cov-ror.azurewebsites.net Open in urlscan Pro
20.49.104.48  Public Scan

Form analysis
1 forms found in the DOM

POST /Search

<form action="/Search" autocomplete="off" class="form-inline" id="contactSearchForm" method="post" novalidate="novalidate"><input name="__RequestVerificationToken" type="hidden"
    value="XxM5ZZ0kyB4uluqKw13T3RiaBXZkpjxwra0E0cZuNsaNPHExc7QpMQ-Gp5kvjqjLLze5QzMjzyIFhz93ZlsIoOuJvQQ1">
  <fieldset style="border: none;">
    <div class="line">
      <label class="form-control-static">All fields are required</label>
    </div>
    <div class="line row">
      <div class="form-group col-md-3">
        <div class="editor-label">
          <label for="FirstName">First Name</label>
        </div>
        <div class="editor-field">
          <input class="text-box single-line" data-val="true" data-val-required="Please enter the first name" id="FirstName" name="FirstName" type="text" value="">
          <span class="field-validation-valid" data-valmsg-for="FirstName" data-valmsg-replace="true"></span>
        </div>
      </div>
      <div class="form-group col-md-3">
        <div class="editor-label">
          <label for="LastName">Last Name</label>
        </div>
        <div class="editor-field">
          <input class="text-box single-line" data-val="true" data-val-required="Please enter the last name" id="LastName" name="LastName" type="text" value="">
          <span class="field-validation-valid" data-valmsg-for="LastName" data-valmsg-replace="true"></span>
        </div>
      </div>
      <div class="form-group col-md-3">
        <div class="editor-label">
          <label for="Dob">Date of Birth</label>
        </div>
        <div class="editor-field">
          <input class="text-box single-line hasDatepicker" data-val="true" data-val-agerestriction="The date of birth should be at least 18 years ago" data-val-agerestriction-minage="18" data-val-date="The field Date of Birth must be a date."
            data-val-required="Please enter the date of birth" id="Dob" name="Dob" type="text" value="" placeholder="MM/DD/YYYY">
          <span class="field-validation-valid" data-valmsg-for="Dob" data-valmsg-replace="true"></span>
        </div>
      </div>
      <div class="form-group col-md-3">
        <div class="editor-label">
          <label for="Ssn">SSN</label>
        </div>
        <div class="editor-field">
          <input class="form-control" data-val="true" data-val-regex="Please enter your full Social Security Number (9 digits, no dashes)" data-val-regex-pattern="\d{9}" data-val-required="Please enter your Social Security Number" id="Ssn"
            maxlength="9" name="Ssn" placeholder="#########" style="border-radius: 0; height: inherit;" type="password">
          <span class="field-validation-valid" data-valmsg-for="Ssn" data-valmsg-replace="true"></span>
        </div>
      </div>
    </div>
    <div class="line">
      <div class="item uniCol">
        <button type="submit" class="btn btn-default">Search</button>
      </div>
    </div>
  </fieldset>
</form>

Text Content

A Commonwealth of Virginia Website
 * Virginia.gov
 * Find an Agency


SECRETARY OF THE COMMONWEALTH RESTORATION OF RIGHTS

 * Secretary of the Commonwealth

 * Commonwealth

JavaScript must be enabled to use this application.


RESTORATION OF RIGHTS

Please fill out the fields below so we can better assist you.

All fields are required
First Name

Last Name

Date of Birth

SSN

Search
Secretary of the Commonwealth
 * Restoration of Rights Process
 * Policy Updates and Timeline
 * Resources for Returning Citizens
 * Frequently Asked Questions
 * Testimonials

Site Resources
 * Website Feedback
 * 
 * Accessibility
 * Site Map

Stay Connected
 * Secretary of the Commonwealth
   P.O. Box 1475
   Richmond, VA 23218
   Send us a message:
   Email the Secretariat