CIMHAR TEST

[{"type":"paragraph","subtype":"p","label":"<div>     Applicants with disabilities may be entitled to reasonable accommodations under the terms of the Americans with Disabilities Act to ensure an equal employment opportunity without imposing undue hardship on the City of Mountain Home. Please inform the Human Resource Department if you need assistance completing any forms or to otherwise participate in the application process.  </div><div>     All information requested on the application must be furnished in detail. Resumes may be attached; however, all requested information must be provided as fully and accurately as possible on the application itself. </div><div>     The City of Mountain Home is an equal employment opportunity employer. Applications are accepted without regard to age (over 40), sex, race, color, creed, physical or mental disability, veteran status, service in the uniformed services (as defined by the Uniformed Services Employment and Reemployment Rights Act of 1994), religion, political affiliation, national origin or ancestry, genetic information, or any other legally recognized protected basis under federal, state, or local laws, regulations, or ordinances. </div><div></div>","className":"d-block"},{"type":"text","required":true,"label":"Position you are applying for","name":"Position","className":"d-block","subtype":"text"},{"type":"select","required":true,"label":"Department (choose one)","description":"Which department does the position belong to?","name":"Department","className":"col-lg-4","values":[{"label":"Administration","value":"option-1","selected":true},{"label":"Bldg Insp / Permits ","value":""},{"label":"Code Enforcement","value":""},{"label":"Court","value":"option-3"},{"label":"Finance","value":""},{"label":"Fire","value":""},{"label":"HR","value":""},{"label":"Parks & Recreation","value":""},{"label":"Police","value":"option-2"},{"label":"Street","value":""},{"label":"Water / Wastewater","value":""},{"label":"Youth Center","value":""}]},{"type":"text","label":"Wage/Salary Desired","placeholder":"$","name":"Wage-Salary","className":"col-lg-4","subtype":"text"},{"type":"date","label":"When can you start?","placeholder":"mm/dd/yyyy","name":"Can-start","className":"col-lg-4"},{"type":"header","subtype":"h2","label":"Personal Information","className":"d-block"},{"type":"text","required":true,"label":"Last Name","name":"Last-name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"First Name","name":"First-Name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Middle Name","name":"Middle-Name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Address","placeholder":"Address","name":"Address","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"City","placeholder":"City","name":"current-city","className":"col-md-6","subtype":"text"},{"type":"select","required":true,"label":"State","name":"State","className":"col-md-6","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR","selected":true},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"ZIP Code","name":"current-zip","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Telephone number where you can be reached or a message left for you","name":"Phone-number","className":"col-md-6","subtype":"text"},{"type":"radio-group","required":true,"label":"Are you under the age of 18?","inline":true,"name":"Under-18","className":"d-block","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"radio-group","required":true,"label":"Have you ever worked for the City of Mountain Home?","inline":true,"name":"Worked-for-city","className":"col-md-6","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"text","label":"If so, what Department and Dates?","name":"Prev-dept","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"blockquote","label":"I know the following people employed by the City of Mountain Home:","className":"d-block"},{"type":"text","label":"First/Last Name","name":"Empl-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Position","name":"Position-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Relationship","name":"Relationship-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"First/Last Name","name":"Employee-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Position","name":"Position-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Relationship","name":"Relationship-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"First/Last Name","name":"Employee-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Position","name":"Position-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Relationship","name":"Relationship-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"First/Last Name","name":"Employee-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Position","name":"Position-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Relationship","name":"Relationship-4","className":"col-lg-4","subtype":"text"},{"type":"radio-group","required":true,"label":"Do you have the legal right to work and remain in the United States?","inline":true,"name":"Legal","className":"col-md-6","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"radio-group","required":true,"label":"If yes, can  you produce evidence of U.S. citizenship or legal work status within three (3) days?","inline":true,"name":"Citizen-doc","className":"col-md-6","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"radio-group","required":true,"label":"Can you perform the duties of the job for which you are applying with or without reasonable accommodation?","inline":true,"name":"perform-job","className":"col-md-6","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"text","label":"If no, will you need any accommodations?  