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Name: form_212342726838055 — POST https://compdrug.jotform.com/submit/212342726838055

<form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' &amp;&amp; testSubmitFunction();" action="https://compdrug.jotform.com/submit/212342726838055" method="post" name="form_212342726838055" id="212342726838055"
  accept-charset="utf-8" autocomplete="off" novalidate="true"><input type="hidden" name="formID" value="212342726838055"><input type="hidden" id="JWTContainer" value=""><input type="hidden" id="cardinalOrderNumber" value=""><input type="hidden"
    id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1732257691461=>init-started:1732257956620=>validator-called:1732257956884=>validator-mounted-false:1732257956886=>init-complete:1732257956895"><input type="hidden"
    id="submitSource" name="submitSource" value="mounted"><input type="hidden" id="buildDate" name="buildDate" value="1732257691461"><input type="hidden" name="eventObserver" value="1">
  <div role="main" class="form-all">
    <ul class="form-section page-section">
      <li id="cid_1" class="form-input-wide" data-type="control_head" data-css-selector="id_1">
        <div style="display:table;width:100%">
          <div class="form-header-group hasImage header-large" data-imagealign="Left">
            <div class="header-logo"><img src="https://compdrug.jotform.com/uploads/compdrug/form_files/ColumbusPolice.66856eb7aefc68.78125840.jpg" alt="CPD Time Sheet" width="131" class="header-logo-left"></div>
            <div class="header-text httal htvam">
              <h1 id="header_1" class="form-header" data-component="header">CPD Time Sheet</h1>
              <div id="subHeader_1" class="form-subHeader">CompDrug Special Duty</div>
            </div>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_dropdown" id="id_45" data-css-selector="id_45"><label class="form-label form-label-top form-label-auto" id="label_45" for="input_45" aria-hidden="false"> Officer Name<span
            class="form-required">*</span> </label>
        <div id="cid_45" class="form-input-wide jf-required" data-layout="half"> <select class="form-dropdown validate[required]" id="input_45" name="q45_officerName" style="width:310px" data-component="dropdown" required=""
            aria-label="Officer Name">
            <option value="">Please Select</option>
            <option value="Joe Johnson Jr.">Joe Johnson Jr.</option>
            <option value="Joel Little">Joel Little</option>
            <option value="Kristen Waugh-Holland">Kristen Waugh-Holland</option>
            <option value="Kylie Lavey">Kylie Lavey</option>
            <option value="Lisa Barbeau">Lisa Barbeau</option>
            <option value="Michelle Boiarski">Michelle Boiarski</option>
            <option value="Rob Beeson">Rob Beeson</option>
            <option value="Sam Rippey">Sam Rippey</option>
          </select> </div>
      </li>
      <li class="form-line jf-required" data-type="control_radio" id="id_66" data-css-selector="id_66"><label class="form-label form-label-top form-label-auto" id="label_66" aria-hidden="false"> Are you entering this form for your own time, or on
          behalf of someone else?<span class="form-required">*</span> </label>
        <div id="cid_66" class="form-input-wide jf-required" data-layout="full">
          <div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_66" data-component="radio"><span class="form-radio-item"><span class="dragger-item"></span><input aria-describedby="label_66" type="radio"
                class="form-radio validate[required]" id="input_66_0" name="q66_areYou" required="" value="Self"><label id="label_input_66_0" for="input_66_0">Self</label></span><span class="form-radio-item"><span class="dragger-item"></span><input
                aria-describedby="label_66" type="radio" class="form-radio validate[required]" id="input_66_1" name="q66_areYou" required="" value="Someone else"><label id="label_input_66_1" for="input_66_1">Someone else</label></span></div>
        </div>
      </li>
      <li class="form-line jf-required" style="" data-type="control_textbox" id="id_67" data-css-selector="id_67"><label class="form-label form-label-top form-label-auto" id="label_67" for="input_67" aria-hidden="false"> If you're completing the form
          on behalf of someone else, please enter your name<span class="form-required">*</span> </label>
        <div id="cid_67" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_67" name="q67_ifYoure" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="nope"
            style="width:310px" size="310" data-component="textbox" aria-labelledby="label_67" required="" value=""> </div>
      </li>
      <li class="form-line form-field-hidden" style="display: none !important;" data-type="control_text" id="id_51" data-css-selector="id_51">
        <div id="cid_51" class="form-input-wide" data-layout="full">
          <div id="text_51" class="form-html" data-component="text" tabindex="0">
            <p><strong>Officer Rate</strong>: $64.50</p>
          </div>
        </div>
      </li>
      <li class="form-line form-field-hidden" style="display: none !important;" data-type="control_text" id="id_52" data-css-selector="id_52">
        <div id="cid_52" class="form-input-wide" data-layout="full">
          <div id="text_52" class="form-html" data-component="text" tabindex="0">
            <p><strong>Sergeant Rate:</strong> $76.00</p>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_datetime" id="id_33" data-css-selector="id_33"><label class="form-label form-label-top" id="label_33" for="lite_mode_33" aria-hidden="false"> Date<span class="form-required">*</span> </label>
