wellnessme.zohorecruit.com Open in urlscan Pro
136.143.191.8  Public Scan

Submitted URL: https://www.applytodaynow.net/
Effective URL: https://wellnessme.zohorecruit.com/recruit/WebFormServeServlet?rid=1a5bc848db2404b481851054bcd65c8bec70705441d006c09f5aca1c26e26b68...
Submission: On July 26 via manual from US — Scanned from DE

Form analysis 2 forms found in the DOM

Name: dependencyform437052000000072351GET https://wellnessme.zohorecruit.com/recruit/FetchDependency.na

<form action="https://wellnessme.zohorecruit.com/recruit/FetchDependency.na" target="webformframe437052000000072351" method="GET" name="dependencyform437052000000072351"><input type="hidden" name="depid"
    value="0c09b2562a6720ccc3c18a1179079a2a"><input name="depmodule" type="hidden" value="Leads"><input name="locale" type="hidden" value="en_US"></form>

Name: WebToLeads437052000000072351POST https://wellnessme.zohorecruit.com/recruit/WebToLeadForm

<form action="https://wellnessme.zohorecruit.com/recruit/WebToLeadForm" name="WebToLeads437052000000072351" target="webformframe437052000000072351" method="POST" enctype="multipart/form-data"
  onsubmit="javascript:document.charset=&quot;UTF-8&quot;; return checkValidation()" accept-charset="UTF-8" onreset="return resetMP();"> <input type="text" style="display:none;" name="xnQsjsdp" value="0c09b2562a6720ccc3c18a1179079a2a"> <input
    type="hidden" name="zc_gad" id="zc_gad" value=""> <input type="text" style="display:none;" name="xmIwtLD" value="1a5bc848db2404b481851054bcd65c8bec70705441d006c09f5aca1c26e26b68"> <input type="text" style="display:none;" name="actionType"
    value="TGVhZHM="> <input type="text" style="display:none;" name="returnURL" value=""> <input type="text" style="display:none;" id="applyjobid" name="applyjobid" value=""> <input type="text" value="" name="embedsource" style="display:none;"
    id="embedsource"> <input type="text" value="" name="duplicateCheckId" style="display:none;" id="duplicateCheckId">
  <p style="background:#f4f4f4;color:#000000;padding:10px 20px;font-size:1em;font-weight:normal;margin:25px 0 0;" tabindex="0">Basic Info</p>
  <div style="padding:0 15px 15px 15px;margin-top:5px;">
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">First Name: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div> <input aria-required="true" aria-label="First Name" type="text" value="" name="First Name" data-it="false"
        data-im="true" data-l="First Name" data-uitype="27" maxlength="125" style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
    </div>
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">Last Name: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div> <input aria-required="true" aria-label="Last Name" type="text" value="" name="Last Name" data-it="false"
        data-im="true" data-l="Last Name" data-uitype="127" maxlength="125" style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
    </div>
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">Phone: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div> <input aria-required="true" aria-label="Phone" type="text" value="" name="Phone" data-it="false" data-im="true"
        data-l="Phone" data-uitype="33" maxlength="30" style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
    </div>
  </div>
  <p style="background:#f4f4f4;color:#000000;padding:10px 20px;font-size:1em;font-weight:normal;margin:25px 0 0;" tabindex="0">Address Information</p>
  <div style="padding:0 15px 15px 15px;margin-top:5px;">
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">Country: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div> <input aria-required="true" aria-label="Country" type="text" value="" name="Country" data-it="false"
        data-im="true" data-l="Country" data-uitype="1" maxlength="255" style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
    </div>
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">Street: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div> <input aria-required="true" aria-label="Street" type="text" value="" name="Street" data-it="false" data-im="true"
        data-l="Street" data-uitype="1" maxlength="250" style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
    </div>
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">City: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div> <input aria-required="true" aria-label="City" type="text" value="" name="City" data-it="false" data-im="true"
        data-l="City" data-uitype="1" maxlength="255" style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
    </div>
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">State/Province: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div> <input aria-required="true" aria-label="State/Province" type="text" value="" name="State" data-it="false"
        data-im="true" data-l="State/Province" data-uitype="1" maxlength="255" style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
    </div>
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">Zip/Postal Code: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div> <input aria-required="true" aria-label="Zip/Postal Code" type="text" value="" name="Zip Code"
        data-it="false" data-im="true" data-l="Zip/Postal Code" data-uitype="1" maxlength="30"
        style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
    </div>
  </div>
  <p style="background:#f4f4f4;color:#000000;padding:10px 20px;font-size:1em;font-weight:normal;margin:25px 0 0;" tabindex="0">Experience Details</p>
  <div class="TD-twocol" style="padding: 20px 20px 0px;" id="437052000000188217" data-l="Experience Details">
    <a href="javascript:;" onclick="addTbData(this)" data-sectionid="437052000000188217" data-gentype="1" class="TD-ExpaddBn solgan-btn" title="Add Experience Details" style="text-decoration: none;display: inline;margin-left:20px;font-size:12px;color: #3b5a99;font-family:Arial"> <span class="f15">+ </span>Add Experience Details</a>
    <div tabindex="0" style="margin-top:5px;padding:10px 0% 10px 3%;position: relative;margin: 20px 0px 0px 0px;border: 1px solid #f0f0f0;display:none" class="innerElem 437052000000188217" data-errormsg="You can add up to five current workplaces.">
      <a href="javascript:;" onclick="deleteTbRow(this)" data-sectionid="437052000000188217" class="TD-delbtn" title="Delete Experience Details" style="float: right;color: #ff0000;font-family: Arial;font-size: 12px;right: 19px;text-decoration: none;position: relative;"><span class="">x</span> Delete</a>
      <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
        <div style="font-size:12px">Occupation / Title:</div> <input aria-required="false" aria-label="Occupation / Title" type="text" value="" data-it="true" class="TF_5513631158662179" data-im="false" data-l="Occupation / Title" data-uitype="1"
          maxlength="255" style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
      </div>
      <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
        <div style="font-size:12px">Company:</div> <input aria-required="false" aria-label="Company" type="text" value="" data-it="true" class="TF_5513631158757704" data-im="false" data-l="Company" data-uitype="1" maxlength="255"
          style="border:1px solid #ddd;color:#000000;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;outline:none;-webkit-appearance:none;width:300px;margin-top:3px;">
      </div>
      <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
        <div style="font-size:12px">Summary:</div> <textarea data-it="true" class="TF_5513631158808221" data-im="false" data-l="Summary" maxlength="6000" data-uitype="110" aria-required="false" aria-label="Summary"
          style="border:1px solid #ddd;color:#000000;resize:vertical;padding:8px 0px 8px 4px;font-size:1.1em;border-radius:2px;height:70px;margin-left:27px;-webkit-appearance:none;outline:none;outline: none;width:300px;margin:3px 0 0;"></textarea>
      </div>
      <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
        <div style="display:none">&nbsp;</div>
        <div style="overflow:hidden;width:320px;" id="TF_5513631158847545" data-uitype="6607">
          <div style="width:48%;float:left;">
            <div style="font-size:12px">Work Duration:</div>
            <div style="float:left;margin-right:6px;width:42%;"><select aria-required="false" aria-label="Work Duration From" style="border:1px solid #ddd;font-size:1em;border-radius:2px;margin-top:4px;color:#666;width:100%;height:32px;outline:none;"
                data-it="true" class="TF_5513631158847545_from_month" data-im="false" data-l="Work Duration" data-uitype="6607">
                <option value="">Month</option>
                <option value="1">Jan</option>
