account.simplifastlending.com
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Submitted URL: https://account.simplifastlending.com/
Effective URL: https://account.simplifastlending.com/MemberPage.aspx?subpage=applyForLoan
Submission: On March 03 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://account.simplifastlending.com/MemberPage.aspx?subpage=applyForLoan
Submission: On March 03 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
POST /MemberPage.aspx?subpage=applyForLoan
<form method="post" action="/MemberPage.aspx?subpage=applyForLoan" id="ctl00">
<div class="aspNetHidden">
<input type="hidden" name="_VIEWSTATE_" id="_VIEWSTATE_"
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<div class="CustomerSite ApplicationForm">
<div class="container ApplicationContainer">
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">CUSTOMER INFORMATION</span>
<span class="Spanish">Información de solicitante</span>
</div>
<div class="SectionTable">
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_FirstName" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_FirstName">
<span class="English">First Name</span>
<span class="Spanish">Primer nombre</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$FirstName" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_FirstName">
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_LastName" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_LastName">
<span class="English">Last Name</span>
<span class="Spanish">Apellido</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<table class="LastNameAndExtensionTable">
<tbody>
<tr>
<td style="padding: 0px;vertical-align: top;">
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$LastName" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_LastName">
</td>
<td style="padding: 0px; padding-left: 2px;">
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$NameSuffix" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_NameSuffix" title="Name Suffix">
<option selected="selected" value=""></option>
<option value="Jr.">Jr.</option>
<option value="Sr.">Sr.</option>
<option value="I">I</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option>
<option value="V">V</option>
<option value="VI">VI</option>
<option value="VII">VII</option>
<option value="VIII">VIII</option>
</select>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_Ssn" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Ssn">
<span class="English">SSN</span>
<span class="Spanish">SSN</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Ssn$SSN_0" type="text" maxlength="3" size="3" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Ssn_SSN_0" class="tel noblock inspectlet-sensitive"
title="SSN" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)"> - <input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Ssn$SSN_1" type="text" maxlength="2" size="2"
id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Ssn_SSN_1" class="tel noblock inspectlet-sensitive" title="SSN" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)"> - <input
name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Ssn$SSN_2" type="text" maxlength="4" size="4" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Ssn_SSN_2" class="tel noblock inspectlet-sensitive" title="SSN"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)">
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</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_Email" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Email">
<span class="English">E-mail</span>
<span class="Spanish">Correo electrónico</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Email" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Email">
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_BirthDate" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_BirthDate_Month">
<span class="English">Birth Date</span>
<span class="Spanish">Fecha de nacimiento</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$BirthDate_Month" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_BirthDate_Month" title="Month" class="tel">
<option value="">Month</option>
<option value="1">Jan</option>
<option value="2">Feb</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">Aug</option>
<option value="9">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dec</option>
</select>
<!-- -->
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$BirthDate_Day" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_BirthDate_Day" title="Day" class="tel">
<option value="">Day</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<!-- -->
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$BirthDate_Year" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_BirthDate_Year" title="Year" class="tel">
<option value="">Year</option>
<option value="1900">1900</option>
<option value="1901">1901</option>
<option value="1902">1902</option>
<option value="1903">1903</option>
<option value="1904">1904</option>
<option value="1905">1905</option>
<option value="1906">1906</option>
<option value="1907">1907</option>
<option value="1908">1908</option>
<option value="1909">1909</option>
<option value="1910">1910</option>
<option value="1911">1911</option>
<option value="1912">1912</option>
<option value="1913">1913</option>
<option value="1914">1914</option>
<option value="1915">1915</option>
<option value="1916">1916</option>
<option value="1917">1917</option>
<option value="1918">1918</option>
<option value="1919">1919</option>
<option value="1920">1920</option>
<option value="1921">1921</option>
<option value="1922">1922</option>
<option value="1923">1923</option>
<option value="1924">1924</option>
<option value="1925">1925</option>
<option value="1926">1926</option>
<option value="1927">1927</option>
<option value="1928">1928</option>
<option value="1929">1929</option>
<option value="1930">1930</option>
<option value="1931">1931</option>
<option value="1932">1932</option>
<option value="1933">1933</option>
<option value="1934">1934</option>
<option value="1935">1935</option>
<option value="1936">1936</option>
<option value="1937">1937</option>
<option value="1938">1938</option>
<option value="1939">1939</option>
<option value="1940">1940</option>
<option value="1941">1941</option>
<option value="1942">1942</option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</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="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>
</select>
</fieldset>
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_Gender" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Gender">
<span class="English">Gender</span>
<span class="Spanish">Sexo</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Gender" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Gender" class="FullWidth">
<option value="">-- Choose --</option>
<option value="m">Male</option>
<option value="f">Female</option>
</select>
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_DriversLicenseAndState" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_DriversLicense">
<span class="English">Valid Driver's License or State ID Number</span>
<span class="Spanish">Numero de licencia</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$DriversLicense" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_DriversLicense" onfocus="filterDriversLicenceInput(this)">
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_DriversLicenseState" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_DriversLicenseState">
<span class="English">State Issued</span>
<span class="Spanish">Estado</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$DriversLicenseState" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_DriversLicenseState" class="FullWidth">
<option selected="selected" value="">--</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select>
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CellPhone" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CellPhone_1">
<span class="English">Cell Phone</span>
<span class="Spanish">Numero de celular</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CellPhone_1" type="text" maxlength="3" size="3" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CellPhone_1" class="tel noblock"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone">
<!-- -->
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CellPhone_2" type="text" maxlength="3" size="3" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CellPhone_2" class="tel noblock"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone">
<!-- -->
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CellPhone_3" type="text" maxlength="4" size="4" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CellPhone_3" class="tel noblock"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone">
</fieldset>
</div>
</div>
</div>
<div class="line">
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_HomeAddress" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeAddress">
<span class="English">Address</span>
<span class="Spanish">Dirección</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$HomeAddress" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeAddress">
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_HomeCity" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeCity">
<span class="English">City</span>
<span class="Spanish">Ciudad</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$HomeCity" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeCity">
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_HomeState" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeState">
<span class="English">State</span>
<span class="Spanish">Estado</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$HomeState" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeState" class="FullWidth">
<option selected="selected" value="">-- Choose --</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select>
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_HomeZip" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeZip_ZIPValue_Single">
<span class="English">Zip</span>
<span class="Spanish">Código postal</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$HomeZip$ZIP_Single" type="text" maxlength="5" size="8" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeZip_ZIP_Single" class="tel" title="Zip"
data-relatedhiddenfieldid="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeZip_ZIPValue_Single" onfocus="filterNumericInput(this)" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onkeyup="moveToNextIfFull(this)"><input
type="hidden" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$HomeZip$ZIPValue_Single" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeZip_ZIPValue_Single">
</fieldset>
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_TimeAtThisAddress" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_TimeAtThisAddress_Years">
<span class="English">Time At Address</span>
<span class="Spanish">Tiempo en residencia</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$TimeAtThisAddress_Years" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_TimeAtThisAddress_Years" title="Years" class="tel">
<option value="">yy</option>
<option value="0">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
</select>
<!-- -->
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$TimeAtThisAddress_Months" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_TimeAtThisAddress_Months" title="Months" class="tel">
<option value="">mm</option>
<option value="0">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
</select>
</fieldset>
</div>
</div>
</div>
<div class="line">
<div>
<label>
<span class="English">Mailing Address</span>
<span class="Spanish">Dirección de correspondencia</span>
</label>
<div class="NoWrap" style="white-space:nowrap;">
<input id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddressIsSame" type="checkbox" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$MailAddressIsSame" onclick="applyMirrorBindings(this);"><label
for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddressIsSame">Check if the same as above</label>
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_MailAddress" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddress">
<span class="English">Mailing Address</span>
<span class="Spanish">Dirección</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$MailAddress" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddress">
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_MailCity" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailCity">
<span class="English">Mailing City</span>
<span class="Spanish">Ciudad</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$MailCity" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailCity">
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_MailState" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailState">
<span class="English">Mailing State</span>
<span class="Spanish">Estado</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$MailState" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailState" class="FullWidth">
<option selected="selected" value="">-- Choose --</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select>
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_MailZip" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailZip_ZIPValue_Single">
<span class="English">Mailing Zip</span>
<span class="Spanish">Código postal</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$MailZip$ZIP_Single" type="text" maxlength="5" size="8" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailZip_ZIP_Single" class="tel" title="Zip"
data-relatedhiddenfieldid="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailZip_ZIPValue_Single" onfocus="filterNumericInput(this)" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onkeyup="moveToNextIfFull(this)"><input
type="hidden" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$MailZip$ZIPValue_Single" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailZip_ZIPValue_Single">
</fieldset>
</div>
</div>
</div>
<script type="text/javascript">
addMirrorBinding('Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddressIsSame', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeAddress', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddress');
addMirrorBinding('Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddressIsSame', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeCity', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailCity');
addMirrorBinding('Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddressIsSame', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeState', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailState');
var mailzip = $('input[type="text"][data-relatedhiddenfieldid="Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailZip_ZIPValue_Single"]');
$('input[type="text"][data-relatedhiddenfieldid="Content_Root_MemberPageDispatcher_subpage_applyForLoan_HomeZip_ZIPValue_Single"]').each(function(i) {
addMirrorBinding('Content_Root_MemberPageDispatcher_subpage_applyForLoan_MailAddressIsSame', $(this).attr('id'), mailzip.eq(i).attr('id'));
});
</script>
<div style="clear: both"></div>
</div>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Div_BankingInfo">
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">BANKING INFORMATION</span>
<span class="Spanish">Información bancaria</span>
</div>
<div class="RoutingInfo">
<a href="javascript:void(0)" onmouseover="this.T_TITLE='Find Your Routing Number';this.T_LEFT=true;this.T_WIDTH=476;this.T_ID='ttImageId';this.T_BORDERCOLOR='#027737';return escape('<img src=\'_Import/CustomerSiteProxyControls/_Export/images/check.gif\' id=\'ttImageId\' alt=\'find your routing number\' />');"><img src="_Import/CustomerSiteProxyControls/_Export/images/check2.gif" alt="Click here to find your routing number." width="170" height="85" style="border: none;"></a>
</div>
<div class="SectionTable">
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo">
<div id="bankinfo_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class="bankinfo" style="border: 0px; margin: 8px 0px;">
<div class="line">
<div style=""> <label for="active_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Active</span> <span class="Spanish">Activo</span> </label>
<div> <input type="hidden" name="id" value="0"> <input type="hidden" name="oldname" value=""> <input type="hidden" name="oldabanumber" value=""> <input type="checkbox"
id="active_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" name="active" checked=""checked"/"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">ABA Number</span> <span class="Spanish">Numero de ABA</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" maxlength="9" size="12" onfocus="filterNumericInput(this)" data-relatedhiddenfieldid="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_AbaValue_Single"
onkeyup="resolveBankByAba(document.getElementById(this.id).getAttribute('data-relatedhiddenfieldid'), 'name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0');;moveToNextIfFull(this);"
onchange="syncHiddenFieldWithTextboxes(this, '-');resolveBankByAba(document.getElementById(this.id).getAttribute('data-relatedhiddenfieldid'), 'name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0');;"
id="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_ABA_Single" name="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_ABA_Single" value=""
title="ABA Number"><input type="hidden" id="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_AbaValue_Single"
name="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_AbaValue_Single" value=""> </div>
</div>
<div style=""> <label for="name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Bank Name</span> <span class="Spanish">Nombre de banco</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" id="name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" name="name" value="" maxlength="255" size="30"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="address_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Bank Address</span> <span class="Spanish">Direccion del banco</span> </label>
<div> <input type="text" name="address" id="address_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" value="" maxlength="255"> </div>
</div>
<div style=""> <label for="city_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Bank City</span> <span class="Spanish">Banco ciudad</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" name="city" id="city_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" value="" maxlength="255"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="state_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Bank State</span> <span class="Spanish">Banco estado</span> <span