Explain:  (Please attach additional pages if more space is needed.)","name":"accommodations","maxlength":100,"className":"col-md-6","subtype":"text"},{"type":"file","label":"Upload additional information regarding accommodations needed.","description":"Upload additional information regarding accommodations needed.","name":"Addl-accommodations","subtype":"file","multiple":true,"className":"d-block"},{"type":"header","subtype":"h2","label":"Education Record","className":"d-block"},{"type":"text","label":"High School Name","description":"Where did you attend High School?","name":"HS-name","className":"col-md-6","subtype":"text"},{"type":"text","label":"Location","description":"City, State where High School located.","name":"HS-location","className":"col-md-6","subtype":"text"},{"type":"text","label":"Years completed","description":"How many years of High School did you complete?","name":"HS-years","className":"col-lg-4","subtype":"text"},{"type":"radio-group","required":true,"label":"Did you graduate?","inline":true,"name":"HS-graduate","className":"col-lg-4","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"radio-group","label":"If \"No\", do you have a GED?","inline":true,"name":"GED","className":"col-lg-4","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"text","label":"College Name","description":"Name of college(s) attended.","name":"College","className":"col-md-6","subtype":"text"},{"type":"text","label":"Location","description":"City, State where college is located.","name":"College-location","className":"col-md-6","subtype":"text"},{"type":"text","label":"Years Completed","description":"How many years of college have you completed?","name":"College-years","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Major","description":"What did you major in?","name":"College-major","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Degree","description":"What college degree(s) did you earn?","name":"college-deg","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Business School","description":"What business school did you attend","name":"business-school","className":"col-md-6","subtype":"text"},{"type":"text","label":"Location","name":"bus-sch-location","className":"col-md-6","subtype":"text"},{"type":"text","label":"Years completed","description":"How many years of business school have you completed?","name":"bus-sch-years","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Course of Study","description":"What was your course of study?","name":"bus-sch-study","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Certificate / Degree Earned","description":"What certificate or degree have you earned?","name":"bus-sch-cert-deg","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Other schools attended and/or special education achievements","description":"What other schools have you attended?  What special education achievements have you received","name":"school-other","maxlength":100,"className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"radio-group","label":"Do you have a current commercial driver's license?","description":"Do you have a current commercial driver's license?","inline":true,"name":"commercial-DL","className":"d-block","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"header","subtype":"h2","label":"List all licenses you hold (Drivers, Electrician, First Aid, CPR, EMT, etc)","className":"d-block"},{"type":"text","label":"Type","description":"Type of license.","name":"Lic-type-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Number","description":"License or certificate number.","name":"lic-number-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Expiration Date","description":"Date license or certificate expires.","name":"lic-exp-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Type","description":"Type of license.","name":"Lic-type-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Number","description":"License or certificate number.","name":"Lic-number-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Expiration Date","description":"Date license or certificate expires.","name":"Lic-exp-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Type","description":"Type of license.","name":"Lic-type-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Number","description":"License or certificate number.","name":"Lic-number-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Expiration Date","description":"Date license or certificate expires.","name":"Lic-exp-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Type","description":"Type of license.","name":"Lic-type-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Number","description":"License or certificate number.","name":"Lic-number-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Expiration Date","description":"Date license or certificate expires.","name":"Lic-exp-4","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Employment History","className":"d-block"},{"type":"paragraph","subtype":"p","label":"List all employment (including military service3 for at least the past five (5) years.  Begin with your most recent and work back.  Include explanation of any gaps in employment.  Attach additional sheets or resume to provide sufficient qualifying experience data.","className":"d-block"},{"type":"text","label":"Company name","description":"What is the name of the company you worked for?","name":"Company-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address","description":"What is the address of the company you worked for?","name":"Company-add-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"City","description":"What city is the company located in?","name":"Company-City-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"State","description":"What state is the company located in?","name":"Company-state-1","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"ZIP code","description":"What is the ZIP Code where the company is located?","name":"Company-Zip-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Phone Number","description":"Please provide a phone number for the company you worked for.","name":"Company-phone-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Dates (From - To)","description":"List dates employed.","name":"Dates-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"Job Title","description":"What was your job title?","name":"Job-title-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"Primary Responsibilities","description":"What were your primary job responsibilities","name":"Prim-Resp-1","className":"d-block","subtype":"text"},{"type":"text","label":"Name of Direct Supervisor","description":"Who was your supervisor","name":"Super-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"Supervisor's Telephone ","description":"What is the supervisor's telephone