                <option value="2">Feb</option>
                <option value="3">Mar</option>
                <option value="4">Apr</option>
                <option value="5">May</option>
                <option value="6">Jun</option>
                <option value="7">Jul</option>
                <option value="8">Aug</option>
                <option value="9">Sep</option>
                <option value="10">Oct</option>
                <option value="11">Nov</option>
                <option value="12">Dec</option>
              </select></div>
            <div style="float:left;width:42%;"><select aria-required="false" aria-label="From" style="border:1px solid #ddd;font-size:1em;border-radius:2px;margin-top:4px;color:#666;width:100%;height:32px;outline:none;"
                class="TF_5513631158847545_from_year">
                <option value="">Year</option>
                <option value="1950">1950</option>
                <option value="1951">1951</option>
                <option value="1952">1952</option>
                <option value="1953">1953</option>
                <option value="1954">1954</option>
                <option value="1955">1955</option>
                <option value="1956">1956</option>
                <option value="1957">1957</option>
                <option value="1958">1958</option>
                <option value="1959">1959</option>
                <option value="1960">1960</option>
                <option value="1961">1961</option>
                <option value="1962">1962</option>
                <option value="1963">1963</option>
                <option value="1964">1964</option>
                <option value="1965">1965</option>
                <option value="1966">1966</option>
                <option value="1967">1967</option>
                <option value="1968">1968</option>
                <option value="1969">1969</option>
                <option value="1970">1970</option>
                <option value="1970">1970</option>
                <option value="1971">1971</option>
                <option value="1972">1972</option>
                <option value="1973">1973</option>
                <option value="1974">1974</option>
                <option value="1975">1975</option>
                <option value="1976">1976</option>
                <option value="1977">1977</option>
                <option value="1978">1978</option>
                <option value="1979">1979</option>
                <option value="1980">1980</option>
                <option value="1981">1981</option>
                <option value="1982">1982</option>
                <option value="1983">1983</option>
                <option value="1984">1984</option>
                <option value="1985">1985</option>
                <option value="1986">1986</option>
                <option value="1987">1987</option>
                <option value="1988">1988</option>
                <option value="1989">1989</option>
                <option value="1990">1990</option>
                <option value="1991">1991</option>
                <option value="1992">1992</option>
                <option value="1993">1993</option>
                <option value="1994">1994</option>
                <option value="1995">1995</option>
                <option value="1996">1996</option>
                <option value="1997">1997</option>
                <option value="1998">1998</option>
                <option value="1999">1999</option>
                <option value="2000">2000</option>
                <option value="2001">2001</option>
                <option value="2002">2002</option>
                <option value="2003">2003</option>
                <option value="2004">2004</option>
                <option value="2005">2005</option>
                <option value="2006">2006</option>
                <option value="2007">2007</option>
                <option value="2008">2008</option>
                <option value="2009">2009</option>
                <option value="2010">2010</option>
                <option value="2011">2011</option>
                <option value="2012">2012</option>
                <option value="2013">2013</option>
                <option value="2014">2014</option>
                <option value="2015">2015</option>
                <option value="2016">2016</option>
                <option value="2017">2017</option>
                <option value="2018">2018</option>
                <option value="2019">2019</option>
                <option value="2020">2020</option>
                <option value="2021">2021</option>
                <option value="2022">2022</option>
                <option value="2023">2023</option>
                <option value="2024">2024</option>
                <option value="2025">2025</option>
                <option value="2026">2026</option>
                <option value="2027">2027</option>
                <option value="2028">2028</option>
                <option value="2029">2029</option>
                <option value="2030">2030</option>
                <option value="2031">2031</option>
                <option value="2032">2032</option>
                <option value="2033">2033</option>
                <option value="2034">2034</option>
                <option value="2035">2035</option>
                <option value="2036">2036</option>
                <option value="2037">2037</option>
                <option value="2038">2038</option>
                <option value="2039">2039</option>
                <option value="2040">2040</option>
                <option value="2041">2041</option>
                <option value="2042">2042</option>
                <option value="2043">2043</option>
                <option value="2044">2044</option>
                <option value="2045">2045</option>
                <option value="2046">2046</option>
                <option value="2047">2047</option>
                <option value="2048">2048</option>
                <option value="2049">2049</option>
                <option value="2050">2050</option>
              </select></div>
          </div>
          <div style="float:left;width:48%;" class="toMonthRange">
            <div style="font-size:12px;">To:</div>
            <div style="float:left;margin-right:6px;width:42%;"><select aria-required="false" aria-label="To" style="border:1px solid #ddd;font-size:1em;border-radius:2px;margin-top:4px;color:#666;width:100%;height:32px;outline:none;"
                class="TF_5513631158847545_to_month">
                <option value="">Month</option>
                <option value="1">Jan</option>
                <option value="2">Feb</option>
                <option value="3">Mar</option>
                <option value="4">Apr</option>
                <option value="5">May</option>
                <option value="6">Jun</option>
                <option value="7">Jul</option>
                <option value="8">Aug</option>
                <option value="9">Sep</option>
                <option value="10">Oct</option>
                <option value="11">Nov</option>
                <option value="12">Dec</option>
              </select></div>
            <div style="float:left;width:42%;"><select aria-required="false" aria-label="To" style="border:1px solid #ddd;font-size:1em;border-radius:2px;margin-top:4px;color:#666;width:100%;height:32px;outline:none;"
                class="TF_5513631158847545_to_year">
                <option value="">Year</option>
                <option value="1950">1950</option>
                <option value="1951">1951</option>
                <option value="1952">1952</option>
                <option value="1953">1953</option>
                <option value="1954">1954</option>
                <option value="1955">1955</option>
                <option value="1956">1956</option>
                <option value="1957">1957</option>
                <option value="1958">1958</option>
                <option value="1959">1959</option>
                <option value="1960">1960</option>
                <option value="1961">1961</option>
                <option value="1962">1962</option>
                <option value="1963">1963</option>
                <option value="1964">1964</option>
                <option value="1965">1965</option>
                <option value="1966">1966</option>
                <option value="1967">1967</option>
                <option value="1968">1968</option>
                <option value="1969">1969</option>
                <option value="1970">1970</option>
                <option value="1970">1970</option>
                <option value="1971">1971</option>
                <option value="1972">1972</option>