class="RedAsterisk">*</span> </label>
<div> <select id="state_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" name="state">
<option value="">-- Choose --</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select> </div>
</div>
<div style="display:none;"> <label for="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Bank Zip</span> <span class="Spanish">Banco codigo postal</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" maxlength="5" size="8" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onfocus="filterNumericInput(this)"
data-relatedhiddenfieldid="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0"
id="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_ZIP_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0"
name="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_ZIP_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" value="" title="Zip"><input type="hidden"
id="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0"
name="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" value=""> </fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="phone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Bank Phone</span> <span class="Spanish">Numero de Telefono</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="phone_1" id="phone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" value="" class="tel noblock"
maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"> <!-- --> <input type="text" name="phone_2" value="" class="tel noblock" maxlength="3" size="3"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"> <!-- --> <input type="text" name="phone_3" value="" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)"
onkeyup="moveToNextIfFull(this)" title="Bank Phone"> </fieldset>
</div>
</div>
</div>
<div class="line" style="">
<div> <label for="accountnumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Account Number</span> <span class="Spanish">Numero de cuenta bancaria</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" name="accountnumber" id="accountnumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" value="" class="inspectlet-sensitive" onfocus="filterAccountNumberInput(this)"
maxlength="255"> </div>
</div>
<div> <label for="accounttype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Account Type</span> <span class="Spanish">Typo de cuenta bancaria</span> <span
class="RedAsterisk">*</span> </label>
<div> <select name="accounttype" id="accounttype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class="SingleDDL">
<option value="C" selected="">Checking Account</option>
<option value="S">Savings Account</option>
</select> </div>
</div>
</div>
<div class="line" style="">
<div> <label for="accountlength_year_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" class=""> <span class="English">Account Length</span> <span class="Spanish">Longitud de cuenta</span> <span
class="RedAsterisk">*</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select name="accountlength_year" id="accountlength_year_Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0" title="Year"
class="tel">
<option value="">yy</option>
<option value="0">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
</select> <!-- --> <select name="accountlength_month" title="Month" class="tel">
<option value="">mm</option>
<option value="0">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
</select> </fieldset>
</div>
</div>
</div>
<script type="text/javascript">
bankAccountInfoInit('Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_0', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo', '');
</script>
</div>
<div style="clear: both;"></div>
</div><input type="hidden" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_json" name="Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_json" value="">
<script type="text/javascript">
(function($) {
window.bankAccountInfoInit = function(unique, bankInfoDivId, otherBankCheckboxId) {
if (otherBankCheckboxId && otherBankCheckboxId != '') {
if ($('#' + bankInfoDivId + ' div:first-child').attr('id') != ('bankinfo_' + unique)) {
$('#bankinfo_' + unique).css("border-top", "solid 1px #ccc");
$('#bankinfo_' + unique).css("margin-top", "4px");
}
}
if ($.mobile) {
$('#bankinfo_' + unique).trigger('create');
}
};
})(jQuery);
</script>
<script id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo_template" type="text/x-jquery-tmpl"> <div id="bankinfo_${$unique}" class="bankinfo" style="border: 0px; margin: 8px 0px;">
<div class="line">
<div style="">
<label for="active_${$unique}" class="${active_title_class}">
<span class="English">Active</span>
<span class="Spanish">Activo</span>
</label>
<div>
<input type="hidden" name="id" value="${id}"/>
<input type="hidden" name="oldname" value="${oldname}"/>
<input type="hidden" name="oldabanumber" value="${oldabanumber}"/>
<input type="checkbox" id="active_${$unique}" name="active" ${active ? 'checked="checked"' : ''}/>
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="abanumber_${$unique}" class="${abanumber_title_class}">
<span class="English">ABA Number</span>
<span class="Spanish">Numero de ABA</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" maxlength="9" size="12" onfocus="filterNumericInput(this)" data-relatedhiddenfieldid="abanumber_${$unique}_AbaValue_Single" onKeyUp="resolveBankByAba(document.getElementById(this.id).getAttribute('data-relatedhiddenfieldid'), 'name_${$unique}');;moveToNextIfFull(this);" onChange="syncHiddenFieldWithTextboxes(this, '-');resolveBankByAba(document.getElementById(this.id).getAttribute('data-relatedhiddenfieldid'), 'name_${$unique}');;" id="abanumber_${$unique}_ABA_Single" name="abanumber_${$unique}_ABA_Single" value="" title="ABA Number" /><input type="hidden" id="abanumber_${$unique}_AbaValue_Single" name="abanumber_${$unique}_AbaValue_Single" value="${abanumber}" />
</div>
</div>
<div style="">
<label for="name_${$unique}" class="${name_title_class}">
<span class="English">Bank Name</span>
<span class="Spanish">Nombre de banco</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" id="name_${$unique}" name="name" value="${name}" maxlength="255" size="30" />
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="address_${$unique}" class="${address_title_class}">
<span class="English">Bank Address</span>
<span class="Spanish">Direccion del banco</span>
</label>
<div>
<input type="text" name="address" id="address_${$unique}" value="${address}" maxlength="255" />
</div>
</div>
<div style="">
<label for="city_${$unique}" class="${city_title_class}">
<span class="English">Bank City</span>
<span class="Spanish">Banco ciudad</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" name="city" id="city_${$unique}" value="${city}" maxlength="255" />
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="state_${$unique}" class="${state_title_class}">
<span class="English">Bank State</span>
<span class="Spanish">Banco estado</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select id="state_${$unique}" name="state" ><option value="">-- Choose --</option><option value="AK" ${state == 'AK' ? 'selected' : ''}>AK</option><option value="AL" ${state == 'AL' ? 'selected' : ''}>AL</option><option value="AR" ${state == 'AR' ? 'selected' : ''}>AR</option><option value="AS" ${state == 'AS' ? 'selected' : ''}>AS</option><option value="AZ" ${state == 'AZ' ? 'selected' : ''}>AZ</option><option value="CA" ${state == 'CA' ? 'selected' : ''}>CA</option><option value="CO" ${state == 'CO' ? 'selected' : ''}>CO</option><option value="CT" ${state == 'CT' ? 'selected' : ''}>CT</option><option value="DC" ${state == 'DC' ? 'selected' : ''}>DC</option><option value="DE" ${state == 'DE' ? 'selected' : ''}>DE</option><option value="FL" ${state == 'FL' ? 'selected' : ''}>FL</option><option value="FM" ${state == 'FM' ? 'selected' : ''}>FM</option><option value="GA" ${state == 'GA' ? 'selected' : ''}>GA</option><option value="GU" ${state == 'GU' ? 'selected' : ''}>GU</option><option value="HI" ${state == 'HI' ? 'selected' : ''}>HI</option><option value="IA" ${state == 'IA' ? 'selected' : ''}>IA</option><option value="ID" ${state == 'ID' ? 'selected' : ''}>ID</option><option value="IL" ${state == 'IL' ? 'selected' : ''}>IL</option><option value="IN" ${state == 'IN' ? 'selected' : ''}>IN</option><option value="KS" ${state == 'KS' ? 'selected' : ''}>KS</option><option value="KY" ${state == 'KY' ? 'selected' : ''}>KY</option><option value="LA" ${state == 'LA' ? 'selected' : ''}>LA</option><option value="MA" ${state == 'MA' ? 'selected' : ''}>MA</option><option value="MD" ${state == 'MD' ? 'selected' : ''}>MD</option><option value="ME" ${state == 'ME' ? 'selected' : ''}>ME</option><option value="MH" ${state == 'MH' ? 'selected' : ''}>MH</option><option value="MI" ${state == 'MI' ? 'selected' : ''}>MI</option><option value="MN" ${state == 'MN' ? 'selected' : ''}>MN</option><option value="MO" ${state == 'MO' ? 'selected' : ''}>MO</option><option value="MP" ${state == 'MP' ? 'selected' : ''}>MP</option><option value="MS" ${state == 'MS' ? 'selected' : ''}>MS</option><option value="MT" ${state == 'MT' ? 'selected' : ''}>MT</option><option value="NC" ${state == 'NC' ? 'selected' : ''}>NC</option><option value="ND" ${state == 'ND' ? 'selected' : ''}>ND</option><option value="NE" ${state == 'NE' ? 'selected' : ''}>NE</option><option value="NH" ${state == 'NH' ? 'selected' : ''}>NH</option><option value="NJ" ${state == 'NJ' ? 'selected' : ''}>NJ</option><option value="NM" ${state == 'NM' ? 'selected' : ''}>NM</option><option value="NV" ${state == 'NV' ? 'selected' : ''}>NV</option><option value="NY" ${state == 'NY' ? 'selected' : ''}>NY</option><option value="OH" ${state == 'OH' ? 'selected' : ''}>OH</option><option value="OK" ${state == 'OK' ? 'selected' : ''}>OK</option><option value="OR" ${state == 'OR' ? 'selected' : ''}>OR</option><option value="PA" ${state == 'PA' ? 'selected' : ''}>PA</option><option value="PR" ${state == 'PR' ? 'selected' : ''}>PR</option><option value="PW" ${state == 'PW' ? 'selected' : ''}>PW</option><option value="RI" ${state == 'RI' ? 'selected' : ''}>RI</option><option value="SC" ${state == 'SC' ? 'selected' : ''}>SC</option><option value="SD" ${state == 'SD' ? 'selected' : ''}>SD</option><option value="TN" ${state == 'TN' ? 'selected' : ''}>TN</option><option value="TX" ${state == 'TX' ? 'selected' : ''}>TX</option><option value="UT" ${state == 'UT' ? 'selected' : ''}>UT</option><option value="VA" ${state == 'VA' ? 'selected' : ''}>VA</option><option value="VI" ${state == 'VI' ? 'selected' : ''}>VI</option><option value="VT" ${state == 'VT' ? 'selected' : ''}>VT</option><option value="WA" ${state == 'WA' ? 'selected' : ''}>WA</option><option value="WI" ${state == 'WI' ? 'selected' : ''}>WI</option><option value="WV" ${state == 'WV' ? 'selected' : ''}>WV</option><option value="WY" ${state == 'WY' ? 'selected' : ''}>WY</option></select>
</div>
</div>
<div style="display:none;">
<label for="zip_${$unique}" class="${zip_title_class}">
<span class="English">Bank Zip</span>
<span class="Spanish">Banco codigo postal</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" maxlength="5" size="8" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onfocus="filterNumericInput(this)" data-relatedhiddenfieldid="zip_${$unique}_ZIPValue_Single_${$unique}" id="zip_${$unique}_ZIP_Single_${$unique}" name="zip_${$unique}_ZIP_Single_${$unique}" value="" title="Zip" /><input type="hidden" id="zip_${$unique}_ZIPValue_Single_${$unique}" name="zip_${$unique}_ZIPValue_Single_${$unique}" value="${zip}" />
</fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="phone_1_${$unique}" class="${phone_title_class}">
<span class="English">Bank Phone</span>
<span class="Spanish">Numero de Telefono</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="phone_1" id="phone_1_${$unique}" value="${phone_1}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"/>
<!-- -->
<input type="text" name="phone_2" value="${phone_2}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"/>
<!-- -->
<input type="text" name="phone_3" value="${phone_3}" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"/>
</fieldset>
</div>
</div>
</div>
<div class="line" style="">
<div>
<label for="accountnumber_${$unique}" class="${accountnumber_title_class}">
<span class="English">Account Number</span>
<span class="Spanish">Numero de cuenta bancaria</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" name="accountnumber" id="accountnumber_${$unique}" value="${accountnumber}" class="inspectlet-sensitive" onfocus="filterAccountNumberInput(this)" maxlength="255" />
</div>
</div>
<div>
<label for="accounttype_${$unique}" class="${accounttype_title_class}">
<span class="English">Account Type</span>
<span class="Spanish">Typo de cuenta bancaria</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="accounttype" id="accounttype_${$unique}" class="SingleDDL">
<option value="C" ${accounttype == 'C' ? 'selected' : ''}>Checking Account</option>
<option value="S" ${accounttype == 'S' ? 'selected' : ''}>Savings Account</option>
</select>
</div>
</div>
</div>
<div class="line" style="">
<div>
<label for="accountlength_year_${$unique}" class="${accountlength_title_class}">
<span class="English">Account Length</span>
<span class="Spanish">Longitud de cuenta</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select name="accountlength_year" id="accountlength_year_${$unique}" title="Year" class="tel">
<option value="">yy</option>
<option value="0" ${accountlength_year == '0' ? 'selected' : ''}>0</option>
<option value="1" ${accountlength_year == '1' ? 'selected' : ''}>1</option>
<option value="2" ${accountlength_year == '2' ? 'selected' : ''}>2</option>
<option value="3" ${accountlength_year == '3' ? 'selected' : ''}>3</option>
<option value="4" ${accountlength_year == '4' ? 'selected' : ''}>4</option>
<option value="5" ${accountlength_year == '5' ? 'selected' : ''}>5</option>
<option value="6" ${accountlength_year == '6' ? 'selected' : ''}>6</option>
<option value="7" ${accountlength_year == '7' ? 'selected' : ''}>7</option>
<option value="8" ${accountlength_year == '8' ? 'selected' : ''}>8</option>
<option value="9" ${accountlength_year == '9' ? 'selected' : ''}>9</option>
<option value="10" ${accountlength_year == '10' ? 'selected' : ''}>10</option>
<option value="11" ${accountlength_year == '11' ? 'selected' : ''}>11</option>
<option value="12" ${accountlength_year == '12' ? 'selected' : ''}>12</option>
<option value="13" ${accountlength_year == '13' ? 'selected' : ''}>13</option>
<option value="14" ${accountlength_year == '14' ? 'selected' : ''}>14</option>
<option value="15" ${accountlength_year == '15' ? 'selected' : ''}>15</option>
<option value="16" ${accountlength_year == '16' ? 'selected' : ''}>16</option>
<option value="17" ${accountlength_year == '17' ? 'selected' : ''}>17</option>
<option value="18" ${accountlength_year == '18' ? 'selected' : ''}>18</option>
<option value="19" ${accountlength_year == '19' ? 'selected' : ''}>19</option>
<option value="20" ${accountlength_year == '20' ? 'selected' : ''}>20</option>
<option value="21" ${accountlength_year == '21' ? 'selected' : ''}>21</option>
<option value="22" ${accountlength_year == '22' ? 'selected' : ''}>22</option>
<option value="23" ${accountlength_year == '23' ? 'selected' : ''}>23</option>
<option value="24" ${accountlength_year == '24' ? 'selected' : ''}>24</option>
</select>
<!-- -->
<select name="accountlength_month" title="Month" class="tel">
<option value="">mm</option>
<option value="0" ${accountlength_month == '0' ? 'selected' : ''}>0</option>
<option value="1" ${accountlength_month == '1' ? 'selected' : ''}>1</option>
<option value="2" ${accountlength_month == '2' ? 'selected' : ''}>2</option>
<option value="3" ${accountlength_month == '3' ? 'selected' : ''}>3</option>
<option value="4" ${accountlength_month == '4' ? 'selected' : ''}>4</option>
<option value="5" ${accountlength_month == '5' ? 'selected' : ''}>5</option>
<option value="6" ${accountlength_month == '6' ? 'selected' : ''}>6</option>
<option value="7" ${accountlength_month == '7' ? 'selected' : ''}>7</option>
<option value="8" ${accountlength_month == '8' ? 'selected' : ''}>8</option>
<option value="9" ${accountlength_month == '9' ? 'selected' : ''}>9</option>
<option value="10" ${accountlength_month == '10' ? 'selected' : ''}>10</option>
<option value="11" ${accountlength_month == '11' ? 'selected' : ''}>11</option>
</select>
</fieldset>
</div>
</div>
</div>
<scr{{= ""}}ipt type="text/javascript">
bankAccountInfoInit('${$unique}', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo', '');
</scr{{= ""}}ipt>
</div>
<div style="clear: both;"></div>
</script>
<script type="text/javascript">
jstemplatetable_initialize('ctl00', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo', [{
"id": "0",
"oldname": "",
"oldabanumber": "",
"active_title_class": "",
"active": true,
"name_title_class": "",
"name": "",
"address_title_class": "",
"address": "",
"city_title_class": "",
"city": "",
"state_title_class": "",
"state": "",
"zip_title_class": "",
"zip": "",
"phone_title_class": "",
"phone_1": "",
"phone_2": "",
"phone_3": "",
"abanumber_title_class": "",
"abanumber": "",
"accountnumber_title_class": "",
"accountnumber": "",
"accounttype_title_class": "",
"accounttype": "C",
"accountlength_title_class": "",
"accountlength_year": "",
"accountlength_month": ""
}], function(el) {
this.id = el.find('input:hidden[name="id"]').val();
this.oldname = el.find('input:hidden[name="oldname"]').val();
this.oldabanumber = el.find('input:hidden[name="oldabanumber"]').val();
this.active = el.find('input:checkbox[name="active"]').is(':checked');
this.name = el.find('input[name="name"]').val();
this.address = el.find('input[name="address"]').val();
this.city = el.find('input[name="city"]').val();
this.state = el.find('select[name="state"] option:selected').val();
this.zip = el.find('input[type=hidden][id^=zip]').val();
this.phone_1 = el.find('input[name="phone_1"]').val();
this.phone_2 = el.find('input[name="phone_2"]').val();
this.phone_3 = el.find('input[name="phone_3"]').val();
this.abanumber = el.find('input[type=hidden][id^=abanumber]').val();
this.accountnumber = el.find('input[name="accountnumber"]').val();
this.accounttype = el.find('select[name="accounttype"] option:selected').val();
this.accountlength_year = el.find('select[name="accountlength_year"] option:selected').val();
this.accountlength_month = el.find('select[name="accountlength_month"] option:selected').val();
}, '.bankinfo');
</script>
<script type="text/javascript">
(function($) {
$('#Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo').find('input[type=hidden][id^=abanumber]').each(function() {