number?","name":"Super-Tel-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"Reason for Leaving","description":"What was your reason for leaving employment?","name":"Reason-1","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"Company name ","description":"What is the name of the company you worked for?","name":"Company2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address ","description":"What is the address of the company you worked for?","name":"Address2","className":"col-md-6","subtype":"text"},{"type":"text","label":"City","description":"What city is the company located in?","name":"City2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"State","description":"What state is the company located in?","name":"State2","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"ZIP code","description":"What is the ZIP Code where the company is located?","name":"ZIP2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Phone Number","description":"Please provide a phone number for the company you worked for.","name":"Phone2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Dates (From - To)","description":"List dates employed.","name":"Dates-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Job Title","description":"What was your job title?","name":"Job-title-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Primary Responsibilities","description":"What were your primary job responsibilities","name":"Prim-Resp-2","className":"d-block","subtype":"text"},{"type":"text","label":"Name of Direct Supervisor","description":"Who was your supervisor","name":"Super-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Supervisor's Telephone ","description":"What is the supervisor's telephone number?","name":"Sup-Tel-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Reason for Leaving","description":"What was your reason for leaving employment?","name":"Reason-2","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"Company name","description":"What is the name of the company you worked for?","name":"Company-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address","description":"What is the address of the company you worked for?","name":"Address3","className":"col-md-6","subtype":"text"},{"type":"text","label":"City","description":"What city is the company located in?","name":"City3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"State","description":"What state is the company located in?","name":"State3","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"ZIP code","description":"What is the ZIP Code where the company is located?","name":"ZIP3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Phone Number","description":"Please provide a phone number for the company you worked for.","name":"Phone3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Dates (From - To)","description":"List dates employed.","name":"Dates-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Job Title","description":"What was your job title?","name":"Job-Title-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Primary Responsibilities","description":"What were your primary job responsibilities","name":"Prim-Resp-3","className":"d-block","subtype":"text"},{"type":"text","label":"Name of Direct Supervisor","description":"Who was your supervisor","name":"Super-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Supervisor's Telephone ","description":"What is the supervisor's telephone number?","name":"Sup-Tel-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Reason for Leaving","description":"What was your reason for leaving employment?","name":"Reason-3","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"Company name","description":"What is the name of the company you worked for?","name":"Company4","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address","description":"What is the address of the company you worked for?","name":"Address4","className":"col-md-6","subtype":"text"},{"type":"text","label":"City","description":"What city is the company located in?","name":"City4","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"State","description":"What state is the company located in?","name":"State4","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL","selected":true},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of 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Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"ZIP code","description":"What is the ZIP Code where the company is located?","name":"ZIP4","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Phone Number","description":"Please provide a phone number for the company you worked for.","name":"Phone4","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Dates (From - To)","description":"List dates employed.","name":"Dates-4","className":"col-md-6","subtype":"text"},{"type":"text","label":"Job Title","description":"What was your job title?","name":"Job-Title-4","className":"col-md-6","subtype":"text"},{"type":"text","label":"Primary Responsibilities","description":"What were your primary job responsibilities","name":"Prim-Resp-4","className":"d-block","subtype":"text"},{"type":"text","label":"Name of Direct Supervisor","description":"Who was your supervisor","name":"Super-4","className":"col-md-6","subtype":"text"},{"type":"text","label":"Supervisor's Telephone ","description":"What is the supervisor's telephone number?","name":"Sup-Tel-4","className":"col-md-6","subtype":"text"},{"type":"text","label":"Reason for Leaving","description":"What was your reason for leaving employment?","name":"Reason-4","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"Company name","description":"What is the name of the company you worked for?","name":"Company5","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address","description":"What is the address of the company you worked for?","name":"Address5","className":"col-md-6","subtype":"text"},{"type":"text","label":"City","description":"What city is the company located in?","name":"City5","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"State","description":"What state is the company located in?","name":"State5","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"ZIP code","description":"What is the ZIP Code where the company is