        <div id="cid_33" class="form-input-wide jf-required" data-layout="half">
          <div data-wrapper-react="true">
            <div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input class="form-textbox validate[required, limitDate]" id="month_33" name="q33_date[month]" type="tel" size="2" data-maxlength="2" data-age=""
                  maxlength="2" required="" autocomplete="off" aria-labelledby="label_33 sublabel_33_month" value="11" inputmode="numeric"><span class="date-separate" aria-hidden="true">&nbsp;-</span><label class="form-sub-label" for="month_33"
                  id="sublabel_33_month" style="min-height:13px">Month</label></span><span class="form-sub-label-container" style="vertical-align:top"><input class="currentDate form-textbox validate[required, limitDate]" id="day_33"
                  name="q33_date[day]" type="tel" size="2" data-maxlength="2" data-age="" maxlength="2" required="" autocomplete="off" aria-labelledby="label_33 sublabel_33_day" value="22" inputmode="numeric"><span class="date-separate"
                  aria-hidden="true">&nbsp;-</span><label class="form-sub-label" for="day_33" id="sublabel_33_day" style="min-height:13px">Day</label></span><span class="form-sub-label-container" style="vertical-align:top"><input
                  class="form-textbox validate[required, limitDate]" id="year_33" name="q33_date[year]" type="tel" size="4" data-maxlength="4" data-age="" maxlength="4" required="" autocomplete="off" aria-labelledby="label_33 sublabel_33_year"
                  value="2024"><label class="form-sub-label" for="year_33" id="sublabel_33_year" style="min-height:13px">Year</label></span></div><span class="form-sub-label-container" style="vertical-align:top"><input
                class="form-textbox validate[required, limitDate, validateLiteDate]" id="lite_mode_33" type="text" size="12" data-maxlength="12" data-age="" required="" data-format="mmddyyyy" data-seperator="-" placeholder="MM-DD-YYYY"
                data-placeholder="MM-DD-YYYY" autocomplete="off" aria-labelledby="label_33 sublabel_33_litemode" value="11-22-2024" inputmode="numeric"><img class="showAutoCalendar newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date"
                id="input_33_pick" src="https://compdrug.jotform.com/images/calendar.png" data-component="datetime" aria-hidden="false" data-allow-time="No" data-version="v2" aria-label="Change date, Thursday, November 21, 2024" role="button"
                tabindex="0" aria-haspopup="dialog" aria-expanded="false"><label class="form-sub-label" for="lite_mode_33" id="sublabel_33_litemode" style="min-height:13px">Date</label></span>
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        </div>
      </li>
      <li class="form-line jf-required" data-type="control_radio" id="id_62" data-css-selector="id_62"><label class="form-label form-label-top form-label-auto" id="label_62" for="input_62_0" aria-hidden="false"> Program<span
            class="form-required">*</span> </label>
        <div id="cid_62" class="form-input-wide jf-required" data-layout="full">
          <div class="form-single-column" role="group" aria-labelledby="label_62" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_62" type="radio"
                class="form-radio validate[required]" id="input_62_0" name="q62_program62" required="" checked="" value="General / MAT"><label id="label_input_62_0" for="input_62_0">General / MAT</label></span><span
              class="form-radio-item formRadioOther" style="clear:left"><input type="radio" class="form-radio-other form-radio validate[required]" name="q62_program62" id="other_62" tabindex="0" aria-label="Other (Special Event)" value="other"><label
                id="label_other_62" style="text-indent:0" for="other_62">Other (Special Event)</label><span id="other_62_input" class="other-input-container is-none" style=""><input type="text" class="form-radio-other-input form-textbox"
                  name="q62_program62[other]" data-otherhint="Other (Special Event)" size="15" id="input_62" data-placeholder="Please type another option here" placeholder="Please type another option here"></span></span></div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_time" id="id_35" data-css-selector="id_35"><label class="form-label form-label-top" id="label_35" for="input_35_hourSelect" aria-hidden="false"> Time In (24 hour format)<span
            class="form-required">*</span> </label>
        <div id="cid_35" class="form-input-wide jf-required" data-layout="half">
          <div data-wrapper-react="true">
            <div class="time-wrapper"><span class="form-sub-label-container" style="vertical-align:top"><input class="time-dropdown form-textbox validate[required, time]" id="input_35_timeInput" name="q35_timeIn[timeInput]" type="text" required=""
                  placeholder="HH : MM" aria-labelledby="label_35 sublabel_35_hour" data-mask="HH:MM" autocomplete="off" data-version="v2" value="" inputmode="numeric"><input type="hidden" class="form-hidden-time" id="input_35_hourSelect"
                  name="q35_timeIn[hourSelect]"><input type="hidden" class="form-hidden-time" id="input_35_minuteSelect" name="q35_timeIn[minuteSelect]"><label data-seperate-translate="true" class="form-sub-label" for="input_35_timeInput"