setAbaValue($(this).attr('id'), $(this).val())
});
$('#Content_Root_MemberPageDispatcher_subpage_applyForLoan_BankInfo_Div_BankInfo').find('input[type=hidden][id^=zip]').each(function() {
setZipValue($(this).attr('id'), $(this).val())
});
})(jQuery);
</script>
<div class="SectionCheckbox">
<input id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Bank_HasOther" type="checkbox" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Bank_HasOther" onclick="applyVisiblityBindings(this);">
<label for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Bank_HasOther">
<span class="English">Other bank account</span>
<span class="Spanish">Other bank account</span>
</label>
</div>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo" style="display: none;">
<div id="bankinfo_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class="bankinfo" style="border: 0px; margin: 8px 0px;">
<div class="line">
<div style=""> <label for="active_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Active</span> <span class="Spanish">Activo</span> </label>
<div> <input type="hidden" name="id" value="0"> <input type="hidden" name="oldname" value=""> <input type="hidden" name="oldabanumber" value=""> <input type="checkbox"
id="active_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" name="active" checked=""checked"/"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">ABA Number</span> <span class="Spanish">Numero de ABA</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" maxlength="9" size="12" onfocus="filterNumericInput(this)" data-relatedhiddenfieldid="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_AbaValue_Single"
onkeyup="resolveBankByAba(document.getElementById(this.id).getAttribute('data-relatedhiddenfieldid'), 'name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0');;moveToNextIfFull(this);"
onchange="syncHiddenFieldWithTextboxes(this, '-');resolveBankByAba(document.getElementById(this.id).getAttribute('data-relatedhiddenfieldid'), 'name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0');;"
id="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_ABA_Single" name="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_ABA_Single"
value="" title="ABA Number"><input type="hidden" id="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_AbaValue_Single"
name="abanumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_AbaValue_Single" value=""> </div>
</div>
<div style=""> <label for="name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Bank Name</span> <span class="Spanish">Nombre de banco</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" id="name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" name="name" value="" maxlength="255" size="30"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="address_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Bank Address</span> <span class="Spanish">Direccion del banco</span> </label>
<div> <input type="text" name="address" id="address_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" value="" maxlength="255"> </div>
</div>
<div style=""> <label for="city_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Bank City</span> <span class="Spanish">Banco ciudad</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" name="city" id="city_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" value="" maxlength="255"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="state_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Bank State</span> <span class="Spanish">Banco estado</span> <span
class="RedAsterisk">*</span> </label>
<div> <select id="state_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" name="state">
<option value="">-- Choose --</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select> </div>
</div>
<div style="display:none;"> <label for="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Bank Zip</span> <span class="Spanish">Banco codigo postal</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" maxlength="5" size="8" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onfocus="filterNumericInput(this)"
data-relatedhiddenfieldid="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0"
id="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_ZIP_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0"
name="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_ZIP_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" value="" title="Zip"><input
type="hidden" id="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0"
name="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" value=""> </fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="phone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Bank Phone</span> <span class="Spanish">Numero de Telefono</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="phone_1" id="phone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" value=""
class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"> <!-- --> <input type="text" name="phone_2" value="" class="tel noblock" maxlength="3" size="3"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"> <!-- --> <input type="text" name="phone_3" value="" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)"
onkeyup="moveToNextIfFull(this)" title="Bank Phone"> </fieldset>
</div>
</div>
</div>
<div class="line" style="">
<div> <label for="accountnumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Account Number</span> <span class="Spanish">Numero de cuenta bancaria</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" name="accountnumber" id="accountnumber_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" value="" class="inspectlet-sensitive" onfocus="filterAccountNumberInput(this)"
maxlength="255"> </div>
</div>
<div> <label for="accounttype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Account Type</span> <span class="Spanish">Typo de cuenta bancaria</span> <span
class="RedAsterisk">*</span> </label>
<div> <select name="accounttype" id="accounttype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class="SingleDDL">
<option value="C" selected="">Checking Account</option>
<option value="S">Savings Account</option>
</select> </div>
</div>
</div>
<div class="line" style="">
<div> <label for="accountlength_year_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" class=""> <span class="English">Account Length</span> <span class="Spanish">Longitud de cuenta</span> <span
class="RedAsterisk">*</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select name="accountlength_year" id="accountlength_year_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0" title="Year"
class="tel">
<option value="">yy</option>
<option value="0">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
</select> <!-- --> <select name="accountlength_month" title="Month" class="tel">
<option value="">mm</option>
<option value="0">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
</select> </fieldset>
</div>
</div>
</div>
<script type="text/javascript">
bankAccountInfoInit('Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_0', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo',
'Content_Root_MemberPageDispatcher_subpage_applyForLoan_Bank_HasOther');
</script>
</div>
<div style="clear: both;"></div>
</div><input type="hidden" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_json" name="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_json" value="">
<script type="text/javascript">
(function($) {
window.bankAccountInfoInit = function(unique, bankInfoDivId, otherBankCheckboxId) {
if (otherBankCheckboxId && otherBankCheckboxId != '') {
if ($('#' + bankInfoDivId + ' div:first-child').attr('id') != ('bankinfo_' + unique)) {
$('#bankinfo_' + unique).css("border-top", "solid 1px #ccc");
$('#bankinfo_' + unique).css("margin-top", "4px");
}
}
if ($.mobile) {
$('#bankinfo_' + unique).trigger('create');
}
};
})(jQuery);
</script>
<script id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo_template" type="text/x-jquery-tmpl"> <div id="bankinfo_${$unique}" class="bankinfo" style="border: 0px; margin: 8px 0px;">
<div class="line">
<div style="">
<label for="active_${$unique}" class="${active_title_class}">
<span class="English">Active</span>
<span class="Spanish">Activo</span>
</label>
<div>
<input type="hidden" name="id" value="${id}"/>
<input type="hidden" name="oldname" value="${oldname}"/>
<input type="hidden" name="oldabanumber" value="${oldabanumber}"/>
<input type="checkbox" id="active_${$unique}" name="active" ${active ? 'checked="checked"' : ''}/>
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="abanumber_${$unique}" class="${abanumber_title_class}">
<span class="English">ABA Number</span>
<span class="Spanish">Numero de ABA</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" maxlength="9" size="12" onfocus="filterNumericInput(this)" data-relatedhiddenfieldid="abanumber_${$unique}_AbaValue_Single" onKeyUp="resolveBankByAba(document.getElementById(this.id).getAttribute('data-relatedhiddenfieldid'), 'name_${$unique}');;moveToNextIfFull(this);" onChange="syncHiddenFieldWithTextboxes(this, '-');resolveBankByAba(document.getElementById(this.id).getAttribute('data-relatedhiddenfieldid'), 'name_${$unique}');;" id="abanumber_${$unique}_ABA_Single" name="abanumber_${$unique}_ABA_Single" value="" title="ABA Number" /><input type="hidden" id="abanumber_${$unique}_AbaValue_Single" name="abanumber_${$unique}_AbaValue_Single" value="${abanumber}" />
</div>
</div>
<div style="">
<label for="name_${$unique}" class="${name_title_class}">
<span class="English">Bank Name</span>
<span class="Spanish">Nombre de banco</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" id="name_${$unique}" name="name" value="${name}" maxlength="255" size="30" />
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="address_${$unique}" class="${address_title_class}">
<span class="English">Bank Address</span>
<span class="Spanish">Direccion del banco</span>
</label>
<div>
<input type="text" name="address" id="address_${$unique}" value="${address}" maxlength="255" />
</div>
</div>
<div style="">
<label for="city_${$unique}" class="${city_title_class}">
<span class="English">Bank City</span>
<span class="Spanish">Banco ciudad</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" name="city" id="city_${$unique}" value="${city}" maxlength="255" />
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="state_${$unique}" class="${state_title_class}">
<span class="English">Bank State</span>
<span class="Spanish">Banco estado</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select id="state_${$unique}" name="state" ><option value="">-- Choose --</option><option value="AK" ${state == 'AK' ? 'selected' : ''}>AK</option><option value="AL" ${state == 'AL' ? 'selected' : ''}>AL</option><option value="AR" ${state == 'AR' ? 'selected' : ''}>AR</option><option value="AS" ${state == 'AS' ? 'selected' : ''}>AS</option><option value="AZ" ${state == 'AZ' ? 'selected' : ''}>AZ</option><option value="CA" ${state == 'CA' ? 'selected' : ''}>CA</option><option value="CO" ${state == 'CO' ? 'selected' : ''}>CO</option><option value="CT" ${state == 'CT' ? 'selected' : ''}>CT</option><option value="DC" ${state == 'DC' ? 'selected' : ''}>DC</option><option value="DE" ${state == 'DE' ? 'selected' : ''}>DE</option><option value="FL" ${state == 'FL' ? 'selected' : ''}>FL</option><option value="FM" ${state == 'FM' ? 'selected' : ''}>FM</option><option value="GA" ${state == 'GA' ? 'selected' : ''}>GA</option><option value="GU" ${state == 'GU' ? 'selected' : ''}>GU</option><option value="HI" ${state == 'HI' ? 'selected' : ''}>HI</option><option value="IA" ${state == 'IA' ? 'selected' : ''}>IA</option><option value="ID" ${state == 'ID' ? 'selected' : ''}>ID</option><option value="IL" ${state == 'IL' ? 'selected' : ''}>IL</option><option value="IN" ${state == 'IN' ? 'selected' : ''}>IN</option><option value="KS" ${state == 'KS' ? 'selected' : ''}>KS</option><option value="KY" ${state == 'KY' ? 'selected' : ''}>KY</option><option value="LA" ${state == 'LA' ? 'selected' : ''}>LA</option><option value="MA" ${state == 'MA' ? 'selected' : ''}>MA</option><option value="MD" ${state == 'MD' ? 'selected' : ''}>MD</option><option value="ME" ${state == 'ME' ? 'selected' : ''}>ME</option><option value="MH" ${state == 'MH' ? 'selected' : ''}>MH</option><option value="MI" ${state == 'MI' ? 'selected' : ''}>MI</option><option value="MN" ${state == 'MN' ? 'selected' : ''}>MN</option><option value="MO" ${state == 'MO' ? 'selected' : ''}>MO</option><option value="MP" ${state == 'MP' ? 'selected' : ''}>MP</option><option value="MS" ${state == 'MS' ? 'selected' : ''}>MS</option><option value="MT" ${state == 'MT' ? 'selected' : ''}>MT</option><option value="NC" ${state == 'NC' ? 'selected' : ''}>NC</option><option value="ND" ${state == 'ND' ? 'selected' : ''}>ND</option><option value="NE" ${state == 'NE' ? 'selected' : ''}>NE</option><option value="NH" ${state == 'NH' ? 'selected' : ''}>NH</option><option value="NJ" ${state == 'NJ' ? 'selected' : ''}>NJ</option><option value="NM" ${state == 'NM' ? 'selected' : ''}>NM</option><option value="NV" ${state == 'NV' ? 'selected' : ''}>NV</option><option value="NY" ${state == 'NY' ? 'selected' : ''}>NY</option><option value="OH" ${state == 'OH' ? 'selected' : ''}>OH</option><option value="OK" ${state == 'OK' ? 'selected' : ''}>OK</option><option value="OR" ${state == 'OR' ? 'selected' : ''}>OR</option><option value="PA" ${state == 'PA' ? 'selected' : ''}>PA</option><option value="PR" ${state == 'PR' ? 'selected' : ''}>PR</option><option value="PW" ${state == 'PW' ? 'selected' : ''}>PW</option><option value="RI" ${state == 'RI' ? 'selected' : ''}>RI</option><option value="SC" ${state == 'SC' ? 'selected' : ''}>SC</option><option value="SD" ${state == 'SD' ? 'selected' : ''}>SD</option><option value="TN" ${state == 'TN' ? 'selected' : ''}>TN</option><option value="TX" ${state == 'TX' ? 'selected' : ''}>TX</option><option value="UT" ${state == 'UT' ? 'selected' : ''}>UT</option><option value="VA" ${state == 'VA' ? 'selected' : ''}>VA</option><option value="VI" ${state == 'VI' ? 'selected' : ''}>VI</option><option value="VT" ${state == 'VT' ? 'selected' : ''}>VT</option><option value="WA" ${state == 'WA' ? 'selected' : ''}>WA</option><option value="WI" ${state == 'WI' ? 'selected' : ''}>WI</option><option value="WV" ${state == 'WV' ? 'selected' : ''}>WV</option><option value="WY" ${state == 'WY' ? 'selected' : ''}>WY</option></select>
</div>
</div>
<div style="display:none;">
<label for="zip_${$unique}" class="${zip_title_class}">
<span class="English">Bank Zip</span>
<span class="Spanish">Banco codigo postal</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" maxlength="5" size="8" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onfocus="filterNumericInput(this)" data-relatedhiddenfieldid="zip_${$unique}_ZIPValue_Single_${$unique}" id="zip_${$unique}_ZIP_Single_${$unique}" name="zip_${$unique}_ZIP_Single_${$unique}" value="" title="Zip" /><input type="hidden" id="zip_${$unique}_ZIPValue_Single_${$unique}" name="zip_${$unique}_ZIPValue_Single_${$unique}" value="${zip}" />
</fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="phone_1_${$unique}" class="${phone_title_class}">
<span class="English">Bank Phone</span>
<span class="Spanish">Numero de Telefono</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="phone_1" id="phone_1_${$unique}" value="${phone_1}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"/>
<!-- -->
<input type="text" name="phone_2" value="${phone_2}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"/>
<!-- -->
<input type="text" name="phone_3" value="${phone_3}" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Bank Phone"/>
</fieldset>
</div>
</div>
</div>
<div class="line" style="">
<div>
<label for="accountnumber_${$unique}" class="${accountnumber_title_class}">
<span class="English">Account Number</span>
<span class="Spanish">Numero de cuenta bancaria</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" name="accountnumber" id="accountnumber_${$unique}" value="${accountnumber}" class="inspectlet-sensitive" onfocus="filterAccountNumberInput(this)" maxlength="255" />
</div>
</div>
<div>
<label for="accounttype_${$unique}" class="${accounttype_title_class}">
<span class="English">Account Type</span>
<span class="Spanish">Typo de cuenta bancaria</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="accounttype" id="accounttype_${$unique}" class="SingleDDL">
<option value="C" ${accounttype == 'C' ? 'selected' : ''}>Checking Account</option>
<option value="S" ${accounttype == 'S' ? 'selected' : ''}>Savings Account</option>
</select>
</div>
</div>
</div>
<div class="line" style="">
<div>
<label for="accountlength_year_${$unique}" class="${accountlength_title_class}">
<span class="English">Account Length</span>
<span class="Spanish">Longitud de cuenta</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select name="accountlength_year" id="accountlength_year_${$unique}" title="Year" class="tel">
<option value="">yy</option>
<option value="0" ${accountlength_year == '0' ? 'selected' : ''}>0</option>
<option value="1" ${accountlength_year == '1' ? 'selected' : ''}>1</option>
<option value="2" ${accountlength_year == '2' ? 'selected' : ''}>2</option>
<option value="3" ${accountlength_year == '3' ? 'selected' : ''}>3</option>
<option value="4" ${accountlength_year == '4' ? 'selected' : ''}>4</option>
<option value="5" ${accountlength_year == '5' ? 'selected' : ''}>5</option>
<option value="6" ${accountlength_year == '6' ? 'selected' : ''}>6</option>
<option value="7" ${accountlength_year == '7' ? 'selected' : ''}>7</option>
<option value="8" ${accountlength_year == '8' ? 'selected' : ''}>8</option>
<option value="9" ${accountlength_year == '9' ? 'selected' : ''}>9</option>
<option value="10" ${accountlength_year == '10' ? 'selected' : ''}>10</option>
<option value="11" ${accountlength_year == '11' ? 'selected' : ''}>11</option>
<option value="12" ${accountlength_year == '12' ? 'selected' : ''}>12</option>
<option value="13" ${accountlength_year == '13' ? 'selected' : ''}>13</option>
<option value="14" ${accountlength_year == '14' ? 'selected' : ''}>14</option>
<option value="15" ${accountlength_year == '15' ? 'selected' : ''}>15</option>
<option value="16" ${accountlength_year == '16' ? 'selected' : ''}>16</option>
<option value="17" ${accountlength_year == '17' ? 'selected' : ''}>17</option>
<option value="18" ${accountlength_year == '18' ? 'selected' : ''}>18</option>
<option value="19" ${accountlength_year == '19' ? 'selected' : ''}>19</option>
<option value="20" ${accountlength_year == '20' ? 'selected' : ''}>20</option>
<option value="21" ${accountlength_year == '21' ? 'selected' : ''}>21</option>
