hra.healthcaresource.com Open in urlscan Pro
64.74.110.196  Public Scan

Form analysis
1 forms found in the DOM

POST /user/referenceVerificationStep2

<form id="reference-form" action="/user/referenceVerificationStep2" method="post">
  <div class="row">
    <div class="panel panel-default">
      <div class="panel-heading"><span>Tell Us about your working relationship with Sydney Walbert</span></div>
      <div class="panel-body">
        <div class="clearfix form-group " id="">
          <label class="col-md-3 col-form-label required" for="ReferenceForm_relationship">Relationship with candidate Sydney Walbert <span class="required">*</span></label>
          <div class="input col-md-9">
            <select class="form-control" name="ReferenceForm[relationship]" id="ReferenceForm_relationship">
              <option value="">Select</option>
              <option value="Supervisor" selected="selected">Lead/Supervisor</option>
              <option value="Peer">Peer</option>
              <option value="Subordinate">Subordinate</option>
              <option value="Customer">Customer</option>
              <option value="Vendor/Service Provider">Vendor/Service Provider</option>
              <option value="Consultant">Consultant</option>
              <option value="Instructor/Trainer">Instructor/Trainer</option>
              <option value="Other">Other</option>
            </select>
          </div>
        </div>
        <div class="clearfix form-group " id="">
          <label class="col-md-3 col-form-label required" for="ReferenceForm_company">Company where you and candidate worked together <span class="required">*</span></label>
          <div class="input col-md-9">
            <input class="form-control" name="ReferenceForm[company]" id="ReferenceForm_company" type="text" maxlength="45" value="One year">
          </div>
        </div>
        <div class="clearfix form-group " id="">
          <label class="col-md-3 col-form-label required" for="ReferenceForm_how_long_reference_know_candidate">How long have you and Sydney Walbert known each other? <span class="required">*</span></label>
          <div class="input col-md-9">
            <select class="form-control" name="ReferenceForm[how_long_reference_know_candidate]" id="ReferenceForm_how_long_reference_know_candidate">
              <option value="">Select</option>
              <option value="Three months or less">Three Months or Less</option>
              <option value="Three months to one year">Three Months to One Year</option>
              <option value="One to two years">One Year</option>
              <option value="Two to five years">Two to Five Years</option>
              <option value="Greater than five years">Greater Than Five Years</option>
            </select>
          </div>
        </div>
        <div class="clearfix form-group " id="">
          <label class="col-md-3 col-form-label required" for="ReferenceForm_title">Title when you worked together <span class="required">*</span></label>
          <div class="input col-md-9">
            <input class="form-control" name="ReferenceForm[title]" id="ReferenceForm_title" type="text" maxlength="45" value="Manager">
          </div>
        </div>
        <div class="clearfix form-group " id="">
          <label class="col-md-3 col-form-label required" for="ReferenceForm_job_category">Job Category <span class="required">*</span></label>
          <div class="input col-md-9">
            <select class="form-control" name="ReferenceForm[job_category]" id="ReferenceForm_job_category">
              <option value="">Select</option>
              <option value="Administrative/Clerical">Administrative/Clerical</option>
              <option value="Arts/Creative/Musician">Arts/Creative/Musician</option>
              <option value="Building Construction" selected="selected">Building Construction</option>
              <option value="Consulting">Consulting</option>
              <option value="Design">Design</option>
              <option value="Customer Service / Client Care">Customer Service / Client Care</option>
              <option value="Doctor/Dentist/Veterinarian">Doctor/Dentist/Veterinarian</option>
              <option value="Education">Education</option>
              <option value="Engineering/Scientific">Engineering/Scientific</option>
              <option value="Executive Management">Executive Management</option>
              <option value="Financial/Accounting/Actuarial">Financial/Accounting/Actuarial</option>
              <option value="Food Service">Food Service</option>
              <option value="Healthcare/Medical">Healthcare/Medical</option>
              <option value="Hospitality/Hotel">Hospitality/Hotel</option>
              <option value="Human Resources">Human Resources</option>
              <option value="Information Technology">Information Technology</option>
              <option value="Labor">Labor</option>
              <option value="Legal">Legal</option>
              <option value="Logistics/Distribution">Logistics/Distribution</option>
              <option value="Management/Strategic Management">Management/Strategic Management</option>
              <option value="Manufacturing">Manufacturing</option>
              <option value="Nurse">Nurse</option>
              <option value="Other">Other</option>
              <option value="Operations">Operations</option>
              <option value="Publishing/Editorial/Writing">Publishing/Editorial/Writing</option>
              <option value="Purchasing">Purchasing</option>
              <option value="Retail">Retail</option>
              <option value="Real Estate">Real Estate</option>
              <option value="Quality Assurance/Safety">Quality Assurance/Safety</option>
              <option value="Sales/Marketing">Sales/Marketing</option>
              <option value="Security/Protection/Law Enforcment">Security/Protection/Law Enforcment</option>
              <option value="Skilled Trade">Skilled Trade</option>
              <option value="Sports">Sports</option>
              <option value="Supply Chain">Supply Chain</option>
              <option value="Telecommunications">Telecommunications</option>
              <option value="Training">Training</option>
              <option value="Transportation">Transportation</option>
            </select>
          </div>
        </div>
        <div class="clearfix form-group " id="">
          <label class="col-md-3 col-form-label required" for="ReferenceForm_job_level">Job Level <span class="required">*</span></label>
          <div class="input col-md-9">
            <select class="form-control" name="ReferenceForm[job_level]" id="ReferenceForm_job_level">
              <option value="">Select</option>
              <option value="Board Member">Board Member</option>
              <option value="C-Level">C-Level</option>
              <option value="Vice President">Vice President</option>
              <option value="Director">Director</option>
              <option value="Manager" selected="selected">Manager</option>
              <option value="Individual Contributor">Individual Contributor</option>
              <option value="Specialist/Professional">Specialist/Professional</option>
              <option value="Unemployed/Retired">Unemployed/Retired</option>
              <option value="Self-Employed">Self-Employed</option>
            </select>
          </div>
        </div>
        <div class="clearfix form-group " id="">
          <label class="col-md-3 col-form-label required" for="ReferenceForm_reference_description">Describe your working relationship <span class="required">*</span></label>
          <div class="input col-md-9">
            <textarea class="autosize form-control" rows="5" name="ReferenceForm[reference_description]" id="ReferenceForm_reference_description"
              style="overflow: hidden; overflow-wrap: break-word; max-height: 114px; min-height: 114px; height: 114px;"></textarea>
          </div>
        </div>
        <p class="note">Fields with <span class="required">*</span> are required.</p>
      </div>
    </div>
  </div>
  <div class="actions centered">
    <input class="btn special large" type="submit" name="yt0" value="Save and Continue >>>">
  </div>
</form>