located?","name":"ZIP5","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Phone Number","description":"Please provide a phone number for the company you worked for.","name":"Phone5","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Job Title","description":"What was your job title?","name":"Job-Title-5","className":"col-md-6","subtype":"text"},{"type":"text","label":"Dates (From - To)","description":"List dates employed.","name":"Dates-5","className":"col-md-6","subtype":"text"},{"type":"text","label":"Primary Responsibilities","description":"What were your primary job responsibilities","name":"Prim-Resp-5","className":"d-block","subtype":"text"},{"type":"text","label":"Name of Direct Supervisor","description":"Who was your supervisor","name":"Super-5","className":"col-md-6","subtype":"text"},{"type":"text","label":"Supervisor's Telephone ","description":"What is the supervisor's telephone number?","name":"Sup-Tel-5","className":"col-md-6","subtype":"text"},{"type":"text","label":"Reason for Leaving","description":"What was your reason for leaving employment?","name":"Reason-5","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"textarea","label":"In addition to your work history, what other experiences, skills or qualifications would especially qualify you for the work with the City of Mountain Home?  Specify office equipment, software, machines, computers you can operate.","name":"Other-Skills","subtype":"textarea","maxlength":300,"rows":3,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"References","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Give the names and addresses/phone numbers of three (3) persons, other than relatives, who have knowledge of your character, experience or ability:","className":"d-block"},{"type":"text","label":"Name","name":"Ref-Name-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Address/Phone Number","name":"Ref-Add-Ph-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Occupation","name":"Ref-occupation-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Name","name":"Ref---Name---2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Address/Phone Number","name":"Ref-Add-Ph-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Occupation","name":"Ref-Occupation-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Name","name":"Ref-Name-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Address/Phone Number","name":"Ref-Add-Ph-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Occupation","name":"Ref-Occupation-3","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Certification and Consent","className":"d-block"},{"type":"paragraph","subtype":"p","label":"     I understand that this application is not intended to create any contractual or other legal rights.  It does not alter the at-will employment status, nor does it create an employment contract.  I understand that no representation, whether oral or written, by any representative or agent of the City of Mountain Home, at any time, can constitute an implied or expressed contract of employment.  I further understand no representative or agent of the City of Mountain Home has the authority to enter into an agreement for employment for any specified period of time or to make any changes in any policy, procedure, benefit or other terms or condition of employment other than in a document signed by the Mayor.  I expressly understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent and may be terminated at will, with or without cause, by either the City of Mountain Home or me without prior notice to the other, unless otherwise prohibited by law.<div></div><div>     I certify that I have made no willful misrepresentations in this application, nor have I withheld information in my statements and answers to questions.  I am aware that the information given by me in my application will be investigated, with my full permission, and that any misrepresentations may cause my application to be rejected or my employment terminated.</div><div></div><div>     I authorize former employers to release to the City of Mountain Home or its authorized representative any and all employment records and other information it may have about my employment.  I understand that the information will be used for the purpose of evaluating my application for employment with the City.  A photocopy of this authorization shall be as valid as the original.</div><div></div><div>I understand that this appointment will be at the discretion of the department head, subject to the approval of the mayor and that this application is the property of the City and will become a part of my file if I am accepted for employment.</div><div></div><div>     I also understand that employment with the City of Mountain Home is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.</div><div></div><div>     I further understand that the City requires a medical examination by a City-designated physician (1) after I have received an offer of employment and prior to my commencement of employment duties; and, (2) during the course of my employment as required by business necessity and for job related purposes.  I hereby consent to such examination and recognize that employment is contingent upon receipt of a satisfactory medical evaluation.  I further understand and agree that prior to commencing employment or after I am employed, I may be requested to submit to tests to determine the presence of alcohol or illegal drugs, and agree to the release of such test results to the appropriate City personnel, and agree that if I refuse and/or fail such tests before commencing employment, my offer of employment will be revoked, or if I refuse and/or fail such tests after being employed, my employment will be terminated.  Additional testing may be required relating to the position.</div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Signature of Applicant","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Typing your name below and submitting constitutes a signature.","className":"d-block"},{"type":"text","required":true,"label":"Signature","name":"Signature","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Date","description":"Date application completed","placeholder":"mm/dd/yyyy","name":"appl-date","className":"col-md-6","subtype":"text"}]