<option value="22" ${accountlength_year == '22' ? 'selected' : ''}>22</option>
<option value="23" ${accountlength_year == '23' ? 'selected' : ''}>23</option>
<option value="24" ${accountlength_year == '24' ? 'selected' : ''}>24</option>
</select>
<!-- -->
<select name="accountlength_month" title="Month" class="tel">
<option value="">mm</option>
<option value="0" ${accountlength_month == '0' ? 'selected' : ''}>0</option>
<option value="1" ${accountlength_month == '1' ? 'selected' : ''}>1</option>
<option value="2" ${accountlength_month == '2' ? 'selected' : ''}>2</option>
<option value="3" ${accountlength_month == '3' ? 'selected' : ''}>3</option>
<option value="4" ${accountlength_month == '4' ? 'selected' : ''}>4</option>
<option value="5" ${accountlength_month == '5' ? 'selected' : ''}>5</option>
<option value="6" ${accountlength_month == '6' ? 'selected' : ''}>6</option>
<option value="7" ${accountlength_month == '7' ? 'selected' : ''}>7</option>
<option value="8" ${accountlength_month == '8' ? 'selected' : ''}>8</option>
<option value="9" ${accountlength_month == '9' ? 'selected' : ''}>9</option>
<option value="10" ${accountlength_month == '10' ? 'selected' : ''}>10</option>
<option value="11" ${accountlength_month == '11' ? 'selected' : ''}>11</option>
</select>
</fieldset>
</div>
</div>
</div>
<scr{{= ""}}ipt type="text/javascript">
bankAccountInfoInit('${$unique}', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_Bank_HasOther');
</scr{{= ""}}ipt>
</div>
<div style="clear: both;"></div>
</script>
<script type="text/javascript">
jstemplatetable_initialize('ctl00', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo', [{
"id": "0",
"oldname": "",
"oldabanumber": "",
"active_title_class": "",
"active": true,
"name_title_class": "",
"name": "",
"address_title_class": "",
"address": "",
"city_title_class": "",
"city": "",
"state_title_class": "",
"state": "",
"zip_title_class": "",
"zip": "",
"phone_title_class": "",
"phone_1": "",
"phone_2": "",
"phone_3": "",
"abanumber_title_class": "",
"abanumber": "",
"accountnumber_title_class": "",
"accountnumber": "",
"accounttype_title_class": "",
"accounttype": "C",
"accountlength_title_class": "",
"accountlength_year": "",
"accountlength_month": ""
}], function(el) {
this.id = el.find('input:hidden[name="id"]').val();
this.oldname = el.find('input:hidden[name="oldname"]').val();
this.oldabanumber = el.find('input:hidden[name="oldabanumber"]').val();
this.active = el.find('input:checkbox[name="active"]').is(':checked');
this.name = el.find('input[name="name"]').val();
this.address = el.find('input[name="address"]').val();
this.city = el.find('input[name="city"]').val();
this.state = el.find('select[name="state"] option:selected').val();
this.zip = el.find('input[type=hidden][id^=zip]').val();
this.phone_1 = el.find('input[name="phone_1"]').val();
this.phone_2 = el.find('input[name="phone_2"]').val();
this.phone_3 = el.find('input[name="phone_3"]').val();
this.abanumber = el.find('input[type=hidden][id^=abanumber]').val();
this.accountnumber = el.find('input[name="accountnumber"]').val();
this.accounttype = el.find('select[name="accounttype"] option:selected').val();
this.accountlength_year = el.find('select[name="accountlength_year"] option:selected').val();
this.accountlength_month = el.find('select[name="accountlength_month"] option:selected').val();
}, '.bankinfo');
</script>
<script type="text/javascript">
(function($) {
$('#Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo').find('input[type=hidden][id^=abanumber]').each(function() {
setAbaValue($(this).attr('id'), $(this).val())
});
$('#Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo').find('input[type=hidden][id^=zip]').each(function() {
setZipValue($(this).attr('id'), $(this).val())
});
addVisiblityBinding('Content_Root_MemberPageDispatcher_subpage_applyForLoan_Bank_HasOther', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_AddMore',
'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo');
})(jQuery);
</script>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_AddMore" style="display: none;">
<span id="addBankInfo" style="cursor: pointer; font-weight: bold; FONT-SIZE: 12px; color: #333333" onclick="jstemplatetable_additem('Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherBankInfo_Div_BankInfo', null,
{
id:'0',
oldname:'',
oldabanumber:'',
active_title_class:'',
active:true,
name_title_class:'',
name:'',
address_title_class:'',
address:'',
city_title_class:'',
city:'',
state_title_class:'',
state:'',
zip_title_class:'',
zip:'',
phone_title_class:'',
phone_1:'',
phone_2:'',
phone_3:'',
abanumber_title_class:'',
abanumber:'',
accountnumber_title_class:'',
accountnumber:'',
accounttype_title_class:'',
accounttype:'',
accountlength_title_class:'',
accountlength_year:'',
accountlength_month:''
});">
<span class="English">[Add More]</span>
<span class="Spanish">[Liste más]</span>
</span>
</div>
<script type="text/javascript">
applyVisiblityBindings($('#Content_Root_MemberPageDispatcher_subpage_applyForLoan_Bank_HasOther')[0]);
</script>
<div style="clear: both;"></div>
</div>
</div>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Div_CreditCardInfo">
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">DEBIT/CREDIT CARD INFORMATION</span>
</div>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Div_CreditCard" class="SectionTable">
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CcName" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcName"> Name On Card </label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcName" type="text" maxlength="255" size="21" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcName" onchange="resetCcRegistration()"
onfocus="filterNameOnCardInput(this)">
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CcBillingAddress" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingAddress"> Billing Address </label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcBillingAddress" type="text" maxlength="255" size="25" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingAddress" onchange="resetCcRegistration()">
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CcNumber" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcNumber_Text"> Card Number </label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcNumber$Text" type="text" maxlength="16" size="21" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcNumber_Text" onfocus="filterNumericInput(this)"
onkeyup="moveToNextIfFull(this)" onchange="resetCcRegistration()" cssclass="tel inspectlet-sensitive"
value=""><a id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcNumber_EditLink" onclick="if ($(this).text() == '[Edit]') { $(this).text('[Cancel]').attr('orig', $(this).prev().val()); $(this).prev().removeAttr('readonly').val('').trigger('change').css('backgroundColor', '').focus(); } else if ($(this).text() == '[Cancel]') { $(this).prev().val($(this).attr('orig')).trigger('change').attr('readonly', 'readonly').css('backgroundColor', '#eeeeee'); $(this).text('[Edit]'); } return false;" href="javascript:">[Edit]</a><input
type="hidden" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcNumber$OldText" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcNumber_OldText" value="ZyXT+bt1BUnZx/hML8ukIw==">
<script type="text/javascript">
</script>
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CcBillingCity" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingCity"> City </label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcBillingCity" type="text" maxlength="255" size="15" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingCity" onchange="resetCcRegistration()">
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CcExpDate" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcExpDate_Month"> Exp Date </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcExpDate_Month" type="text" maxlength="2" size="2" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcExpDate_Month" class="tel noblock"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" onchange="resetCcRegistration()">
<label for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcExpDate_Year" style="display:inline"><span class="slashForDate">/</span></label>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcExpDate_Year" type="text" maxlength="2" size="2" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcExpDate_Year" class="tel noblock"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" onchange="resetCcRegistration()">
</fieldset>
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CcBillingState" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingState"> State </label>
<div>
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcBillingState" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingState" onchange="resetCcRegistration()">
<option selected="selected" value="">-- Choose --</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select>
</div>
</div>
</div>
<div class="line">
<div>
<label></label>
<div></div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CcBillingZip" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingZip"> Zip </label>
<div>
<span id="span_ccBillingZipContainer">
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcBillingZip$ZIP_Single" type="text" maxlength="5" size="8" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingZip_ZIP_Single" class="tel"
title="Zip" data-relatedhiddenfieldid="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingZip_ZIPValue_Single" onfocus="filterNumericInput(this)" onchange="syncHiddenFieldWithTextboxes(this, ' ')"
onkeyup="moveToNextIfFull(this)"><input type="hidden" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcBillingZip$ZIPValue_Single"
id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcBillingZip_ZIPValue_Single">
</fieldset>
</span>
<script type="text/javascript">
$("#span_ccBillingZipContainer").change(resetCcRegistration);
// ZipControl doesn't have inherent onchange support
</script>
</div>
</div>
</div>
<div id="div_ccRegistrationControls" style="display: none;">
<div class="line">
<div class="single aligned">
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_CcSecurityCode" class="regularlabel" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcSecurityCode"> CVC <span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$CcSecurityCode" type="text" size="3" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_CcSecurityCode">
</div>
</div>
<div class="single aligned">
<div class="label"></div>
<div> We may need to authenticate your debit/credit card to confirm it's valid. This will be done only once, provided there are no changes to your debit/credit card details. During this process, the card may be charged a nominal
amount (typically $0.01) which will in turn be refunded. </div>
</div>
</div>
</div>
<input type="hidden" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Hidden_CcRegistered" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Hidden_CcRegistered">
<script type="text/javascript">
applyCcRegistrationStatus();
</script>
<div style="clear: both;"></div>
</div>
</div>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Div_EmpInfo">
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">INCOME & EMPLOYMENT INFORMATION</span>
<span class="Spanish">Ingresos y empleo información</span>
</div>
<div class="SectionMessage">
<span class="English"> Income from alimony, child support or separate maintenance payments need not be disclosed if you don't wish us to consider this as a source of repayment. </span>
<span class="Spanish"> Ingresos por manutención de menores o pensión matrimonial u otros ingresos no es necesario declarar esta información si no va hacer utilizado como forma de pago. </span>
</div>
<div class="SectionTable">
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo">
<div id="empinfo_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class="empinfo"> <input type="hidden" name="id" value="0">
<div class="line">
<div style=""> <label for="income_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Monthly Income</span> <span class="Spanish">Ingresos Mensuales</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" name="income" id="income_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" maxlength="15" size="12" onfocus="filterMoneyInput(this)" step="any" class="number"> </div>
</div>
<div style="display:none;"> <label for="obligations_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Monthly Obligations</span> <span class="Spanish">Monthly
Obligations</span> </label>
<div> <input type="text" name="obligations" id="obligations_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" maxlength="15" size="12" onfocus="filterMoneyInput(this)" step="any" class="number">
</div>
</div>
</div>
<div class="line">
<div style=""> <label for="incometypeid_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Income Type</span> <span class="Spanish">Income Type</span> <span
class="RedAsterisk">*</span> </label>
<div> <select id="incometypeid_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" name="incometypeid" class="SingleDDL"
onchange="incomeTypeChanged('Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', false, 1); showIncomeTypeText('incometypeid_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0','incometypetext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0');">
<option value="">-- Select One --</option>
<option value="1">Employment</option>
<option value="4">Social Security</option>
<option value="5">Disability</option>
<option value="6">Retirement</option>
<option value="7">Self-Employed</option>
<option value="8">Other</option>
<option value="10">Unemployment Benefits</option>
</select> <input type="text" id="incometypetext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" name="incometypetext" value="" size="12" maxlength="255" title="Income Type"
style="display:none !important"> </div>
</div>
<script type="text/javascript">
showIncomeTypeText('incometypeid_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', 'incometypetext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0');
</script>
<div> <label for="payrolltype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Payroll Type</span> <span class="Spanish">Tipo de saldo</span> <span
class="RedAsterisk">*</span> </label>
<div> <select name="payrolltype" id="payrolltype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class="SingleDDL">
<option value="">-- Select One --</option>
<option value="1">Cash</option>
<option value="2">Check</option>
<option value="3">Direct Deposit</option>
</select> </div>
</div>
</div>
<div class="line" style="">
<div> <label for="paydayfrequencytype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Pay Frequency</span> <span class="Spanish">Frecuencia de pago</span> <span
class="RedAsterisk">*</span> </label>
<div>
<script type="text/javascript">
function applyEmpPaydayFrequencyTypesVisibility_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0() {
applyPaymentTypeFrequencyTypesVisibility('paydayfrequencytype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', [
'input_paydaydayinmonthsubtype_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'input_paydaydayinmonthsubtype_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0'
], ['div_frequencyweekly_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', 'div_frequencyweekly_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0'], [
'div_frequencybiweekly_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', 'div_frequencybiweekly_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'div_frequencybiweekly_3_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', 'div_frequencybiweekly_4_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0'
], ['div_frequencymonthbased_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', 'div_frequencymonthbased_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'span_frequencymonthly_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'span_frequencymonthly_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0'
], ['div_frequencymonthbased_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', 'div_frequencymonthbased_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'span_frequencytwicepermonth_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'span_frequencytwicepermonth_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0'
], [], []);
}
function applyEmpPaydayDayInMonthSubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0(initFromHidden) {
applyPaymentTypeDayInMonthSubtype('input_paydaydayinmonthsubtype_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'input_paydaydayinmonthsubtype_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', initFromHidden);
applyEmpPaydayDayInMonthSubtypesDimming_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0();
}
function applyEmpPaydayDayInMonthSubtypesDimming_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0() {
applyPaymentTypeDayInMonthSubtypesDimming('paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', [
'span_frequencymonthly_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'span_frequencytwicepermonth_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencymonthly_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_firstday_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_secondday_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0'
], ['span_frequencymonthly_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'span_frequencytwicepermonth_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencymonthly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', 'frequencymonthly_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_firstday_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_secondday_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_secondday_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_firstday_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0'
]);
}
</script> <select id="paydayfrequencytype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" name="paydayfrequencytype" class="SingleDDL"
onchange="applyEmpPaydayFrequencyTypesVisibility_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0();">
<option value="">-- Select One --</option>
<option value="1">Weekly</option>
<option value="2">Bi-weekly</option>
<option value="3">Monthly</option>
<option value="4">Twice per Month</option>
</select>
</div>
</div>
</div>
<div class="line" style="">
<div id="div_frequencyweekly_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <label
for="frequencyweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> Pay Day <span class="RedAsterisk">*</span> </label>