                <option value="1973">1973</option>
                <option value="1974">1974</option>
                <option value="1975">1975</option>
                <option value="1976">1976</option>
                <option value="1977">1977</option>
                <option value="1978">1978</option>
                <option value="1979">1979</option>
                <option value="1980">1980</option>
                <option value="1981">1981</option>
                <option value="1982">1982</option>
                <option value="1983">1983</option>
                <option value="1984">1984</option>
                <option value="1985">1985</option>
                <option value="1986">1986</option>
                <option value="1987">1987</option>
                <option value="1988">1988</option>
                <option value="1989">1989</option>
                <option value="1990">1990</option>
                <option value="1991">1991</option>
                <option value="1992">1992</option>
                <option value="1993">1993</option>
                <option value="1994">1994</option>
                <option value="1995">1995</option>
                <option value="1996">1996</option>
                <option value="1997">1997</option>
                <option value="1998">1998</option>
                <option value="1999">1999</option>
                <option value="2000">2000</option>
                <option value="2001">2001</option>
                <option value="2002">2002</option>
                <option value="2003">2003</option>
                <option value="2004">2004</option>
                <option value="2005">2005</option>
                <option value="2006">2006</option>
                <option value="2007">2007</option>
                <option value="2008">2008</option>
                <option value="2009">2009</option>
                <option value="2010">2010</option>
                <option value="2011">2011</option>
                <option value="2012">2012</option>
                <option value="2013">2013</option>
                <option value="2014">2014</option>
                <option value="2015">2015</option>
                <option value="2016">2016</option>
                <option value="2017">2017</option>
                <option value="2018">2018</option>
                <option value="2019">2019</option>
                <option value="2020">2020</option>
                <option value="2021">2021</option>
                <option value="2022">2022</option>
                <option value="2023">2023</option>
                <option value="2024">2024</option>
                <option value="2025">2025</option>
                <option value="2026">2026</option>
                <option value="2027">2027</option>
                <option value="2028">2028</option>
                <option value="2029">2029</option>
                <option value="2030">2030</option>
                <option value="2031">2031</option>
                <option value="2032">2032</option>
                <option value="2033">2033</option>
                <option value="2034">2034</option>
                <option value="2035">2035</option>
                <option value="2036">2036</option>
                <option value="2037">2037</option>
                <option value="2038">2038</option>
                <option value="2039">2039</option>
                <option value="2040">2040</option>
                <option value="2041">2041</option>
                <option value="2042">2042</option>
                <option value="2043">2043</option>
                <option value="2044">2044</option>
                <option value="2045">2045</option>
                <option value="2046">2046</option>
                <option value="2047">2047</option>
                <option value="2048">2048</option>
                <option value="2049">2049</option>
                <option value="2050">2050</option>
              </select></div>
          </div>
        </div>
      </div>
      <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
        <div style="font-size:12px;overflow:hidden;margin-right:18px;"><input aria-required="false" aria-label="I currently work here" style="margin:12px 0 0 27px;margin-left:10px;float:left;margin-right:10px" data-uitype="301" maxlength="3"
            data-it="true" class="TF_5513631158888549" data-im="false" data-l="I currently work here" onclick="tabularChkBx(event,this)" type="checkbox">
          <div style="float:left;padding:10px 0 0 0;font-size:12px;margin-top:1px;cursor: default;" onclick="tabularChkBx(event,this)">I currently work here</div>
        </div>
      </div>
    </div><input type="hidden" readonly="readonly" id="Tinfo_437052000000188217" disabled="disabled"
      value="[{&quot;gentype&quot;:1,&quot;name&quot;:&quot;TF_5513631158662179&quot;,&quot;uitype&quot;:1,&quot;colid&quot;:&quot;437052000000188218&quot;,&quot;l&quot;:&quot;Occupation / Title&quot;},{&quot;gentype&quot;:1,&quot;name&quot;:&quot;TF_5513631158757704&quot;,&quot;uitype&quot;:1,&quot;colid&quot;:&quot;437052000000188220&quot;,&quot;l&quot;:&quot;Company&quot;},{&quot;gentype&quot;:1,&quot;name&quot;:&quot;TF_5513631158808221&quot;,&quot;uitype&quot;:110,&quot;colid&quot;:&quot;437052000000188222&quot;,&quot;l&quot;:&quot;Summary&quot;},{&quot;gentype&quot;:1,&quot;name&quot;:&quot;TF_5513631158847545&quot;,&quot;uitype&quot;:6607,&quot;colid&quot;:&quot;437052000000188224&quot;,&quot;l&quot;:&quot;Work Duration&quot;},{&quot;gentype&quot;:1,&quot;name&quot;:&quot;TF_5513631158888549&quot;,&quot;uitype&quot;:301,&quot;colid&quot;:&quot;437052000000188226&quot;,&quot;l&quot;:&quot;I currently work here&quot;}]">
  </div>
  <div class="TD-AddBnMr" style="display:none;">
    <ul style="text-align: center; font-size: 0; padding: 0; margin: 0; position: relative; bottom: -11px; list-style: none outside none;">
      <li style="display: inline-block;">
        <a href="javascript:;" onclick="addTbData(this)" style="color: #5f7bad;text-decoration:none;border: 1px solid #ededed;padding: 10px 40px;font-size: 12px;float: left;font-family:Arial" data-sectionid="437052000000188217" title="Add Experience Details"> <span>+</span>Add Experience Details</a>
      </li>
    </ul><input type="hidden" value="" class="tabularInput" data-t="437052000000188217" data-l="Experience Details" data-ism="false" id="T_437052000000188217" name="T_437052000000188217" data-uitype="6604"><input type="hidden" value=""
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  <p style="background:#f4f4f4;color:#000000;padding:10px 20px;font-size:1em;font-weight:normal;margin:25px 0 0;" tabindex="0">Attachment Information</p>
  <div style="padding:0 15px 15px 15px;margin-top:5px;">
    <div style="margin:25px 0 0 0;font-size:13px;overflow:hidden;">
      <div style="font-size:12px">Resume: <span style="color:#ff5400;font-family:InterRegular,sans-serif;font-size:12px;">*</span></div>
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                break;
              case 33:
                result = /^[0-9a-zA-Z!#%\*\^\(\)=\{\}\[\]\?`~_\-\.\$@\?\,\:\'\/\!\P{InBasicLatin}\s\+\|;]+$/.test(value);
                break;
              case 38:
              case 34:
                result = !isNaN(parseFloat(value)) && isFinite(value);
                break;
              default:
                result = 'nocheck';
            }
          } else if (currData.im == 'true') {
            result = uiType == '6601' && (document.getElementsByName(currElem.name).length > 1 || currElem.parentNode.parentNode.querySelector('.closeFileType') != undefined);
            errMsg = currData.l + errMsgCant;
          }
          if (result != 'nocheck' && result == false) {
            countOfFalse++;
            if (uiType != 6604) {
              addAlertMessage(currElem, uiType, errMsg);
              if (uiType == 6601) {
                elementToFocus = currElem.parentNode;
              } else {
                elementToFocus = document.getElementsByName(name)[0];
              }
            }
          }
        }
      }
      if (countOfFalse == 0) {
        document.getElementsByName('save')[0].setAttribute('disabled', 'disabled');
        if (document.getElementById('skillTags1')) {
          document.getElementById('skillTags1').removeAttribute('name');
          document.getElementById('skillTags2').removeAttribute('name');
          document.getElementById('skillTags3').removeAttribute('name');
        }
        return true;
      }
      if (elementToFocus != undefined) {
        elementToFocus.focus();
      }
      return false;
    }

