_2_77' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_77' >Dari-Mart Stores Inc., requires consistent attendance from our employees. Physical attendance is an essential duty of most positions. Please describe your attendance record. Include how many days off work you had, for any reason, during the last year you worked:<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_77' id='input_2_77' class='textarea medium' tabindex='101'   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_2_78' class='gfield large gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_2_78_shim' >References<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><input type='text' id='input_2_78_shim' style='position:absolute;left:-999em;' onfocus='jQuery( \"#field_2_78 table tr td:first-child input\" ).focus();' \/><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_78_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_78_col_2' class='gfield_list_col_even' \/><col id='gfield_list_78_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_78_col_4' class='gfield_list_col_even' \/><col id='gfield_list_78_col_5' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th>Name<\/th><th>Address<\/th><th>Phone Number<\/th><th>Relationship\/Years Known<\/th><th>&nbsp;<\/th><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_78_cell1' data-label='Name'><input type='text' name='input_78[]' value='' tabindex='102' \/><\/td><td class='gfield_list_cell gfield_list_78_cell2' data-label='Address'><input type='text' name='input_78[]' value='' tabindex='103' \/><\/td><td class='gfield_list_cell gfield_list_78_cell3' data-label='Phone Number'><input type='text' name='input_78[]' value='' tabindex='104' \/><\/td><td class='gfield_list_cell gfield_list_78_cell4' data-label='Relationship\/Years Known'><input type='text' name='input_78[]' value='' tabindex='105' \/><\/td><td class='gfield_list_icons'>   <img src='https:\/\/www.darimart.com\/wp-content\/plugins\/gravityforms-master\/images\/list-add.svg' class='add_list_item '  title='Add another row' alt='Add a new row' onclick='gformAddListItem(this, 3)' onkeypress='gformAddListItem(this, 3)' style='cursor:pointer;' tabindex='106'\/>   <img src='https:\/\/www.darimart.com\/wp-content\/plugins\/gravityforms-master\/images\/list-remove.svg' class='delete_list_item'  title='Remove this row' alt='Remove this row' onclick='gformDeleteListItem(this, 3)' onkeypress='gformDeleteListItem(this, 3)' style='cursor:pointer; visibility:hidden;' tabindex='107'\/><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id='field_2_75' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>AGREEMENT &amp; RELEASE<\/h2><\/li><li id='field_2_41' class='gfield gf_left_half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >By signing this application I declare that the information provided by me is complete and true to the best of my knowledge. I understand that any misrepresentation or omission on this application may preclude an offer of employment or may result in a withdrawal of an employment offer or may result in my discharge from employment if I am already employed at the time the misrepresentation or omission is discovered.<\/li><li id='field_2_44' class='gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_44' >Initial<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_2_44' type='text' value='' class='medium'  tabindex='108'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_45' class='gfield gf_left_half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >In the event I undergo a medical examination or evaluation as part of the job placement process, I agree to supply only information which is true to the best of my knowledge and I authorize the physician or his\/her representative to provide any information or opinion, as it relates to my employment, to the Company regarding this examination or evaluation, I understand that if the Company determines that I have made any false oral or written statements or answers or any misreprentation or any omission of significant information to the Company or to the physician or to his\/her representative, the Company is entitled to terminate my conditional offer of employment or actual employment at any time.<\/li><li id='field_2_46' class='gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_46' >Initial<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='medium'  tabindex='109'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_47' class='gfield gf_left_half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >I authorize this company or its agents to verify any information on this applicaion including, but not limited to references, past employment, and motor vehicle driving records. I authorize all persons, schools, companies, to release any information concerning the information I provided, and release any said persons, schools, companies, or agencies from any liability for issuing this information.<\/li><li id='field_2_48' class='gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_48' >Initial<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_2_48' type='text' value='' class='medium'  tabindex='110'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_49' class='gfield gf_left_half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >In the event that I\u2019m given a conditional offer of employment with Dari-Mart Stores, Inc., I will be required to complete Criminal Records Check Consent. I understand and agree to supply information which is true to the best of my knowledge. I understand that if the Company determines I have made any false oral or written statements, provided answers of misreprentation or omission of&nbsp;significant information, the Company is entitled to withdraw the conditional offer of employment at any time.<\/li><li id='field_2_50' class='gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_50' >Initial<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_2_50' type='text' value='' class='medium'  tabindex='111'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_51' class='gfield gf_left_half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >Dari-Mart Stores Inc., supports a drug and alcohol free working environment. Employees are expected to be in a suitable mental and physical condition to perfrom their jobs. I am willing to submit to drug\/alcohol testing to detect the use of illegal drugs and\/or alcohol prior to and during employment.<\/li><li id='field_2_52' class='gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_52' >Initial<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_2_52' type='text' value='' class='medium'  tabindex='112'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_53' class='gfield gf_left_half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >I understand that employment at Dari-Mart Stores Inc., is on an \u201cat will\u201d (that is, mutual consent) basis. Therefore I agree that either I or the Company has the proper right to terminate my employment with or without cause at any time, so long as there is no violation of applicable state or federal laws.<\/li><li id='field_2_54' class='gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_54' >Initial<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_2_54' type='text' value='' class='medium'  tabindex='113'   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_2_82' class='gfield large field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_2_82' >How did you hear about Dari Mart\u2019s job openings?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_82' id='input_2_82' class='textarea 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