<div id="div_frequencyweekly_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <select
id="frequencyweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" name="frequencyweekly_weekday">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday">Friday</option>
<option value="saturday">Saturday</option>
</select> </div>
</div>
<div id="div_frequencybiweekly_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <label
for="frequencybiweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> Pay Day <span class="RedAsterisk">*</span> </label>
<div id="div_frequencybiweekly_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden">
<script type="text/javascript">
function updateEmpBiWeeklySampleDateSetup_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0(initFromHidden) {
updateBiWeeklySampleDateSetupWithRadio('frequencybiweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'fieldset_frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'input_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'label_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'input_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'label_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'span_frequencybiweekly_noweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', 'frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
initFromHidden);
}
function applyEmpBiWeeklySampleDate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0() {
applyBiWeeklySampleDateWithRadio('input_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'input_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0',
'frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0');
}
</script> <select id="frequencybiweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" name="frequencybiweekly_weekday"
onchange="updateEmpBiWeeklySampleDateSetup_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0(false);">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday">Friday</option>
<option value="saturday">Saturday</option>
</select>
</div>
</div>
<div id="div_frequencybiweekly_3_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <label class=""> Next Pay Date <span class="RedAsterisk">*</span> </label>
<div id="div_frequencybiweekly_4_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden">
<fieldset id="fieldset_frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input
id="input_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" type="radio"
name="name_frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
onclick="applyEmpBiWeeklySampleDate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0();"> <label
for="input_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
id="label_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0">Sample Date</label> <!-- --> <input
id="input_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" type="radio"
name="name_frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
onclick="applyEmpBiWeeklySampleDate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0();"> <label
for="input_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
id="label_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0">Sample Date</label> </fieldset> <span
id="span_frequencybiweekly_noweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="">(Select week day)</span> <input type="hidden"
id="frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" name="frequencybiweekly_sampledate" value="">
<script type="text/javascript">
updateEmpBiWeeklySampleDateSetup_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0(true);
</script>
</div>
</div>
<div id="div_frequencymonthbased_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <label class=""> Pay Day <span class="RedAsterisk">*</span> </label>
<div id="div_frequencymonthbased_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden">
<div> <input type="hidden" id="paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" name="paydaydayinmonthsubtype" value="">
<table>
<tbody>
<tr>
<td> <input id="input_paydaydayinmonthsubtype_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" type="radio"
name="name_paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
onclick="applyEmpPaydayDayInMonthSubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0();" title="Day Of Month" class=" ForceHidden" style="display: none;"> <span> </span> </td>
<td id="span_frequencymonthly_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none; color: gray;" class=" ForceHidden">
<table>
<tbody>
<tr>
<td> <select id="frequencymonthly_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencymonthly_dayordinal" disabled="" style="color: gray;">
<option value="1">1st</option>
<option value="15">15th</option>
<option value="-1">Last</option>
<option disabled="disabled" value="">----</option>
<option value="1">1st</option>
<option value="2">2nd</option>
<option value="3">3rd</option>
<option value="4">4th</option>
<option value="5">5th</option>
<option value="6">6th</option>
<option value="7">7th</option>
<option value="8">8th</option>
<option value="9">9th</option>
<option value="10">10th</option>
<option value="11">11th</option>
<option value="12">12th</option>
<option value="13">13th</option>
<option value="14">14th</option>
<option value="15">15th</option>
<option value="16">16th</option>
<option value="17">17th</option>
<option value="18">18th</option>
<option value="19">19th</option>
<option value="20">20th</option>
<option value="21">21st</option>
<option value="22">22nd</option>
<option value="23">23rd</option>
<option value="24">24th</option>
<option value="25">25th</option>
<option value="26">26th</option>
<option value="27">27th</option>
<option value="28">28th</option>
<option value="29">29th</option>
<option value="30">30th</option>
<option value="31">31st</option>
</select> </td>
<td>of month</td>
</tr>
</tbody>
</table>
</td>
<td id="span_frequencytwicepermonth_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none; color: gray;" class=" ForceHidden">
<table>
<tbody>
<tr>
<td> <select id="frequencytwicepermonth_firstday_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencytwicepermonth_firstday_dayordinal"
disabled="" style="color: gray;">
<option value="1">1st</option>
<option value="15">15th</option>
<option value="-1">Last</option>
<option disabled="disabled" value="">----</option>
<option value="1">1st</option>
<option value="2">2nd</option>
<option value="3">3rd</option>
<option value="4">4th</option>
<option value="5">5th</option>
<option value="6">6th</option>
<option value="7">7th</option>
<option value="8">8th</option>
<option value="9">9th</option>
<option value="10">10th</option>
<option value="11">11th</option>
<option value="12">12th</option>
<option value="13">13th</option>
<option value="14">14th</option>
<option value="15">15th</option>
<option value="16">16th</option>
<option value="17">17th</option>
<option value="18">18th</option>
<option value="19">19th</option>
<option value="20">20th</option>
<option value="21">21st</option>
<option value="22">22nd</option>
<option value="23">23rd</option>
<option value="24">24th</option>
<option value="25">25th</option>
<option value="26">26th</option>
<option value="27">27th</option>
<option value="28">28th</option>
<option value="29">29th</option>
<option value="30">30th</option>
<option value="31">31st</option>
</select> </td>
<td><b>and</b></td>
<td> <select id="frequencytwicepermonth_secondday_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencytwicepermonth_secondday_dayordinal"
disabled="" style="color: gray;">
<option value="1">1st</option>
<option value="15" selected="">15th</option>
<option value="-1">Last</option>
<option disabled="disabled" value="">----</option>
<option value="1">1st</option>
<option value="2">2nd</option>
<option value="3">3rd</option>
<option value="4">4th</option>
<option value="5">5th</option>
<option value="6">6th</option>
<option value="7">7th</option>
<option value="8">8th</option>
<option value="9">9th</option>
<option value="10">10th</option>
<option value="11">11th</option>
<option value="12">12th</option>
<option value="13">13th</option>
<option value="14">14th</option>
<option value="15" selected="">15th</option>
<option value="16">16th</option>
<option value="17">17th</option>
<option value="18">18th</option>
<option value="19">19th</option>
<option value="20">20th</option>
<option value="21">21st</option>
<option value="22">22nd</option>
<option value="23">23rd</option>
<option value="24">24th</option>
<option value="25">25th</option>
<option value="26">26th</option>
<option value="27">27th</option>
<option value="28">28th</option>
<option value="29">29th</option>
<option value="30">30th</option>
<option value="31">31st</option>
</select> </td>
<td>of month</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div>
<div>
<table>
<tbody>
<tr>
<td> <input id="input_paydaydayinmonthsubtype_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" type="radio"
name="name_paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
onclick="applyEmpPaydayDayInMonthSubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0();" title="Day Of Week" class=" ForceHidden" style="display: none;"> <span> </span> </td>
<td id="span_frequencymonthly_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none; color: gray;" class=" ForceHidden">
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select id="frequencymonthly_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" title="Pay Day"
name="frequencymonthly_weekdayordinal" disabled="" style="color: gray;">
<option value="1">First</option>
<option value="2">Second</option>
<option value="3">Third</option>
<option value="4">Fourth</option>
<option value="-1">Last</option>
</select> <!-- --> <select id="frequencymonthly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencymonthly_weekday" disabled="" style="color: gray;">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday" selected="">Friday</option>
<option value="saturday">Saturday</option>
</select> </fieldset>
</td>
<td id="span_frequencytwicepermonth_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" nowrap="nowrap" style="display: none; color: gray;" class=" ForceHidden">
<table>
<tbody>
<tr>
<td>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select id="frequencytwicepermonth_firstday_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
title="Pay Day" name="frequencytwicepermonth_firstday_weekdayordinal" disabled="" style="color: gray;">
<option value="1">First</option>
<option value="2">Second</option>
<option value="3">Third</option>
<option value="4">Fourth</option>
<option value="-1">Last</option>
</select> <!-- --> <select id="frequencytwicepermonth_firstday_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" title="Pay Day"
name="frequencytwicepermonth_firstday_weekday" disabled="" style="color: gray;">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday" selected="">Friday</option>
<option value="saturday">Saturday</option>
</select> </fieldset>
</td>
<td><b>and</b></td>
<td>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select id="frequencytwicepermonth_secondday_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
title="Pay Day" name="frequencytwicepermonth_secondday_weekdayordinal" disabled="" style="color: gray;">
<option value="1">First</option>
<option value="2">Second</option>
<option value="3" selected="">Third</option>
<option value="4">Fourth</option>
<option value="-1">Last</option>
</select> <!-- --> <select id="frequencytwicepermonth_secondday_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" title="Pay Day"
name="frequencytwicepermonth_secondday_weekday" disabled="" style="color: gray;">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday" selected="">Friday</option>
<option value="saturday">Saturday</option>
</select> </fieldset>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<script type="text/javascript">
employmentInfoFrequencyInit('Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0');
</script>
<div class="line" style="">
<div class="single"> <label class=""> <span class="English">If Payday On Bank Holiday</span> <span class="Spanish">If Payday On Bank Holiday</span> </label>
<div class="field"> <input id="paydayholidayskippingtype_none_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" type="radio"
name="paydayholidayskippingtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="1" style="vertical-align: middle;"> <label
for="paydayholidayskippingtype_none_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0">Do Nothing</label> <input
id="paydayholidayskippingtype_moveearlier_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" type="radio"
name="paydayholidayskippingtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="2" checked="" style="vertical-align: middle;"> <label
for="paydayholidayskippingtype_moveearlier_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0">Move To Previous Business Day</label> <input
id="paydayholidayskippingtype_movelater_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" type="radio"
name="paydayholidayskippingtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="3" style="vertical-align: middle;"> <label
for="paydayholidayskippingtype_movelater_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0">Move To Next Business Day</label> </div>
</div>
</div>
<div style="clear: both;"></div>
<div id="div_employmentinfo_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: none;">
<div class="line">
<div style=""> <label for="name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer</span> <span class="Spanish">Empleador</span> <span class="RedAsterisk">*</span>
</label>
<div> <input type="text" name="name" id="name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" size="12" maxlength="255"> </div>
</div>
<div style="display:none;"> <label for="occupation_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Occupation</span> <span class="Spanish">Posición / Título</span>
</label>
<div> <input type="text" name="occupation" id="occupation_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" size="20" maxlength="255"> </div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="dateofhire_year_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Date Of Hire</span> <span class="Spanish">Fecha de
contratación</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select name="dateofhire_year" id="dateofhire_year_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class="tel">
<option value="">Year</option>
<option value="1900">1900</option>
<option value="1901">1901</option>
<option value="1902">1902</option>
<option value="1903">1903</option>
<option value="1904">1904</option>
<option value="1905">1905</option>
<option value="1906">1906</option>
<option value="1907">1907</option>
<option value="1908">1908</option>
<option value="1909">1909</option>
<option value="1910">1910</option>
<option value="1911">1911</option>
<option value="1912">1912</option>
<option value="1913">1913</option>
<option value="1914">1914</option>
<option value="1915">1915</option>
<option value="1916">1916</option>
<option value="1917">1917</option>
<option value="1918">1918</option>
<option value="1919">1919</option>
<option value="1920">1920</option>
<option value="1921">1921</option>
<option value="1922">1922</option>
<option value="1923">1923</option>
<option value="1924">1924</option>
<option value="1925">1925</option>
<option value="1926">1926</option>
<option value="1927">1927</option>
<option value="1928">1928</option>
<option value="1929">1929</option>
<option value="1930">1930</option>
<option value="1931">1931</option>
<option value="1932">1932</option>
<option value="1933">1933</option>
<option value="1934">1934</option>
<option value="1935">1935</option>
<option value="1936">1936</option>
<option value="1937">1937</option>
<option value="1938">1938</option>
<option value="1939">1939</option>
<option value="1940">1940</option>
<option value="1941">1941</option>
<option value="1942">1942</option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</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="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>
</select> <!-- --> <select name="dateofhire_month" title="Month" class="tel">
<option value="">Month</option>
<option value="1">Jan</option>
<option value="2">Feb</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</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> </fieldset>
</div>
</div>
<div style="display:none;"> <label for="shift_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Shift</span> <span class="Spanish">Horario</span> </label>
<div> <input type="text" name="shift" id="shift_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" size="20" maxlength="255"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="phone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Work Phone</span> <span class="Spanish">Numero del teléfono del empleo</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="phone_1" id="phone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value=""
class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"> <!-- --> <input type="text" name="phone_2" value="" class="tel noblock FourBox"
maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"> <!-- --> <input type="text" name="phone_3" value="" class="tel noblock FourBox" maxlength="4" size="4"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"> <!-- --> <label for="phoneext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
style="display: inline;"><span class="English">Ext.:</span><span class="Spanish">Extensión:</span></label> <input type="text" name="phoneext"
id="phoneext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" class="tel noblock FourBox" size="12" maxlength="40" onfocus="filterNumericInput(this)"> </fieldset>
</div>
</div>
<div style="display:none;"> <label for="fax_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Work Fax</span> <span class="Spanish">Fax del trabajo</span>: </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="fax_1" id="fax_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" class="tel noblock"
maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"> <!-- --> <input type="text" name="fax_2" value="" class="tel noblock" maxlength="3" size="3"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"> <!-- --> <input type="text" name="fax_3" value="" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)"
onkeyup="moveToNextIfFull(this)" title="Work Fax"> </fieldset>
</div>
</div>
</div>
<div class="line" style="display:none;">
<div> <label for="cellphone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Cell Phone (Work)</span> <span class="Spanish">Numero de celular del empleo</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="cellphone_1" id="cellphone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value=""