    function addAlertMessage(currElem, uiType, errMsg) {
      var node = document.createElement('span');
      node.className = 'errormsg';
      node.style.cssText = 'clear:both;color:red;margin:0;font-size:12px;line-height:12px;display:block;max-width:300px;font-family:inherit;margin-left:0px;padding-top: 5px;';
      node.appendChild(document.createTextNode(errMsg));
      if (uiType == 786) {
        currElem.setAttribute('onblur', 'removeAlertMessage(this.parentNode)');
      } else {
        currElem.setAttribute('onblur', 'removeAlertMessage(this)');
      }
      var parentElement = currElem.parentNode;
      if (uiType == 786) {
        parentElement = parentElement.parentNode;
      } else if (uiType == 6606 || uiType == 6605) {
        parentElement = parentElement.parentNode.parentNode;
      } else if (uiType == 100 || uiType == 6607) {
        parentElement = parentElement.parentNode.parentNode.parentNode;
      } else if (uiType == 6601) {
        parentElement = parentElement.parentNode;
        node.style.marginLeft = '0px';
      }
      if (uiType == 6603) {
        node.style.marginLeft = '0px';
        currElem.insertAdjacentElement('afterend', node);
      } else {
        parentElement.appendChild(node);
      }
    }

    function getDMY(datepat, dateVal) {
      var dayMonthYear = [];
      var dateReg = datepat.replace(/dd/i, '(\\d{1,2})');
      dateReg = dateReg.replace(/mm/i, '\\d{1,2}');
      dateReg = dateReg.replace(/yyyy/i, '\\d{4}');
      re = new RegExp(dateReg);
      dateArr = re.exec(dateVal);
      if (!re.test(dateVal) || dateVal.match(re)[0] !== dateVal) {
        return [];
      }
      dayMonthYear[0] = Number(dateArr[1]);
      var monthReg = datepat.replace(/mm/i, '(\\d{1,2})');
      monthReg = monthReg.replace(/dd/i, '\\d{1,2}');
      monthReg = monthReg.replace(/yyyy/i, '\\d{4}');
      re = new RegExp(monthReg);
      var dateArr = re.exec(dateVal);
      dayMonthYear[1] = Number(dateArr[1]);
      var yearReg = datepat.replace(/yyyy/i, '(\\d{4})');
      yearReg = yearReg.replace(/dd/i, '\\d{1,2}');
      yearReg = yearReg.replace(/mm/i, '\\d{1,2}');
      re = new RegExp(yearReg);
      dateArr = re.exec(dateVal);
      dayMonthYear[2] = Number(dateArr[1]);
      return dayMonthYear;
    }