                  id="sublabel_35_hour" style="min-height:13px">Hour Minutes</label></span></div>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_time" id="id_36" data-css-selector="id_36"><label class="form-label form-label-top" id="label_36" for="input_36_hourSelect" aria-hidden="false"> Time Out (24 hour format)<span
            class="form-required">*</span> </label>
        <div id="cid_36" class="form-input-wide jf-required" data-layout="half">
          <div data-wrapper-react="true">
            <div class="time-wrapper"><span class="form-sub-label-container" style="vertical-align:top"><input class="time-dropdown form-textbox validate[required, time]" id="input_36_timeInput" name="q36_time36[timeInput]" type="text" required=""
                  placeholder="HH : MM" aria-labelledby="label_36 sublabel_36_hour" data-mask="HH:MM" autocomplete="off" data-version="v2" value="" inputmode="numeric"><input type="hidden" class="form-hidden-time" id="input_36_hourSelect"
                  name="q36_time36[hourSelect]"><input type="hidden" class="form-hidden-time" id="input_36_minuteSelect" name="q36_time36[minuteSelect]"><label data-seperate-translate="true" class="form-sub-label" for="input_36_timeInput"
                  id="sublabel_36_hour" style="min-height:13px">Hour Minutes</label></span></div>
          </div>
        </div>
      </li>
      <li class="form-line calculatedOperand" data-type="control_calculation" id="id_37" data-css-selector="id_37"><label class="form-label form-label-top form-label-auto" id="label_37" for="input_37" aria-hidden="false"> Total Hours </label>
        <div id="cid_37" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input aria-labelledby="label_37" data-component="calculation" type="text" data-defaultvalue="0"
              class="form-textbox" data-type="input-textbox" id="input_37" name="q37_totalHours" size="20" value="0"><label class="form-sub-label" for="input_37" style="min-height:13px">Calculated Field</label></span> </div>
      </li>
      <li class="form-line" data-type="control_calculation" id="id_55" data-css-selector="id_55"><label class="form-label form-label-top form-label-auto" id="label_55" for="input_55" aria-hidden="false"> Daily Pay </label>
        <div id="cid_55" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input aria-labelledby="label_55" data-component="calculation" type="text" data-defaultvalue="0"
              class="form-textbox" data-type="input-textbox" id="input_55" name="q55_dailyPay" size="20" value="0"><label class="form-sub-label" for="input_55" style="min-height:13px">Calculated Field</label></span> </div>
      </li>
      <li class="form-line always-hidden" data-type="control_email" id="id_58" data-css-selector="id_58"><label class="form-label form-label-top form-label-auto" id="label_58" for="input_58" aria-hidden="false"> Email </label>
        <div id="cid_58" class="form-input-wide always-hidden" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_58" name="q58_email" class="form-textbox validate[Email]"
              data-defaultvalue="" autocomplete="nope" style="width:310px" size="310" data-component="email" aria-labelledby="label_58 sublabel_input_58" value=""><label class="form-sub-label" for="input_58" id="sublabel_input_58"
              style="min-height:13px">example@example.com</label></span> </div>
      </li>
      <li class="form-line jf-required" data-type="control_radio" id="id_61" data-css-selector="id_61"><label class="form-label form-label-top form-label-auto" id="label_61" for="input_61_0" aria-hidden="true"> <span class="form-required">*</span>
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        <div id="cid_61" class="form-input-wide jf-required" data-layout="full">
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      </li>
      <li class="form-line" data-type="control_button" id="id_2" data-css-selector="id_2">
        <div id="cid_2" class="form-input-wide" data-layout="full">
          <div data-align="auto" class="form-buttons-wrapper form-buttons-auto   jsTest-button-wrapperField"><button id="input_2" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField legacy-submit"
              data-component="button" data-content="" aria-live="polite">Submit</button></div>
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      </li>
      <li style="display:none">Should be Empty: <input type="text" name="website" value=""></li>
    </ul>
    <div class="badge-wrapper">
      <a class="badge-wrapper-button hipaa-badge-wrapper"><img class="hipaa-badge" src="https://cdn.jotfor.ms/assets/img/uncategorized/hipaa-badge-compliance.png" alt="HIPAA Compliance Form" style="display: block; width: 95px;"></a></div>
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</form>

Text Content

 * CPD TIME SHEET
   
   CompDrug Special Duty
 * Officer Name*
   Please Select Joe Johnson Jr. Joel Little Kristen Waugh-Holland Kylie Lavey
   Lisa Barbeau Michelle Boiarski Rob Beeson Sam Rippey
 * Are you entering this form for your own time, or on behalf of someone else?*
   SelfSomeone else
 * If you're completing the form on behalf of someone else, please enter your
   name*
   

 * Officer Rate: $64.50

 * Sergeant Rate: $76.00

 * Date*
    -Month -DayYear
   Date
 * Program*
   General / MATOther (Special Event)
 * Time In (24 hour format)*
   Hour Minutes
 * Time Out (24 hour format)*
   Hour Minutes
 * Total Hours
   Calculated Field
 * Daily Pay
   Calculated Field
 * Email
   example@example.com
 * *
   I acknowledge that this information is correct to the best of my knowledge.
 * Submit
 * Should be Empty:



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