class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"> <!-- --> <input type="text" name="cellphone_2" value="" class="tel noblock"
maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"> <!-- --> <input type="text" name="cellphone_3" value="" class="tel noblock" maxlength="4" size="4"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"> </fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="address_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer Address</span> <span class="Spanish">Dirección de empleo</span>
</label>
<div> <input type="text" name="address" id="address_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" size="20" maxlength="255"> </div>
</div>
<div style="display:none;"> <label for="city_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer City</span> <span class="Spanish">Ciudad de empleo</span> </label>
<div> <input type="text" name="city" id="city_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" size="12" maxlength="255"> </div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="state_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer State</span> <span class="Spanish">Estado</span> </label>
<div> <select id="state_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" name="state">
<option value="">-- Choose --</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select> </div>
</div>
<div style="display:none;"> <label for="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer Zip</span> <span class="Spanish">Código postal</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" maxlength="5" size="8" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onfocus="filterNumericInput(this)"
data-relatedhiddenfieldid="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
id="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0_ZIP_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
name="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0_ZIP_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" title="Zip"><input type="hidden"
id="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0"
name="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value=""> </fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="supervisor_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Supervisor</span> <span class="Spanish">Supervisor</span> </label>
<div> <input type="text" name="supervisor" id="supervisor_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" size="12" maxlength="255"> </div>
</div>
<div style="display:none;"> <label for="supervisorphone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" class=""> <span class="English">Supervisor Phone</span> <span class="Spanish">Numero de
teléfono</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="supervisorphone_1" id="supervisorphone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value=""
class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"> <!-- --> <input type="text" name="supervisorphone_2" value=""
class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"> <!-- --> <input type="text" name="supervisorphone_3" value=""
class="tel noblock FourBox" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"> <!-- --> <label
for="supervisorphoneext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" style="display: inline;"><span class="English">Ext.:</span><span class="Spanish">Extensión:</span></label> <input
type="text" name="supervisorphoneext" id="supervisorphoneext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0" value="" class="tel noblock FourBox" size="12" maxlength="40"> </fieldset>
</div>
</div>
</div>
</div>
<script type="text/javascript">
employmentInfoInit('Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_0', false, 1, true, 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo');
</script>
<div style="clear: both;"></div>
</div>
</div><input type="hidden" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_json" name="Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_json" value="">
<script type="text/javascript">
(function($) {
window.incomeTypeChanged = function(unique, showEmploymentFieldsForAllIncomeTypes, incomeTypeEmploymentId) {
if (showEmploymentFieldsForAllIncomeTypes) return;
var incomeType = $('#incometypeid_' + unique).val();
var required = incomeType == incomeTypeEmploymentId;
$('#div_employmentinfo_' + unique).toggle(required);
};
window.employmentInfoInit = function(unique, showEmploymentFieldsForAllIncomeTypes, incomeTypeEmploymentId, isMainEmpInfo, empInfoDivId) {
if (!isMainEmpInfo && $('#' + empInfoDivId + ' div:first-child').attr('id') != 'empinfo_' + unique) {
$('#empinfo_' + unique).css("border-top", "solid 1px #ccc");
$('#empinfo_' + unique).css("margin-top", "4px");
}
incomeTypeChanged(unique, showEmploymentFieldsForAllIncomeTypes, incomeTypeEmploymentId);
if ($.mobile) {
$('#empinfo_' + unique).trigger('create');
}
};
window.employmentInfoFrequencyInit = function(unique) {
if ($.mobile) {
$('#frequencymonthly_dayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_firstday_dayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_secondday_dayordinal_' + unique).selectmenu();
$('#frequencymonthly_weekday_' + unique).selectmenu();
$('#frequencymonthly_weekdayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_firstday_weekdayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_secondday_weekdayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_secondday_weekday_' + unique).selectmenu();
$('#frequencytwicepermonth_firstday_weekday_' + unique).selectmenu();
}
eval('applyEmpPaydayFrequencyTypesVisibility_' + unique + '()');
eval('applyEmpPaydayDayInMonthSubtype_' + unique + '(true)');
};
})(jQuery);
</script>
<script id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo_template" type="text/x-jquery-tmpl"> <div id="empinfo_${$unique}" class="empinfo">
<input type="hidden" name="id" value="${id}"/>
<div class="line">
<div style="">
<label for="income_${$unique}" class="${income_title_class}">
<span class="English">Monthly Income</span> <span class="Spanish">Ingresos Mensuales</span> <span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" name="income" id="income_${$unique}" value="${income}" maxlength="15" size="12" onfocus="filterMoneyInput(this)" step="any" class="number" />
</div>
</div>
<div style="display:none;">
<label for="obligations_${$unique}" class="${obligations_title_class}">
<span class="English">Monthly Obligations</span> <span class="Spanish">Monthly Obligations</span>
</label>
<div>
<input type="text" name="obligations" id="obligations_${$unique}" value="${obligations}" maxlength="15" size="12" onfocus="filterMoneyInput(this)" step="any" class="number" />
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="incometypeid_${$unique}" class="${incometypeid_title_class}">
<span class="English">Income Type</span> <span class="Spanish">Income Type</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select id="incometypeid_${$unique}" name="incometypeid" class="SingleDDL" onchange="incomeTypeChanged('${$unique}', false, 1); showIncomeTypeText('incometypeid_${$unique}','incometypetext_${$unique}');">
<option value="">-- Select One --</option>
<option value="1" ${incometypeid == '1' ? 'selected' : ''}>Employment</option>
<option value="4" ${incometypeid == '4' ? 'selected' : ''}>Social Security</option>
<option value="5" ${incometypeid == '5' ? 'selected' : ''}>Disability</option>
<option value="6" ${incometypeid == '6' ? 'selected' : ''}>Retirement</option>
<option value="7" ${incometypeid == '7' ? 'selected' : ''}>Self-Employed</option>
<option value="8" ${incometypeid == '8' ? 'selected' : ''}>Other</option>
<option value="10" ${incometypeid == '10' ? 'selected' : ''}>Unemployment Benefits</option>
</select>
<input type="text" id="incometypetext_${$unique}" name="incometypetext" value="${incometypetext}" size="12" maxlength="255" title="Income Type" />
</div>
</div>
<scr{{= ""}}ipt type="text/javascript">showIncomeTypeText('incometypeid_${$unique}', 'incometypetext_${$unique}');</scr{{= ""}}ipt>
<div>
<label for="payrolltype_${$unique}" class="${payrolltype_title_class}">
<span class="English">Payroll Type</span> <span class="Spanish">Tipo de saldo</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="payrolltype" id="payrolltype_${$unique}" class="SingleDDL">
<option value="">-- Select One --</option>
<option value="1" ${payrolltype == '1' ? 'selected' : ''}>Cash</option>
<option value="2" ${payrolltype == '2' ? 'selected' : ''}>Check</option>
<option value="3" ${payrolltype == '3' ? 'selected' : ''}>Direct Deposit</option>
</select>
</div>
</div>
</div>
<div class="line" style="">
<div>
<label for="paydayfrequencytype_${$unique}" class="${paydayfrequencytype_title_class}">
<span class="English">Pay Frequency</span> <span class="Spanish">Frecuencia de pago</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<scr{{= ""}}ipt type="text/javascript">
function applyEmpPaydayFrequencyTypesVisibility_${$unique}()
{
applyPaymentTypeFrequencyTypesVisibility(
'paydayfrequencytype_${$unique}',
['input_paydaydayinmonthsubtype_dayofmonth_${$unique}', 'input_paydaydayinmonthsubtype_nthweekday_${$unique}'],
['div_frequencyweekly_1_${$unique}', 'div_frequencyweekly_2_${$unique}'],
['div_frequencybiweekly_1_${$unique}', 'div_frequencybiweekly_2_${$unique}', 'div_frequencybiweekly_3_${$unique}', 'div_frequencybiweekly_4_${$unique}'],
['div_frequencymonthbased_1_${$unique}', 'div_frequencymonthbased_2_${$unique}', 'span_frequencymonthly_dayofmonth_${$unique}', 'span_frequencymonthly_nthweekday_${$unique}'],
['div_frequencymonthbased_1_${$unique}', 'div_frequencymonthbased_2_${$unique}', 'span_frequencytwicepermonth_dayofmonth_${$unique}', 'span_frequencytwicepermonth_nthweekday_${$unique}'],
[],
[]
);
}
function applyEmpPaydayDayInMonthSubtype_${$unique}(initFromHidden)
{
applyPaymentTypeDayInMonthSubtype('input_paydaydayinmonthsubtype_dayofmonth_${$unique}', 'input_paydaydayinmonthsubtype_nthweekday_${$unique}', 'paydaydayinmonthsubtype_${$unique}', initFromHidden);
applyEmpPaydayDayInMonthSubtypesDimming_${$unique}();
}
function applyEmpPaydayDayInMonthSubtypesDimming_${$unique}()
{
applyPaymentTypeDayInMonthSubtypesDimming(
'paydaydayinmonthsubtype_${$unique}',
['span_frequencymonthly_dayofmonth_${$unique}', 'span_frequencytwicepermonth_dayofmonth_${$unique}', 'frequencymonthly_dayordinal_${$unique}', 'frequencytwicepermonth_firstday_dayordinal_${$unique}', 'frequencytwicepermonth_secondday_dayordinal_${$unique}'],
['span_frequencymonthly_nthweekday_${$unique}', 'span_frequencytwicepermonth_nthweekday_${$unique}', 'frequencymonthly_weekday_${$unique}', 'frequencymonthly_weekdayordinal_${$unique}', 'frequencytwicepermonth_firstday_weekdayordinal_${$unique}', 'frequencytwicepermonth_secondday_weekdayordinal_${$unique}', 'frequencytwicepermonth_secondday_weekday_${$unique}', 'frequencytwicepermonth_firstday_weekday_${$unique}']);
}
</scr{{= ""}}ipt>
<select id="paydayfrequencytype_${$unique}" name="paydayfrequencytype" class="SingleDDL" onchange="applyEmpPaydayFrequencyTypesVisibility_${$unique}();">
<option value="">-- Select One --</option>
<option value="1" ${paydayfrequencytype == '1' ? 'selected' : ''}>Weekly</option>
<option value="2" ${paydayfrequencytype == '2' ? 'selected' : ''}>Bi-weekly</option>
<option value="3" ${paydayfrequencytype == '3' ? 'selected' : ''}>Monthly</option>
<option value="4" ${paydayfrequencytype == '4' ? 'selected' : ''}>Twice per Month</option>
</select>
</div>
</div>
</div>
<div class="line" style="">
<div id="div_frequencyweekly_1_${$unique}" style="display: none;">
<label for="frequencyweekly_weekday_${$unique}" class="${frequencyweekly_weekday_title_class}">
Pay Day <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencyweekly_2_${$unique}" style="display: none;">
<select id="frequencyweekly_weekday_${$unique}" name="frequencyweekly_weekday">
<option value="">-- Select --</option>
<option value="sunday" ${frequencyweekly_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencyweekly_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencyweekly_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencyweekly_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencyweekly_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencyweekly_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencyweekly_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</div>
</div>
<div id="div_frequencybiweekly_1_${$unique}" style="display: none;">
<label for="frequencybiweekly_weekday_${$unique}" class="${frequencybiweekly_weekday_title_class}">
Pay Day <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencybiweekly_2_${$unique}" style="display: none;">
<scr{{= ""}}ipt type="text/javascript">
function updateEmpBiWeeklySampleDateSetup_${$unique}(initFromHidden)
{ updateBiWeeklySampleDateSetupWithRadio('frequencybiweekly_weekday_${$unique}', 'fieldset_frequencybiweekly_sampledate_${$unique}', 'input_frequencybiweekly_sampledate_first_${$unique}', 'label_frequencybiweekly_sampledate_first_${$unique}', 'input_frequencybiweekly_sampledate_second_${$unique}', 'label_frequencybiweekly_sampledate_second_${$unique}', 'span_frequencybiweekly_noweekday_${$unique}', 'frequencybiweekly_sampledate_${$unique}', initFromHidden); }
function applyEmpBiWeeklySampleDate_${$unique}()
{ applyBiWeeklySampleDateWithRadio('input_frequencybiweekly_sampledate_first_${$unique}', 'input_frequencybiweekly_sampledate_second_${$unique}', 'frequencybiweekly_sampledate_${$unique}'); }
</scr{{= ""}}ipt>
<select id="frequencybiweekly_weekday_${$unique}" name="frequencybiweekly_weekday" onchange="updateEmpBiWeeklySampleDateSetup_${$unique}(false);">
<option value="">-- Select --</option>
<option value="sunday" ${frequencybiweekly_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencybiweekly_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencybiweekly_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencybiweekly_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencybiweekly_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencybiweekly_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencybiweekly_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</div>
</div>
<div id="div_frequencybiweekly_3_${$unique}" style="display: none;">
<label class="${frequencybiweekly_sampledate_title_class}">
Next Pay Date <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencybiweekly_4_${$unique}" style="display: none;">
<fieldset id="fieldset_frequencybiweekly_sampledate_${$unique}" style="display: none;" data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input id="input_frequencybiweekly_sampledate_first_${$unique}" type="radio" name="name_frequencybiweekly_sampledate_${$unique}" onclick="applyEmpBiWeeklySampleDate_${$unique}();" />
<label for="input_frequencybiweekly_sampledate_first_${$unique}" id="label_frequencybiweekly_sampledate_first_${$unique}">Sample Date</label>
<!-- -->
<input id="input_frequencybiweekly_sampledate_second_${$unique}" type="radio" name="name_frequencybiweekly_sampledate_${$unique}" onclick="applyEmpBiWeeklySampleDate_${$unique}();"/>
<label for="input_frequencybiweekly_sampledate_second_${$unique}" id="label_frequencybiweekly_sampledate_second_${$unique}">Sample Date</label>
</fieldset>
<span id="span_frequencybiweekly_noweekday_${$unique}" style="display: none;">(Select week day)</span>
<input type="hidden" id="frequencybiweekly_sampledate_${$unique}" name="frequencybiweekly_sampledate" value="${frequencybiweekly_sampledate}" />
<scr{{= ""}}ipt type="text/javascript">updateEmpBiWeeklySampleDateSetup_${$unique}(true);</scr{{= ""}}ipt>
</div>
</div>
<div id="div_frequencymonthbased_1_${$unique}" style="display: none;">
<label class="${frequencymonthbased_title_class}">
Pay Day <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencymonthbased_2_${$unique}" style="display: none;">
<div>
<input type="hidden" id="paydaydayinmonthsubtype_${$unique}" name="paydaydayinmonthsubtype" value="${paydaydayinmonthsubtype}"/>
<table>
<tr>
<td>
<input id="input_paydaydayinmonthsubtype_dayofmonth_${$unique}" type="radio" name="name_paydaydayinmonthsubtype_${$unique}" onclick="applyEmpPaydayDayInMonthSubtype_${$unique}();" title="Day Of Month" />
<span> </span>
</td>
<td id="span_frequencymonthly_dayofmonth_${$unique}" style="display: none;">
<table>
<tr>
<td>
<select id="frequencymonthly_dayordinal_${$unique}" title="Pay Day" name="frequencymonthly_dayordinal">
<option value="1" ${frequencymonthly_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="15" ${frequencymonthly_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="-1" ${frequencymonthly_dayordinal == '-1' ? 'selected' : ''}>Last</option>
<option disabled="disabled" value="">----</option>
<option value="1" ${frequencymonthly_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="2" ${frequencymonthly_dayordinal == '2' ? 'selected' : ''}>2nd</option>
<option value="3" ${frequencymonthly_dayordinal == '3' ? 'selected' : ''}>3rd</option>
<option value="4" ${frequencymonthly_dayordinal == '4' ? 'selected' : ''}>4th</option>
<option value="5" ${frequencymonthly_dayordinal == '5' ? 'selected' : ''}>5th</option>
<option value="6" ${frequencymonthly_dayordinal == '6' ? 'selected' : ''}>6th</option>
<option value="7" ${frequencymonthly_dayordinal == '7' ? 'selected' : ''}>7th</option>
<option value="8" ${frequencymonthly_dayordinal == '8' ? 'selected' : ''}>8th</option>
<option value="9" ${frequencymonthly_dayordinal == '9' ? 'selected' : ''}>9th</option>
<option value="10" ${frequencymonthly_dayordinal == '10' ? 'selected' : ''}>10th</option>
<option value="11" ${frequencymonthly_dayordinal == '11' ? 'selected' : ''}>11th</option>
<option value="12" ${frequencymonthly_dayordinal == '12' ? 'selected' : ''}>12th</option>
<option value="13" ${frequencymonthly_dayordinal == '13' ? 'selected' : ''}>13th</option>
<option value="14" ${frequencymonthly_dayordinal == '14' ? 'selected' : ''}>14th</option>
<option value="15" ${frequencymonthly_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="16" ${frequencymonthly_dayordinal == '16' ? 'selected' : ''}>16th</option>
<option value="17" ${frequencymonthly_dayordinal == '17' ? 'selected' : ''}>17th</option>
<option value="18" ${frequencymonthly_dayordinal == '18' ? 'selected' : ''}>18th</option>
<option value="19" ${frequencymonthly_dayordinal == '19' ? 'selected' : ''}>19th</option>
<option value="20" ${frequencymonthly_dayordinal == '20' ? 'selected' : ''}>20th</option>
<option value="21" ${frequencymonthly_dayordinal == '21' ? 'selected' : ''}>21st</option>
<option value="22" ${frequencymonthly_dayordinal == '22' ? 'selected' : ''}>22nd</option>