    function checkDateWithFormat(datepat, dateVal) {
      var dmy = getDMY(datepat.toLowerCase(), dateVal);
      var date = dmy[0];
      var month = dmy[1];
      var year = dmy[2];
      if (month > 12 || month < 1) {
        return false;
      }
      if (month == 1 || month == 3 || month == 5 || month == 7 || month == 8 || month == 10 || month == 12) {
        return (date <= 31);
      } else if (month == 2) {
        if (year % 4 && !(year % 100 || year % 400)) {
          return (date <= 29)
        }
        return (date <= 28);
      } else {
        return (date <= 30);
      }
    }

    function removeAlertMessage(focusElem) {
      var divElem = '';
      switch (focusElem.dataset.uitype) {
        case '6605':
          divElem = focusElem.parentNode.parentNode.parentNode.querySelector('.errormsg');
          break;
        case '6607':
          divElem = focusElem.parentNode.parentNode.parentNode.parentNode.querySelector('.errormsg');
          break;
        default:
          divElem = focusElem.parentNode.querySelector('.errormsg');
      }
      if (divElem != '' && divElem != null) {
        focusElem.setAttribute('onblur', '');
        divElem.parentNode.removeChild(divElem);
      }
    }

    function checkAttachFiles() {
      var fileSize = 0;
      var allInputAttachFiles = document.querySelectorAll('input[type=file]');
      for (var i = 0; allInputAttachFiles && i < allInputAttachFiles.length; i++) {
        var inputElems = allInputAttachFiles[i];
        var fileList = inputElems.files;
        for (var j = 0; fileList && j < fileList.length; j++) {
          var files = fileList[j];
          fileSize += files != undefined ? files.size : 0;
        }
      }
      if (fileSize > 10 * 1024 * 1024) {
        alert('File limit should not exceed more than 10MB.');
      }
    }

    function triggerAttachClick(elem) {
      var countVal = elem.getAttribute('count');
      countVal = (countVal != undefined && countVal != null) ? parseInt(countVal) : 1;
      var elemId = elem.getAttribute('id');
      var idVal = (elemId != undefined && elemId != null) ? elemId.substring(13, elemId.length - 1) : undefined;
      if (idVal != undefined && idVal != null) {
        if (document.getElementById('theFile_link(' + idVal + ')')) {
          var noOfFiles = document.getElementById('theFile_link(' + idVal + ')').getElementsByTagName('input').length - 1;
          if (noOfFiles >= 25) {
            alert('You have exceeded the limit. You can attach a maximum of 25 files.');
            return false;
          }
        }
        document.getElementById('theFile_property(' + idVal + ')_' + countVal + '').click()
      }
    }