Text Content

REFERENCE VERIFICATION

Tell Us about your working relationship with Sydney Walbert
Relationship with candidate Sydney Walbert *
Select Lead/Supervisor Peer Subordinate Customer Vendor/Service Provider
Consultant Instructor/Trainer Other
Company where you and candidate worked together *

How long have you and Sydney Walbert known each other? *
Select Three Months or Less Three Months to One Year One Year Two to Five Years
Greater Than Five Years
Title when you worked together *

Job Category *
Select Administrative/Clerical Arts/Creative/Musician Building Construction
Consulting Design Customer Service / Client Care Doctor/Dentist/Veterinarian
Education Engineering/Scientific Executive Management
Financial/Accounting/Actuarial Food Service Healthcare/Medical Hospitality/Hotel
Human Resources Information Technology Labor Legal Logistics/Distribution
Management/Strategic Management Manufacturing Nurse Other Operations
Publishing/Editorial/Writing Purchasing Retail Real Estate Quality
Assurance/Safety Sales/Marketing Security/Protection/Law Enforcment Skilled
Trade Sports Supply Chain Telecommunications Training Transportation
Job Level *
Select Board Member C-Level Vice President Director Manager Individual
Contributor Specialist/Professional Unemployed/Retired Self-Employed
Describe your working relationship *


Fields with * are required.



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