<option value="23" ${frequencymonthly_dayordinal == '23' ? 'selected' : ''}>23rd</option>
<option value="24" ${frequencymonthly_dayordinal == '24' ? 'selected' : ''}>24th</option>
<option value="25" ${frequencymonthly_dayordinal == '25' ? 'selected' : ''}>25th</option>
<option value="26" ${frequencymonthly_dayordinal == '26' ? 'selected' : ''}>26th</option>
<option value="27" ${frequencymonthly_dayordinal == '27' ? 'selected' : ''}>27th</option>
<option value="28" ${frequencymonthly_dayordinal == '28' ? 'selected' : ''}>28th</option>
<option value="29" ${frequencymonthly_dayordinal == '29' ? 'selected' : ''}>29th</option>
<option value="30" ${frequencymonthly_dayordinal == '30' ? 'selected' : ''}>30th</option>
<option value="31" ${frequencymonthly_dayordinal == '31' ? 'selected' : ''}>31st</option>
</select>
</td>
<td>of month</td>
</tr>
</table>
</td>
<td id="span_frequencytwicepermonth_dayofmonth_${$unique}" style="display: none;">
<table>
<tr>
<td>
<select id="frequencytwicepermonth_firstday_dayordinal_${$unique}" title="Pay Day" name="frequencytwicepermonth_firstday_dayordinal">
<option value="1" ${frequencytwicepermonth_firstday_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="15" ${frequencytwicepermonth_firstday_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="-1" ${frequencytwicepermonth_firstday_dayordinal == '-1' ? 'selected' : ''}>Last</option>
<option disabled="disabled" value="">----</option>
<option value="1" ${frequencytwicepermonth_firstday_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="2" ${frequencytwicepermonth_firstday_dayordinal == '2' ? 'selected' : ''}>2nd</option>
<option value="3" ${frequencytwicepermonth_firstday_dayordinal == '3' ? 'selected' : ''}>3rd</option>
<option value="4" ${frequencytwicepermonth_firstday_dayordinal == '4' ? 'selected' : ''}>4th</option>
<option value="5" ${frequencytwicepermonth_firstday_dayordinal == '5' ? 'selected' : ''}>5th</option>
<option value="6" ${frequencytwicepermonth_firstday_dayordinal == '6' ? 'selected' : ''}>6th</option>
<option value="7" ${frequencytwicepermonth_firstday_dayordinal == '7' ? 'selected' : ''}>7th</option>
<option value="8" ${frequencytwicepermonth_firstday_dayordinal == '8' ? 'selected' : ''}>8th</option>
<option value="9" ${frequencytwicepermonth_firstday_dayordinal == '9' ? 'selected' : ''}>9th</option>
<option value="10" ${frequencytwicepermonth_firstday_dayordinal == '10' ? 'selected' : ''}>10th</option>
<option value="11" ${frequencytwicepermonth_firstday_dayordinal == '11' ? 'selected' : ''}>11th</option>
<option value="12" ${frequencytwicepermonth_firstday_dayordinal == '12' ? 'selected' : ''}>12th</option>
<option value="13" ${frequencytwicepermonth_firstday_dayordinal == '13' ? 'selected' : ''}>13th</option>
<option value="14" ${frequencytwicepermonth_firstday_dayordinal == '14' ? 'selected' : ''}>14th</option>
<option value="15" ${frequencytwicepermonth_firstday_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="16" ${frequencytwicepermonth_firstday_dayordinal == '16' ? 'selected' : ''}>16th</option>
<option value="17" ${frequencytwicepermonth_firstday_dayordinal == '17' ? 'selected' : ''}>17th</option>
<option value="18" ${frequencytwicepermonth_firstday_dayordinal == '18' ? 'selected' : ''}>18th</option>
<option value="19" ${frequencytwicepermonth_firstday_dayordinal == '19' ? 'selected' : ''}>19th</option>
<option value="20" ${frequencytwicepermonth_firstday_dayordinal == '20' ? 'selected' : ''}>20th</option>
<option value="21" ${frequencytwicepermonth_firstday_dayordinal == '21' ? 'selected' : ''}>21st</option>
<option value="22" ${frequencytwicepermonth_firstday_dayordinal == '22' ? 'selected' : ''}>22nd</option>
<option value="23" ${frequencytwicepermonth_firstday_dayordinal == '23' ? 'selected' : ''}>23rd</option>
<option value="24" ${frequencytwicepermonth_firstday_dayordinal == '24' ? 'selected' : ''}>24th</option>
<option value="25" ${frequencytwicepermonth_firstday_dayordinal == '25' ? 'selected' : ''}>25th</option>
<option value="26" ${frequencytwicepermonth_firstday_dayordinal == '26' ? 'selected' : ''}>26th</option>
<option value="27" ${frequencytwicepermonth_firstday_dayordinal == '27' ? 'selected' : ''}>27th</option>
<option value="28" ${frequencytwicepermonth_firstday_dayordinal == '28' ? 'selected' : ''}>28th</option>
<option value="29" ${frequencytwicepermonth_firstday_dayordinal == '29' ? 'selected' : ''}>29th</option>
<option value="30" ${frequencytwicepermonth_firstday_dayordinal == '30' ? 'selected' : ''}>30th</option>
<option value="31" ${frequencytwicepermonth_firstday_dayordinal == '31' ? 'selected' : ''}>31st</option>
</select>
</td>
<td><b>and</b></td>
<td>
<select id="frequencytwicepermonth_secondday_dayordinal_${$unique}" title="Pay Day" name="frequencytwicepermonth_secondday_dayordinal">
<option value="1" ${frequencytwicepermonth_secondday_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="15" ${frequencytwicepermonth_secondday_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="-1" ${frequencytwicepermonth_secondday_dayordinal == '-1' ? 'selected' : ''}>Last</option>
<option disabled="disabled" value="">----</option>
<option value="1" ${frequencytwicepermonth_secondday_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="2" ${frequencytwicepermonth_secondday_dayordinal == '2' ? 'selected' : ''}>2nd</option>
<option value="3" ${frequencytwicepermonth_secondday_dayordinal == '3' ? 'selected' : ''}>3rd</option>
<option value="4" ${frequencytwicepermonth_secondday_dayordinal == '4' ? 'selected' : ''}>4th</option>
<option value="5" ${frequencytwicepermonth_secondday_dayordinal == '5' ? 'selected' : ''}>5th</option>
<option value="6" ${frequencytwicepermonth_secondday_dayordinal == '6' ? 'selected' : ''}>6th</option>
<option value="7" ${frequencytwicepermonth_secondday_dayordinal == '7' ? 'selected' : ''}>7th</option>
<option value="8" ${frequencytwicepermonth_secondday_dayordinal == '8' ? 'selected' : ''}>8th</option>
<option value="9" ${frequencytwicepermonth_secondday_dayordinal == '9' ? 'selected' : ''}>9th</option>
<option value="10" ${frequencytwicepermonth_secondday_dayordinal == '10' ? 'selected' : ''}>10th</option>
<option value="11" ${frequencytwicepermonth_secondday_dayordinal == '11' ? 'selected' : ''}>11th</option>
<option value="12" ${frequencytwicepermonth_secondday_dayordinal == '12' ? 'selected' : ''}>12th</option>
<option value="13" ${frequencytwicepermonth_secondday_dayordinal == '13' ? 'selected' : ''}>13th</option>
<option value="14" ${frequencytwicepermonth_secondday_dayordinal == '14' ? 'selected' : ''}>14th</option>
<option value="15" ${frequencytwicepermonth_secondday_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="16" ${frequencytwicepermonth_secondday_dayordinal == '16' ? 'selected' : ''}>16th</option>
<option value="17" ${frequencytwicepermonth_secondday_dayordinal == '17' ? 'selected' : ''}>17th</option>
<option value="18" ${frequencytwicepermonth_secondday_dayordinal == '18' ? 'selected' : ''}>18th</option>
<option value="19" ${frequencytwicepermonth_secondday_dayordinal == '19' ? 'selected' : ''}>19th</option>
<option value="20" ${frequencytwicepermonth_secondday_dayordinal == '20' ? 'selected' : ''}>20th</option>
<option value="21" ${frequencytwicepermonth_secondday_dayordinal == '21' ? 'selected' : ''}>21st</option>
<option value="22" ${frequencytwicepermonth_secondday_dayordinal == '22' ? 'selected' : ''}>22nd</option>
<option value="23" ${frequencytwicepermonth_secondday_dayordinal == '23' ? 'selected' : ''}>23rd</option>
<option value="24" ${frequencytwicepermonth_secondday_dayordinal == '24' ? 'selected' : ''}>24th</option>
<option value="25" ${frequencytwicepermonth_secondday_dayordinal == '25' ? 'selected' : ''}>25th</option>
<option value="26" ${frequencytwicepermonth_secondday_dayordinal == '26' ? 'selected' : ''}>26th</option>
<option value="27" ${frequencytwicepermonth_secondday_dayordinal == '27' ? 'selected' : ''}>27th</option>
<option value="28" ${frequencytwicepermonth_secondday_dayordinal == '28' ? 'selected' : ''}>28th</option>
<option value="29" ${frequencytwicepermonth_secondday_dayordinal == '29' ? 'selected' : ''}>29th</option>
<option value="30" ${frequencytwicepermonth_secondday_dayordinal == '30' ? 'selected' : ''}>30th</option>
<option value="31" ${frequencytwicepermonth_secondday_dayordinal == '31' ? 'selected' : ''}>31st</option>
</select>
</td>
<td>of month</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
<div>
<table>
<tr>
<td>
<input id="input_paydaydayinmonthsubtype_nthweekday_${$unique}" type="radio" name="name_paydaydayinmonthsubtype_${$unique}" onclick="applyEmpPaydayDayInMonthSubtype_${$unique}();" title="Day Of Week"/>
<span> </span>
</td>
<td id="span_frequencymonthly_nthweekday_${$unique}" style="display: none;">
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select id="frequencymonthly_weekdayordinal_${$unique}" title="Pay Day" name="frequencymonthly_weekdayordinal">
<option value="1" ${frequencymonthly_weekdayordinal == '1' ? 'selected' : ''}>First</option>
<option value="2" ${frequencymonthly_weekdayordinal == '2' ? 'selected' : ''}>Second</option>
<option value="3" ${frequencymonthly_weekdayordinal == '3' ? 'selected' : ''}>Third</option>
<option value="4" ${frequencymonthly_weekdayordinal == '4' ? 'selected' : ''}>Fourth</option>
<option value="-1" ${frequencymonthly_weekdayordinal == '-1' ? 'selected' : ''}>Last</option>
</select>
<!-- -->
<select id="frequencymonthly_weekday_${$unique}" title="Pay Day" name="frequencymonthly_weekday">
<option value="">-- Select --</option>
<option value="sunday" ${frequencymonthly_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencymonthly_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencymonthly_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencymonthly_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencymonthly_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencymonthly_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencymonthly_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</fieldset>
</td>
<td id="span_frequencytwicepermonth_nthweekday_${$unique}" nowrap="nowrap" style="display: none;">
<table>
<tr>
<td>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select id="frequencytwicepermonth_firstday_weekdayordinal_${$unique}" title="Pay Day" name="frequencytwicepermonth_firstday_weekdayordinal">
<option value="1" ${frequencytwicepermonth_firstday_weekdayordinal == '1' ? 'selected' : ''}>First</option>
<option value="2" ${frequencytwicepermonth_firstday_weekdayordinal == '2' ? 'selected' : ''}>Second</option>
<option value="3" ${frequencytwicepermonth_firstday_weekdayordinal == '3' ? 'selected' : ''}>Third</option>
<option value="4" ${frequencytwicepermonth_firstday_weekdayordinal == '4' ? 'selected' : ''}>Fourth</option>
<option value="-1" ${frequencytwicepermonth_firstday_weekdayordinal == '-1' ? 'selected' : ''}>Last</option>
</select>
<!-- -->
<select id="frequencytwicepermonth_firstday_weekday_${$unique}" title="Pay Day" name="frequencytwicepermonth_firstday_weekday">
<option value="">-- Select --</option>
<option value="sunday" ${frequencytwicepermonth_firstday_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencytwicepermonth_firstday_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencytwicepermonth_firstday_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencytwicepermonth_firstday_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencytwicepermonth_firstday_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencytwicepermonth_firstday_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencytwicepermonth_firstday_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</fieldset>
</td>
<td><b>and</b></td>
<td>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select id="frequencytwicepermonth_secondday_weekdayordinal_${$unique}" title="Pay Day" name="frequencytwicepermonth_secondday_weekdayordinal">
<option value="1" ${frequencytwicepermonth_secondday_weekdayordinal == '1' ? 'selected' : ''}>First</option>
<option value="2" ${frequencytwicepermonth_secondday_weekdayordinal == '2' ? 'selected' : ''}>Second</option>
<option value="3" ${frequencytwicepermonth_secondday_weekdayordinal == '3' ? 'selected' : ''}>Third</option>
<option value="4" ${frequencytwicepermonth_secondday_weekdayordinal == '4' ? 'selected' : ''}>Fourth</option>
<option value="-1" ${frequencytwicepermonth_secondday_weekdayordinal == '-1' ? 'selected' : ''}>Last</option>
</select>
<!-- -->
<select id="frequencytwicepermonth_secondday_weekday_${$unique}" title="Pay Day" name="frequencytwicepermonth_secondday_weekday">
<option value="">-- Select --</option>
<option value="sunday" ${frequencytwicepermonth_secondday_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencytwicepermonth_secondday_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencytwicepermonth_secondday_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencytwicepermonth_secondday_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencytwicepermonth_secondday_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencytwicepermonth_secondday_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencytwicepermonth_secondday_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</fieldset>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</div>
</div>
<scr{{= ""}}ipt type="text/javascript">
employmentInfoFrequencyInit('${$unique}');
</scr{{= ""}}ipt>
<div class="line" style="">
<div class="single">
<label class="${paydayholidayskippingtype_title_class}">
<span class="English">If Payday On Bank Holiday</span> <span class="Spanish">If Payday On Bank Holiday</span>
</label>
<div class="field">
<input id="paydayholidayskippingtype_none_${$unique}" type="radio" name="paydayholidayskippingtype_${$unique}" value="1" ${paydayholidayskippingtype == '1' ? 'checked' : ''} style="vertical-align: middle;"/>
<label for="paydayholidayskippingtype_none_${$unique}">Do Nothing</label>
<input id="paydayholidayskippingtype_moveearlier_${$unique}" type="radio" name="paydayholidayskippingtype_${$unique}" value="2" ${paydayholidayskippingtype == '2' ? 'checked' : ''} style="vertical-align: middle;"/>
<label for="paydayholidayskippingtype_moveearlier_${$unique}">Move To Previous Business Day</label>
<input id="paydayholidayskippingtype_movelater_${$unique}" type="radio" name="paydayholidayskippingtype_${$unique}" value="3" ${paydayholidayskippingtype == '3' ? 'checked' : ''} style="vertical-align: middle;"/>
<label for="paydayholidayskippingtype_movelater_${$unique}">Move To Next Business Day</label>
</div>
</div>
</div>
<div style="clear: both;"></div>
<div id="div_employmentinfo_${$unique}">
<div class="line">
<div style="">
<label for="name_${$unique}" class="${name_title_class}">
<span class="English">Employer</span> <span class="Spanish">Empleador</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" name="name" id="name_${$unique}" value="${name}" size="12" maxlength="255" />
</div>
</div>
<div style="display:none;">
<label for="occupation_${$unique}" class="${occupation_title_class}">
<span class="English">Occupation</span> <span class="Spanish">Posición / Título</span>
</label>
<div>
<input type="text" name="occupation" id="occupation_${$unique}" value="${occupation}" size="20" maxlength="255" />
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="dateofhire_year_${$unique}" class="${dateofhire_title_class}">
<span class="English">Date Of Hire</span> <span class="Spanish">Fecha de contratación</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select name="dateofhire_year" id="dateofhire_year_${$unique}" class="tel">
<option value="">Year</option>
<option value="1900" ${dateofhire_year == '1900' ? 'selected' : ''}>1900</option>
<option value="1901" ${dateofhire_year == '1901' ? 'selected' : ''}>1901</option>
<option value="1902" ${dateofhire_year == '1902' ? 'selected' : ''}>1902</option>
<option value="1903" ${dateofhire_year == '1903' ? 'selected' : ''}>1903</option>
<option value="1904" ${dateofhire_year == '1904' ? 'selected' : ''}>1904</option>
<option value="1905" ${dateofhire_year == '1905' ? 'selected' : ''}>1905</option>
<option value="1906" ${dateofhire_year == '1906' ? 'selected' : ''}>1906</option>
<option value="1907" ${dateofhire_year == '1907' ? 'selected' : ''}>1907</option>
<option value="1908" ${dateofhire_year == '1908' ? 'selected' : ''}>1908</option>
<option value="1909" ${dateofhire_year == '1909' ? 'selected' : ''}>1909</option>
<option value="1910" ${dateofhire_year == '1910' ? 'selected' : ''}>1910</option>
<option value="1911" ${dateofhire_year == '1911' ? 'selected' : ''}>1911</option>
<option value="1912" ${dateofhire_year == '1912' ? 'selected' : ''}>1912</option>
<option value="1913" ${dateofhire_year == '1913' ? 'selected' : ''}>1913</option>
<option value="1914" ${dateofhire_year == '1914' ? 'selected' : ''}>1914</option>
<option value="1915" ${dateofhire_year == '1915' ? 'selected' : ''}>1915</option>
<option value="1916" ${dateofhire_year == '1916' ? 'selected' : ''}>1916</option>
<option value="1917" ${dateofhire_year == '1917' ? 'selected' : ''}>1917</option>
<option value="1918" ${dateofhire_year == '1918' ? 'selected' : ''}>1918</option>
<option value="1919" ${dateofhire_year == '1919' ? 'selected' : ''}>1919</option>
<option value="1920" ${dateofhire_year == '1920' ? 'selected' : ''}>1920</option>
<option value="1921" ${dateofhire_year == '1921' ? 'selected' : ''}>1921</option>
<option value="1922" ${dateofhire_year == '1922' ? 'selected' : ''}>1922</option>
<option value="1923" ${dateofhire_year == '1923' ? 'selected' : ''}>1923</option>
<option value="1924" ${dateofhire_year == '1924' ? 'selected' : ''}>1924</option>
<option value="1925" ${dateofhire_year == '1925' ? 'selected' : ''}>1925</option>
<option value="1926" ${dateofhire_year == '1926' ? 'selected' : ''}>1926</option>
<option value="1927" ${dateofhire_year == '1927' ? 'selected' : ''}>1927</option>
<option value="1928" ${dateofhire_year == '1928' ? 'selected' : ''}>1928</option>
<option value="1929" ${dateofhire_year == '1929' ? 'selected' : ''}>1929</option>
<option value="1930" ${dateofhire_year == '1930' ? 'selected' : ''}>1930</option>
<option value="1931" ${dateofhire_year == '1931' ? 'selected' : ''}>1931</option>
<option value="1932" ${dateofhire_year == '1932' ? 'selected' : ''}>1932</option>
<option value="1933" ${dateofhire_year == '1933' ? 'selected' : ''}>1933</option>
<option value="1934" ${dateofhire_year == '1934' ? 'selected' : ''}>1934</option>
<option value="1935" ${dateofhire_year == '1935' ? 'selected' : ''}>1935</option>
<option value="1936" ${dateofhire_year == '1936' ? 'selected' : ''}>1936</option>