    function attachMoreUpload(elem) {
      var fileFR = /(pdf|rtf|zipx|zip|doc|dot|docx|dotx|odt|css|rtf|html|htm|sgml|txt|xls|xlt|xla|xlsx|xltx|ppt|pot|pptx|pot|potx|mdb|jpeg|jpg|tiff|fax|png|gif|ico|svg)\b/i;
      var photoFR = /(jpeg|jpg|tiff|fax|png|gif|ico|svg)\b/i;
      var parentElem = elem.parentNode;
      var countVal = parentElem.getAttribute('count');
      countVal = (countVal != undefined && countVal != null) ? parseInt(countVal) : 1;
      var count = countVal + 1;
      var elemName = elem.getAttribute('name');
      var idVal = (elemName != undefined && elemName != null) ? elemName.substring(17, elemName.length - 1) : undefined;
      var fileList = elem.files[0];
      var fileName = (fileList != undefined && fileList != null) ? fileList.name : '';
      var isBulk = elem.getAttribute('data-isbulk');
      var errM = parentElem.parentNode.querySelector('.errormsg');
      if (errM != null) {
        errM.parentNode.removeChild(errM);
      }
      var fFormat = fileName.substring(fileName.lastIndexOf('.') + 1, fileName.length);
      if (fileName != '' && (fFormat == undefined || fFormat.trim().length == 0 || (idVal == '111222333444' && photoFR.test(fFormat) == false) || fileFR.test(fFormat) == false)) {
        addAlertMessage(elem, 6601, 'Selected file type is not supported - ' + fileName);
        var cloneElem = elem.cloneNode(true);
        cloneElem.value = '';
        elem.parentElement.replaceChild(cloneElem, elem);
        var oldElem = document.getElementById('theFileName(' + idVal + ')_' + (count - 1));
        if (oldElem != undefined) {
          oldElem.parentNode.removeChild(oldElem);
        }
        return;
      }
      var fileDiv = constructAttachFile(fileName, idVal, countVal);
      if (idVal != undefined && idVal != null) {
        if (isBulk != undefined && isBulk != null && isBulk == 'true') {
          document.getElementById('theFile_content(' + idVal + ')').appendChild(fileDiv);
          parentElem.childNodes[0].textContent = 'Attach more';
          var newElem = elem.cloneNode('true');
          newElem.setAttribute('id', 'theFile_property(' + idVal + ')_' + count + '');
          newElem.setAttribute('value', null);
          parentElem.appendChild(newElem);
          var createElem = document.getElementById('theFile_property(' + idVal + ')_' + count + '');
          if (createElem != undefined && createElem != null) {
            createElem.value = null;
          }
          parentElem.setAttribute('count', count);
        } else {
          document.getElementById('theFile_content(' + idVal + ')').innerHTML = '';
          document.getElementById('theFile_content(' + idVal + ')').appendChild(fileDiv);
        }
        document.getElementById('theFile_content(' + idVal + ')').style.display = 'block';
      }
    }

    function constructAttachFile(fileName, idVal, count) {
      var fileDis = document.createElement('div');
      fileDis.setAttribute('id', 'theFileName(' + idVal + ')_' + count + '');
      fileDis.setAttribute('count', count);
      fileDis.setAttribute('style', 'position:relative; margin:0px 0px 8px 0px;word-wrap: break-word; font-size:12px; width:300px; padding:6px 10px; background-color:#f3f3f3; color:#111;font-family:Arial');
      var textFile = document.createTextNode(fileName);
      fileDis.appendChild(textFile);
      var closeDiv = document.createElement('a');
      closeDiv.setAttribute('href', 'javascript:void(0)');
      closeDiv.setAttribute('style', 'position:absolute;top:5px;right:12px;font-size:14px;color:#fa8c8c;text-decoration:none;');
      closeDiv.setAttribute('class', 'closeFileType');
      closeDiv.setAttribute('onclick', 'removeAttachFile(this)');
      var closeText = document.createTextNode('x');
      closeDiv.appendChild(closeText);
      fileDis.appendChild(closeDiv);
      return fileDis;
    }

    function removeAttachFile(elem) {
      var childNode = elem.parentNode;
      var elemId = childNode.getAttribute('id');
      var idVal = (elemId != undefined && elemId != null) ? elemId.substring(12, elemId.length - 3) : undefined;
      var countVal = childNode.getAttribute('count');
      countVal = (countVal != undefined && countVal != null) ? parseInt(countVal) : 1;
      elem.parentNode.parentNode.removeChild(childNode);
      var browElem = document.getElementById('theFile_link(' + idVal + ')');
      if (browElem.childNodes.length == 2) {
        var childElem = document.getElementById('theFile_property(' + idVal + ')_' + countVal + '');
        var newElem = childElem.cloneNode(true);
        newElem.setAttribute('value', null);
        document.getElementById('theFile_link(' + idVal + ')').removeChild(childElem);
        document.getElementById('theFile_link(' + idVal + ')').appendChild(newElem);
        document.getElementById('theFile_property(' + idVal + ')_' + countVal + '').value = '';
      } else {
        var childElem = document.getElementById('theFile_property(' + idVal + ')_' + countVal + '');
        document.getElementById('theFile_link(' + idVal + ')').removeChild(childElem);
      }
    }

