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3.222.161.165  Public Scan

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URL: https://www.perimeter.org/my/perimeter/membership/profile/bb69950e-3e6e-448e-9f1a-e1eb8e95debf/b601fc4b-ddae-4c0d-8ddc-977...
Submission: On February 24 via manual from US — Scanned from DE

Form analysis 2 forms found in the DOM

GET /search/

<form method="get" action="/search/" style="width: 100%; display: flex; flex-direction: row; flex-grow: 3;">
  <input type="text" name="find" placeholder="SEARCH" style="width: 100%;">
  <button type="submit" style="margin-left: 30px;">
    <img src="/assets-5.0/img/search.png">
  </button>
</form>

<form novalidate="">
  <div class="form">
    <h3>Personal Info</h3>
    <div class="field"><label class="floating-swamped-label filled">First Name</label>
      <fieldset>
        <div class="input">
          <div class="text_container"><input type="text" value="Jill"></div>
        </div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">Nickname</label>
      <fieldset>
        <div class="input">
          <div class="text_container"><input type="text" value="Jill"></div>
        </div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">Last Name</label>
      <fieldset>
        <div class="input">
          <div class="text_container"><input type="text" value="Yee"></div>
        </div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">Date of Birth</label>
      <fieldset>
        <div class="input">
          <div class="text_container"><input value="06/17/1970"></div>
        </div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">Picture</label>
      <fieldset>
        <div class="input">
          <div class="picture-input">
            <div class="picture-preview"><img src="https://ministryplatform.perimeter.org/ministryplatformapi/files/912d6367-21b6-427a-bfa4-ed6f22b9a849"></div>
            <div class="drop-zone">
              <h3>Drop image here or click to upload</h3><svg stroke="currentColor" fill="currentColor" stroke-width="0" viewBox="0 0 24 24" height="1em" width="1em" xmlns="http://www.w3.org/2000/svg">
                <path d="M19.35 10.04C18.67 6.59 15.64 4 12 4 9.11 4 6.6 5.64 5.35 8.04 2.34 8.36 0 10.91 0 14c0 3.31 2.69 6 6 6h13c2.76 0 5-2.24 5-5 0-2.64-2.05-4.78-4.65-4.96zM14 13v4h-4v-4H7l5-5 5 5h-3z"></path>
              </svg>
            </div><input type="file" style="display: none;">
          </div>
        </div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">Ethnicity</label>
      <fieldset>
        <div class="input"><select>
            <option value="null"></option>
            <option value="299">Asian - Chinese</option>
            <option value="1251">Asian - Filipino</option>
            <option value="300">Asian - Indian</option>
            <option value="1288">Asian - Japanese</option>
            <option value="298">Asian - Korean</option>
            <option value="301">Asian - South Asia</option>
            <option value="1338">Asian - Taiwanese</option>
            <option value="1252">Asian - Thai</option>
            <option value="1237">Asian - Vietnamese</option>
            <option value="297">Black/African American</option>
            <option value="302">Latino/Hispanic</option>
            <option value="303">Middle Eastern</option>
            <option value="304">Native American/American Indian/Alaskan Native</option>
            <option value="305">Native Hawaiian/Other Pacific Islander</option>
            <option value="307">Other</option>
            <option value="308">Prefer not to disclose</option>
            <option value="1253">Two or More Races</option>
            <option value="296">White/Caucasian</option>
          </select></div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">Marital Status</label>
      <fieldset>
        <div class="input"><select>
            <option value="null"></option>
            <option value="1">Single</option>
            <option value="2">Married</option>
            <option value="3">Divorced</option>
            <option value="4">Widowed</option>
            <option value="5">Partnered</option>
            <option value="6">Separated</option>
          </select></div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">Vocational Field</label>
      <fieldset>
        <div class="input"><select>
            <option value="null"></option>
            <option value="&quot;Business&quot;">Business</option>
            <option value="&quot;Healthcare&quot;">Healthcare</option>
            <option value="&quot;Homemaker&quot;">Homemaker</option>
            <option value="&quot;Government&quot;">Government</option>
            <option value="&quot;Education&quot;">Education</option>
            <option value="&quot;Arts &amp; Entertainment&quot;">Arts &amp; Entertainment</option>
            <option value="&quot;Media&quot;">Media</option>
            <option value="&quot;Law/Judicial&quot;">Law/Judicial</option>
            <option value="&quot;Non-profit&quot;">Non-profit</option>
            <option value="&quot;Retired&quot;">Retired</option>
            <option value="&quot;Student&quot;">Student</option>
          </select></div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">If employed, Employer</label>
      <fieldset>
        <div class="input">
          <div class="text_container"><input type="text" value="Cotiviti"></div>
        </div>
      </fieldset>
    </div>
    <div class="field"><label class="floating-swamped-label filled">Job Title</label>
      <fieldset>
        <div class="input">
          <div class="text_container"><input type="text" value="Sr. Mgr. Human Resources Business Partner"></div>
        </div>
      </fieldset>
    </div>
  </div>
  <div class="submit"><button class="button" type="submit">Next</button></div>
</form>

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PERSONAL INFO

First Name

Nickname

Last Name

Date of Birth

Picture


DROP IMAGE HERE OR CLICK TO UPLOAD

Ethnicity
Asian - ChineseAsian - FilipinoAsian - IndianAsian - JapaneseAsian - KoreanAsian
- South AsiaAsian - TaiwaneseAsian - ThaiAsian - VietnameseBlack/African
AmericanLatino/HispanicMiddle EasternNative American/American Indian/Alaskan
NativeNative Hawaiian/Other Pacific IslanderOtherPrefer not to discloseTwo or
More RacesWhite/Caucasian
Marital Status
SingleMarriedDivorcedWidowedPartneredSeparated
Vocational Field
BusinessHealthcareHomemakerGovernmentEducationArts &
EntertainmentMediaLaw/JudicialNon-profitRetiredStudent
If employed, Employer

Job Title

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9500 Medlock Bridge Rd
Johns Creek, GA 30097

678.405.2000

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