    function setDependent(module, curObj) {
      var selectedFieldObject = curObj;
      var detailData = selectedFieldObject.getAttribute('data-detail');
      var selectedFieldData = JSON.parse(detailData);
      var selectedFieldValue = selectedFieldObject.value;
      var parentFieldName = selectedFieldData.colname;
      var dependencyDetails = fieldDependency;
      var depFieldName, depFieldValue, depFieldValueIdx, childFieldName, parentFieldValue, childValueIdx;
      if (dependencyDetails && dependencyDetails[parentFieldName]) {
        for (childFieldName in dependencyDetails[parentFieldName]) {
          if (dependencyDetails[parentFieldName][childFieldName]) {
            var childFieldObject = document.getElementById('ZR_' + module + '_' + childFieldName);
            if (childFieldObject != null && childFieldObject != undefined) {
              var uiType = childFieldObject.getAttribute('data-uitype');
              uiType = (uiType != null && uiType != undefined) ? parseInt(uiType) : 0;
              var defOptions = childFieldObject.children[0];
              var existingOptions = '';
              var hiddenOption = '';
              if (uiType == 100) {
                var defOptions = childFieldObject.children[0].children[1].querySelector('.fstResultItem');
                childFieldObject.children[0].children[0].querySelector('.fstControlsSelected').innerHTML = '';
                existingOptions = childFieldObject.children[0].children[0].children[2];
                hiddenOption = existingOptions.children[0];
                existingOptions.innerHTML = '';
                childFieldObject = childFieldObject.children[0].children[1];
              }
              var newOptions = defOptions.cloneNode(true);
              childFieldObject.innerHTML = '';
              var childFieldValues;
              if (dependencyDetails[parentFieldName][childFieldName][selectedFieldValue]) {
                childFieldValues = dependencyDetails[parentFieldName][childFieldName][selectedFieldValue];
              } else {
                if (uiType == 100) {
                  childFieldValues = JSON.parse(document.getElementById('ZR_' + module + '_' + childFieldName).getAttribute('data-values'));
                } else {
                  childFieldValues = JSON.parse(childFieldObject.getAttribute('data-values'));
                }
              }
              var oldValues = childFieldObject.getAttribute('data-oldvalue');
              var defVal = (oldValues != null && oldValues.length != 0) ? oldValues.split(';') : [];
              defVal = (defVal != null && defVal != undefined) ? defVal : [];
              for (var i = 0; i < defVal.length; i++) {
                if (!childFieldValues.contains(defVal[i])) {
                  childFieldValues[childFieldValues.length] = defVal[i];
                }
              }
              childFieldValues = (childFieldValues != undefined && childFieldValues != null) ? childFieldValues : [];
              for (var childValueIdx = 0; childValueIdx < childFieldValues.length; childValueIdx++) {
                var depFieldValue = childFieldValues[childValueIdx];
                var optionElem = newOptions.cloneNode(true);
                if (uiType != 100) {
                  optionElem.innerHTML = childFieldValues[childValueIdx];
                  optionElem.setAttribute('value', depFieldValue);
                } else {
                  var tempHidElem = hiddenOption.cloneNode(true);
                  tempHidElem.setAttribute('value', depFieldValue);
                  tempHidElem.removeAttribute('selected');
                  existingOptions.appendChild(tempHidElem); /*span element*/
                  optionElem.className = 'fstResultItem dB';
                  optionElem.setAttribute('value', depFieldValue);
                  optionElem.setAttribute('style', 'display: block;');
                  optionElem.textContent = depFieldValue;
                }
                childFieldObject.appendChild(optionElem);
              }
              setDependencyValue(uiType, childFieldName, defVal, module);
              if (uiType != 100) {
                childFieldObject.onchange();
              } else if (uiType == 100) {
                /*Adding no result element*/
                var optionElem = newOptions.cloneNode(true);
                optionElem.setAttribute('class', 'fstNoResults');
                optionElem.setAttribute('style', 'display:none;padding:10px 5px 10px 2.8%;color:#111;');
                optionElem.textContent = 'No Results';
                childFieldObject.appendChild(optionElem);
              }
            }
          }
        }
      }
    }

    function setDependencyValue(uiType, fieldLabel, oldValue, module) {
      var listElem = document.getElementsByName(fieldLabel);
      listElem = (uiType == 100) ? document.getElementById('ZR_' + module + '_' + fieldLabel).querySelectorAll('.fstResultItem') : listElem[0].children;
      if (listElem != null && listElem != undefined) {
        for (var i = 0; i < listElem.length; i++) {
          var elemVal = uiType == 100 ? listElem[i].getAttribute('value') : listElem[i].value;
          if (oldValue != null && oldValue != undefined && oldValue.contains(elemVal)) {
            if (uiType == 100) {
              selectItem(listElem[i]);
            } else {
              listElem[i].selected = true;
            }
          } else if (uiType != 100) {
            listElem[i].selected = false;
          }
        }
      }
    }
    Array.prototype.contains = function(element) {
      for (var i = 0; i < this.length; i++) {
        if (this[i] == element) {
          return true;
        }
      }
      return false;
    };
    skillsVersion = 1.14;
    skills = [];
    isSkillsLoaded = false;

    function skillsTagInt() {
      document.querySelector('body').onclick = function(event, target) {
        if (!document.querySelector('skills-tag').parentElement.parentElement.contains(event.target) || !event.target == document.querySelector('skills-tag').parentElement.parentElement) {
          if (!(event.target.nodeName == "LI" && !document.querySelector('body').contains(event.target)) && !document.querySelector('.skl-create-tag-container').contains(event.target)) {
            document.querySelector('.skl-create-tag-container').style.display = 'none';
          }
        }
        if (document.querySelector('.modal-block.portalFormView') != null && document.querySelector('.skl-create-tag-container')) {
          document.querySelector('.skl-create-tag-container').style.left = "50px";
        } else if (document.querySelector('.skl-create-tag-container')) {
          document.querySelector('.skl-create-tag-container').style.left = document.getElementById('edit_SKILLSET_parent').getBoundingClientRect().left + "px";
        }
      }
    }

    function getSkillProficiencyFromLevel(val, type) {
      if (typeof val !== 'undefined' || (typeof val === 'string' && val.trim() !== '')) {
        val = parseInt(val);
        if (val >= 80) {
          return type == "class" ? "master" : I18n.getMsg('crm.sme.skill.level.master');
        } else if (val >= 50) {
          return type == "class" ? "intermediate" : I18n.getMsg('crm.sme.skill.level.intermediate');
        } else if (val >= 20) {
          return type == "class" ? "beginner" : I18n.getMsg('crm.sme.skill.level.beginner');
        } else {
          return "";
        }
      }
      return "";
    }

    function getSkillLevelFromProficiency(level) {
      if (level == 'master') {
        return 80;
      } else if (level == 'intermediate') {
        return 50;
      } else if (level == 'beginner') {
        return 20;
      } else {
        return 0;
      }
    }

    function updateSkillsTagComp() {
      var listHTML = "";
      skills.forEach(function(skill1, index) {
        listHTML = listHTML + "\n" + '<li class="skl-' + getSkillProficiencyFromLevel(skill1.level, "class") + '"> <em></em> <span id="skill-index-' + index + '"> </span> <a class="skl-close-icon" style="display: inline;" onclick="deleteSkill(' +
          skill1.id + ')"></a> </li>';
      });
      listHTML = listHTML + "\n" + '<li> <input id="addSkillsInput" type="text" placeholder="Add Skills" class="skillset-input" style="display: inline-block;" onkeyup="updateSuggestedSkills()" onkeydown="selectFirstSuggestion(event)"> </li>';
      document.getElementsByClassName("skl-selected-skill")[0].innerHTML = '';
      document.getElementsByClassName("skl-selected-skill")[0].innerHTML = listHTML;
      skills.forEach(function(skill1, index) {
        document.getElementById('skill-index-' + index).innerText = skill1.name;
      });
      if (skills.length == 0) {
        document.getElementsByName("Skill Set")[0].value = '';
      } else {
        document.getElementsByName("Skill Set")[0].value = JSON.stringify(skills);
      }
    }

    function deleteSkill(toBeRemovedId) {
      skills = skills.filter(function(skill) {
        return skill.id != toBeRemovedId;
      });
      updateSkillsTagComp();
    }

    function getRelatedSkills() {
      var searchTxt = document.getElementById("addSkillsInput").value;
      if (searchTxt == "") {
        document.querySelector(".skl-create-tag-container").style.display = "none";
        var resultJSON = {};
        resultJSON.relatedSkills = [];
        return resultJSON;
      } else {
        var xmlHttp = new XMLHttpRequest();
        xmlHttp.open("GET", document.getElementsByClassName("skl-selected-skill")[0].closest('form').getAttribute('action').replace("WebToLeadForm", "v2/competency_skills") + "?searchText=" + searchTxt, false);
        xmlHttp.send();
        return xmlHttp.responseText;
      }
    }

    function updateSuggestedSkills() {
      if (!isSkillsLoaded) {
        skillsTagInt();
        isSkillsLoaded = true;
      }
      var searchTxt = document.getElementById("addSkillsInput").value;
      if (searchTxt == "") {
        document.querySelector(".skl-create-tag-container").style.display = "none";
      } else {
        var relatedSkillsResult = getRelatedSkills();
        var skills;
        if (relatedSkillsResult == '') {
          skills = [];
        } else {
          skills = JSON.parse(relatedSkillsResult).relatedSkills;
        }
        if (!skills.contains(searchTxt)) {
          skills.splice(0, 0, searchTxt);
        }
        var listHTML = "";
        skills.forEach(function(skill, index) {
          listHTML = listHTML + "\n" + '<li onclick="selectSuggestedSkill(\'' + index + '\')" id="sugg-skill-li-' + index + '">' + index + '</li>'
        });
        document.getElementsByClassName("skl-suggested-skill")[0].innerHTML = listHTML;
        skills.forEach(function(skill, index) {
          document.getElementById('sugg-skill-li-' + index).innerText = skill;
        });
        if (skills.length > 0) {
          document.querySelector(".skl-create-tag-container").style.display = "block";
        } else {
          document.querySelector(".skl-create-tag-container").style.display = "none";
        }
        document.getElementById('addSkillsInput').click();
      }
    }

    function selectSuggestedSkill(skillIndex) {
      var skill = document.getElementById('sugg-skill-li-' + skillIndex).innerText;
      var newSkill = {};
      if (skills.length > 0) {
        newSkill.id = skills[skills.length - 1].id + 1;
      } else {
        newSkill.id = 1;
      }
      newSkill.name = skill;
      var proficiencyLevelOptions = document.getElementsByName('skillTags');
      proficiencyLevelOptions.forEach(function(item, index) {
        if (item.checked) {
          newSkill.level = getSkillLevelFromProficiency(item.value);
        }
      });
      newSkill.source = "1";
      skills.push(newSkill);
      var liTags = document.querySelectorAll("ul.skl-suggested-skill li");
      var searchText = skill;
      var found;
      for (var i = 0; i < liTags.length; i++) {
        if (liTags[i].textContent == searchText) {
          found = liTags[i];
          break;
        }
      }
      if (found) {
        found.remove();
      }
      if (document.querySelectorAll('.skl-suggested-skill li').length == 0) {
        document.querySelector('.skl-create-tag-container').style.display = 'none';
      }
      updateSkillsTagComp();
    }

    function selectFirstSuggestion(ev) {
      var tgt = ev.target;
      switch (ev.which) {
        case 13:
        case 27:
        case 9:
          selectFirstSuggestionAction();
          ev.stopImmediatePropagation();
          ev.stopPropagation();
          ev.preventDefault();
          ev.cancelBubble = true;
          return false;
      }
    }

    function selectFirstSuggestionAction() {
      var firstSuggestion = document.querySelector('ul.skl-suggested-skill li');
      if (firstSuggestion != undefined) {
        firstSuggestion.click();
      }
    }
  </script>
</form>

Text Content

Basic Info

First Name: *
Last Name: *
Phone: *

Address Information

Country: *
Street: *
City: *
State/Province: *
Zip/Postal Code: *

Experience Details

+ Add Experience Details
x Delete
Occupation / Title:
Company:
Summary:
 
Work Duration:
MonthJanFebMarAprMayJunJulAugSepOctNovDec
Year195019511952195319541955195619571958195919601961196219631964196519661967196819691970197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050
To:
MonthJanFebMarAprMayJunJulAugSepOctNovDec
Year195019511952195319541955195619571958195919601961196219631964196519661967196819691970197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050
I currently work here
 * +Add Experience Details

Attachment Information

Resume: *

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