<option value="1937" ${dateofhire_year == '1937' ? 'selected' : ''}>1937</option>
<option value="1938" ${dateofhire_year == '1938' ? 'selected' : ''}>1938</option>
<option value="1939" ${dateofhire_year == '1939' ? 'selected' : ''}>1939</option>
<option value="1940" ${dateofhire_year == '1940' ? 'selected' : ''}>1940</option>
<option value="1941" ${dateofhire_year == '1941' ? 'selected' : ''}>1941</option>
<option value="1942" ${dateofhire_year == '1942' ? 'selected' : ''}>1942</option>
<option value="1943" ${dateofhire_year == '1943' ? 'selected' : ''}>1943</option>
<option value="1944" ${dateofhire_year == '1944' ? 'selected' : ''}>1944</option>
<option value="1945" ${dateofhire_year == '1945' ? 'selected' : ''}>1945</option>
<option value="1946" ${dateofhire_year == '1946' ? 'selected' : ''}>1946</option>
<option value="1947" ${dateofhire_year == '1947' ? 'selected' : ''}>1947</option>
<option value="1948" ${dateofhire_year == '1948' ? 'selected' : ''}>1948</option>
<option value="1949" ${dateofhire_year == '1949' ? 'selected' : ''}>1949</option>
<option value="1950" ${dateofhire_year == '1950' ? 'selected' : ''}>1950</option>
<option value="1951" ${dateofhire_year == '1951' ? 'selected' : ''}>1951</option>
<option value="1952" ${dateofhire_year == '1952' ? 'selected' : ''}>1952</option>
<option value="1953" ${dateofhire_year == '1953' ? 'selected' : ''}>1953</option>
<option value="1954" ${dateofhire_year == '1954' ? 'selected' : ''}>1954</option>
<option value="1955" ${dateofhire_year == '1955' ? 'selected' : ''}>1955</option>
<option value="1956" ${dateofhire_year == '1956' ? 'selected' : ''}>1956</option>
<option value="1957" ${dateofhire_year == '1957' ? 'selected' : ''}>1957</option>
<option value="1958" ${dateofhire_year == '1958' ? 'selected' : ''}>1958</option>
<option value="1959" ${dateofhire_year == '1959' ? 'selected' : ''}>1959</option>
<option value="1960" ${dateofhire_year == '1960' ? 'selected' : ''}>1960</option>
<option value="1961" ${dateofhire_year == '1961' ? 'selected' : ''}>1961</option>
<option value="1962" ${dateofhire_year == '1962' ? 'selected' : ''}>1962</option>
<option value="1963" ${dateofhire_year == '1963' ? 'selected' : ''}>1963</option>
<option value="1964" ${dateofhire_year == '1964' ? 'selected' : ''}>1964</option>
<option value="1965" ${dateofhire_year == '1965' ? 'selected' : ''}>1965</option>
<option value="1966" ${dateofhire_year == '1966' ? 'selected' : ''}>1966</option>
<option value="1967" ${dateofhire_year == '1967' ? 'selected' : ''}>1967</option>
<option value="1968" ${dateofhire_year == '1968' ? 'selected' : ''}>1968</option>
<option value="1969" ${dateofhire_year == '1969' ? 'selected' : ''}>1969</option>
<option value="1970" ${dateofhire_year == '1970' ? 'selected' : ''}>1970</option>
<option value="1971" ${dateofhire_year == '1971' ? 'selected' : ''}>1971</option>
<option value="1972" ${dateofhire_year == '1972' ? 'selected' : ''}>1972</option>
<option value="1973" ${dateofhire_year == '1973' ? 'selected' : ''}>1973</option>
<option value="1974" ${dateofhire_year == '1974' ? 'selected' : ''}>1974</option>
<option value="1975" ${dateofhire_year == '1975' ? 'selected' : ''}>1975</option>
<option value="1976" ${dateofhire_year == '1976' ? 'selected' : ''}>1976</option>
<option value="1977" ${dateofhire_year == '1977' ? 'selected' : ''}>1977</option>
<option value="1978" ${dateofhire_year == '1978' ? 'selected' : ''}>1978</option>
<option value="1979" ${dateofhire_year == '1979' ? 'selected' : ''}>1979</option>
<option value="1980" ${dateofhire_year == '1980' ? 'selected' : ''}>1980</option>
<option value="1981" ${dateofhire_year == '1981' ? 'selected' : ''}>1981</option>
<option value="1982" ${dateofhire_year == '1982' ? 'selected' : ''}>1982</option>
<option value="1983" ${dateofhire_year == '1983' ? 'selected' : ''}>1983</option>
<option value="1984" ${dateofhire_year == '1984' ? 'selected' : ''}>1984</option>
<option value="1985" ${dateofhire_year == '1985' ? 'selected' : ''}>1985</option>
<option value="1986" ${dateofhire_year == '1986' ? 'selected' : ''}>1986</option>
<option value="1987" ${dateofhire_year == '1987' ? 'selected' : ''}>1987</option>
<option value="1988" ${dateofhire_year == '1988' ? 'selected' : ''}>1988</option>
<option value="1989" ${dateofhire_year == '1989' ? 'selected' : ''}>1989</option>
<option value="1990" ${dateofhire_year == '1990' ? 'selected' : ''}>1990</option>
<option value="1991" ${dateofhire_year == '1991' ? 'selected' : ''}>1991</option>
<option value="1992" ${dateofhire_year == '1992' ? 'selected' : ''}>1992</option>
<option value="1993" ${dateofhire_year == '1993' ? 'selected' : ''}>1993</option>
<option value="1994" ${dateofhire_year == '1994' ? 'selected' : ''}>1994</option>
<option value="1995" ${dateofhire_year == '1995' ? 'selected' : ''}>1995</option>
<option value="1996" ${dateofhire_year == '1996' ? 'selected' : ''}>1996</option>
<option value="1997" ${dateofhire_year == '1997' ? 'selected' : ''}>1997</option>
<option value="1998" ${dateofhire_year == '1998' ? 'selected' : ''}>1998</option>
<option value="1999" ${dateofhire_year == '1999' ? 'selected' : ''}>1999</option>
<option value="2000" ${dateofhire_year == '2000' ? 'selected' : ''}>2000</option>
<option value="2001" ${dateofhire_year == '2001' ? 'selected' : ''}>2001</option>
<option value="2002" ${dateofhire_year == '2002' ? 'selected' : ''}>2002</option>
<option value="2003" ${dateofhire_year == '2003' ? 'selected' : ''}>2003</option>
<option value="2004" ${dateofhire_year == '2004' ? 'selected' : ''}>2004</option>
<option value="2005" ${dateofhire_year == '2005' ? 'selected' : ''}>2005</option>
<option value="2006" ${dateofhire_year == '2006' ? 'selected' : ''}>2006</option>
<option value="2007" ${dateofhire_year == '2007' ? 'selected' : ''}>2007</option>
<option value="2008" ${dateofhire_year == '2008' ? 'selected' : ''}>2008</option>
<option value="2009" ${dateofhire_year == '2009' ? 'selected' : ''}>2009</option>
<option value="2010" ${dateofhire_year == '2010' ? 'selected' : ''}>2010</option>
<option value="2011" ${dateofhire_year == '2011' ? 'selected' : ''}>2011</option>
<option value="2012" ${dateofhire_year == '2012' ? 'selected' : ''}>2012</option>
<option value="2013" ${dateofhire_year == '2013' ? 'selected' : ''}>2013</option>
<option value="2014" ${dateofhire_year == '2014' ? 'selected' : ''}>2014</option>
<option value="2015" ${dateofhire_year == '2015' ? 'selected' : ''}>2015</option>
<option value="2016" ${dateofhire_year == '2016' ? 'selected' : ''}>2016</option>
<option value="2017" ${dateofhire_year == '2017' ? 'selected' : ''}>2017</option>
<option value="2018" ${dateofhire_year == '2018' ? 'selected' : ''}>2018</option>
<option value="2019" ${dateofhire_year == '2019' ? 'selected' : ''}>2019</option>
<option value="2020" ${dateofhire_year == '2020' ? 'selected' : ''}>2020</option>
<option value="2021" ${dateofhire_year == '2021' ? 'selected' : ''}>2021</option>
<option value="2022" ${dateofhire_year == '2022' ? 'selected' : ''}>2022</option>
<option value="2023" ${dateofhire_year == '2023' ? 'selected' : ''}>2023</option>
</select>
<!-- -->
<select name="dateofhire_month" title="Month" class="tel">
<option value="">Month</option>
<option value="1" ${dateofhire_month == '1' ? 'selected' : ''}>Jan</option>
<option value="2" ${dateofhire_month == '2' ? 'selected' : ''}>Feb</option>
<option value="3" ${dateofhire_month == '3' ? 'selected' : ''}>March</option>
<option value="4" ${dateofhire_month == '4' ? 'selected' : ''}>April</option>
<option value="5" ${dateofhire_month == '5' ? 'selected' : ''}>May</option>
<option value="6" ${dateofhire_month == '6' ? 'selected' : ''}>June</option>
<option value="7" ${dateofhire_month == '7' ? 'selected' : ''}>July</option>
<option value="8" ${dateofhire_month == '8' ? 'selected' : ''}>Aug</option>
<option value="9" ${dateofhire_month == '9' ? 'selected' : ''}>Sep</option>
<option value="10" ${dateofhire_month == '10' ? 'selected' : ''}>Oct</option>
<option value="11" ${dateofhire_month == '11' ? 'selected' : ''}>Nov</option>
<option value="12" ${dateofhire_month == '12' ? 'selected' : ''}>Dec</option>
</select>
</fieldset>
</div>
</div>
<div style="display:none;">
<label for="shift_${$unique}" class="${shift_title_class}">
<span class="English">Shift</span> <span class="Spanish">Horario</span>
</label>
<div>
<input type="text" name="shift" id="shift_${$unique}" value="${shift}" size="20" maxlength="255" />
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="phone_1_${$unique}" class="${phone_title_class}">
<span class="English">Work Phone</span> <span class="Spanish">Numero del teléfono del empleo</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="phone_1" id="phone_1_${$unique}" value="${phone_1}" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"/>
<!-- -->
<input type="text" name="phone_2" value="${phone_2}" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"/>
<!-- -->
<input type="text" name="phone_3" value="${phone_3}" class="tel noblock FourBox" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"/>
<!-- -->
<label for="phoneext_${$unique}" style="display: inline;"><span class="English">Ext.:</span><span class="Spanish">Extensión:</span></label>
<input type="text" name="phoneext" id="phoneext_${$unique}" value="${phoneext}" class="tel noblock FourBox" size="12" maxlength="40" onfocus="filterNumericInput(this)" />
</fieldset>
</div>
</div>
<div style="display:none;">
<label for="fax_1_${$unique}" class="${fax_title_class}">
<span class="English">Work Fax</span> <span class="Spanish">Fax del trabajo</span>:
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="fax_1" id="fax_1_${$unique}" value="${fax_1}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"/>
<!-- -->
<input type="text" name="fax_2" value="${fax_2}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"/>
<!-- -->
<input type="text" name="fax_3" value="${fax_3}" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"/>
</fieldset>
</div>
</div>
</div>
<div class="line" style="display:none;">
<div>
<label for="cellphone_1_${$unique}" class="${cellphone_title_class}">
<span class="English">Cell Phone (Work)</span> <span class="Spanish">Numero de celular del empleo</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="cellphone_1" id="cellphone_1_${$unique}" value="${cellphone_1}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"/>
<!-- -->
<input type="text" name="cellphone_2" value="${cellphone_2}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"/>
<!-- -->
<input type="text" name="cellphone_3" value="${cellphone_3}" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"/>
</fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="address_${$unique}" class="${address_title_class}">
<span class="English">Employer Address</span> <span class="Spanish">Dirección de empleo</span>
</label>
<div>
<input type="text" name="address" id="address_${$unique}" value="${address}" size="20" maxlength="255" />
</div>
</div>
<div style="display:none;">
<label for="city_${$unique}" class="${city_title_class}">
<span class="English">Employer City</span> <span class="Spanish">Ciudad de empleo</span>
</label>
<div>
<input type="text" name="city" id="city_${$unique}" value="${city}" size="12" maxlength="255" />
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="state_${$unique}" class="${state_title_class}">
<span class="English">Employer State</span>
<span class="Spanish">Estado</span>
</label>
<div>
<select id="state_${$unique}" name="state" ><option value="">-- Choose --</option><option value="AK" ${state == 'AK' ? 'selected' : ''}>AK</option><option value="AL" ${state == 'AL' ? 'selected' : ''}>AL</option><option value="AR" ${state == 'AR' ? 'selected' : ''}>AR</option><option value="AS" ${state == 'AS' ? 'selected' : ''}>AS</option><option value="AZ" ${state == 'AZ' ? 'selected' : ''}>AZ</option><option value="CA" ${state == 'CA' ? 'selected' : ''}>CA</option><option value="CO" ${state == 'CO' ? 'selected' : ''}>CO</option><option value="CT" ${state == 'CT' ? 'selected' : ''}>CT</option><option value="DC" ${state == 'DC' ? 'selected' : ''}>DC</option><option value="DE" ${state == 'DE' ? 'selected' : ''}>DE</option><option value="FL" ${state == 'FL' ? 'selected' : ''}>FL</option><option value="FM" ${state == 'FM' ? 'selected' : ''}>FM</option><option value="GA" ${state == 'GA' ? 'selected' : ''}>GA</option><option value="GU" ${state == 'GU' ? 'selected' : ''}>GU</option><option value="HI" ${state == 'HI' ? 'selected' : ''}>HI</option><option value="IA" ${state == 'IA' ? 'selected' : ''}>IA</option><option value="ID" ${state == 'ID' ? 'selected' : ''}>ID</option><option value="IL" ${state == 'IL' ? 'selected' : ''}>IL</option><option value="IN" ${state == 'IN' ? 'selected' : ''}>IN</option><option value="KS" ${state == 'KS' ? 'selected' : ''}>KS</option><option value="KY" ${state == 'KY' ? 'selected' : ''}>KY</option><option value="LA" ${state == 'LA' ? 'selected' : ''}>LA</option><option value="MA" ${state == 'MA' ? 'selected' : ''}>MA</option><option value="MD" ${state == 'MD' ? 'selected' : ''}>MD</option><option value="ME" ${state == 'ME' ? 'selected' : ''}>ME</option><option value="MH" ${state == 'MH' ? 'selected' : ''}>MH</option><option value="MI" ${state == 'MI' ? 'selected' : ''}>MI</option><option value="MN" ${state == 'MN' ? 'selected' : ''}>MN</option><option value="MO" ${state == 'MO' ? 'selected' : ''}>MO</option><option value="MP" ${state == 'MP' ? 'selected' : ''}>MP</option><option value="MS" ${state == 'MS' ? 'selected' : ''}>MS</option><option value="MT" ${state == 'MT' ? 'selected' : ''}>MT</option><option value="NC" ${state == 'NC' ? 'selected' : ''}>NC</option><option value="ND" ${state == 'ND' ? 'selected' : ''}>ND</option><option value="NE" ${state == 'NE' ? 'selected' : ''}>NE</option><option value="NH" ${state == 'NH' ? 'selected' : ''}>NH</option><option value="NJ" ${state == 'NJ' ? 'selected' : ''}>NJ</option><option value="NM" ${state == 'NM' ? 'selected' : ''}>NM</option><option value="NV" ${state == 'NV' ? 'selected' : ''}>NV</option><option value="NY" ${state == 'NY' ? 'selected' : ''}>NY</option><option value="OH" ${state == 'OH' ? 'selected' : ''}>OH</option><option value="OK" ${state == 'OK' ? 'selected' : ''}>OK</option><option value="OR" ${state == 'OR' ? 'selected' : ''}>OR</option><option value="PA" ${state == 'PA' ? 'selected' : ''}>PA</option><option value="PR" ${state == 'PR' ? 'selected' : ''}>PR</option><option value="PW" ${state == 'PW' ? 'selected' : ''}>PW</option><option value="RI" ${state == 'RI' ? 'selected' : ''}>RI</option><option value="SC" ${state == 'SC' ? 'selected' : ''}>SC</option><option value="SD" ${state == 'SD' ? 'selected' : ''}>SD</option><option value="TN" ${state == 'TN' ? 'selected' : ''}>TN</option><option value="TX" ${state == 'TX' ? 'selected' : ''}>TX</option><option value="UT" ${state == 'UT' ? 'selected' : ''}>UT</option><option value="VA" ${state == 'VA' ? 'selected' : ''}>VA</option><option value="VI" ${state == 'VI' ? 'selected' : ''}>VI</option><option value="VT" ${state == 'VT' ? 'selected' : ''}>VT</option><option value="WA" ${state == 'WA' ? 'selected' : ''}>WA</option><option value="WI" ${state == 'WI' ? 'selected' : ''}>WI</option><option value="WV" ${state == 'WV' ? 'selected' : ''}>WV</option><option value="WY" ${state == 'WY' ? 'selected' : ''}>WY</option></select>
</div>
</div>
<div style="display:none;">
<label for="zip_${$unique}" class="${zip_title_class}">
<span class="English">Employer Zip</span>
<span class="Spanish">Código postal</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" maxlength="5" size="8" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onfocus="filterNumericInput(this)" data-relatedhiddenfieldid="zip_${$unique}_ZIPValue_Single_${$unique}" id="zip_${$unique}_ZIP_Single_${$unique}" name="zip_${$unique}_ZIP_Single_${$unique}" value="" title="Zip" /><input type="hidden" id="zip_${$unique}_ZIPValue_Single_${$unique}" name="zip_${$unique}_ZIPValue_Single_${$unique}" value="${zip}" />
</fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="supervisor_${$unique}" class="${supervisor_title_class}">
<span class="English">Supervisor</span> <span class="Spanish">Supervisor</span>
</label>
<div>
<input type="text" name="supervisor" id="supervisor_${$unique}" value="${supervisor}" size="12" maxlength="255" />
</div>
</div>
<div style="display:none;">
<label for="supervisorphone_1_${$unique}" class="${supervisorphone_title_class}">
<span class="English">Supervisor Phone</span> <span class="Spanish">Numero de teléfono</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="supervisorphone_1" id="supervisorphone_1_${$unique}" value="${supervisorphone_1}" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"/>
<!-- -->
<input type="text" name="supervisorphone_2" value="${supervisorphone_2}" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"/>
<!-- -->
<input type="text" name="supervisorphone_3" value="${supervisorphone_3}" class="tel noblock FourBox" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"/>
<!-- -->
<label for="supervisorphoneext_${$unique}" style="display: inline;"><span class="English">Ext.:</span><span class="Spanish">Extensión:</span></label>
<input type="text" name="supervisorphoneext" id="supervisorphoneext_${$unique}" value="${supervisorphoneext}" class="tel noblock FourBox" size="12" maxlength="40" />
</fieldset>
</div>
</div>
</div>
</div>
<scr{{= ""}}ipt type="text/javascript">
employmentInfoInit('${$unique}', false, 1, true, 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo');
</scr{{= ""}}ipt>
<div style="clear: both;"></div>
</div>
</script>
<script type="text/javascript">
jstemplatetable_initialize('ctl00', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo', [{
"id": "0",
"income_title_class": "",
"income": "",
"obligations_title_class": "",
"obligations": "",
"incometypeid_title_class": "",
"incometypeid": "",
"incometypetext": "",
"payrolltype_title_class": "",
"payrolltype": "",
"paydayfrequencytype_title_class": "",
"paydayfrequencytype": "",
"frequencyweekly_weekday_title_class": "",
"frequencyweekly_weekday": "",
"frequencybiweekly_weekday_title_class": "",
"frequencybiweekly_weekday": "",
"frequencybiweekly_sampledate_title_class": "",
"frequencybiweekly_sampledate": "",
"paydaydayinmonthsubtype": "",
"frequencymonthbased_title_class": "",
"frequencymonthly_dayordinal": "",
"frequencytwicepermonth_firstday_dayordinal": "",
"frequencytwicepermonth_secondday_dayordinal": "15",
"frequencymonthly_weekdayordinal": "",
"frequencytwicepermonth_firstday_weekdayordinal": "",
"frequencymonthly_weekday": "friday",
"frequencytwicepermonth_firstday_weekday": "friday",
"frequencytwicepermonth_secondday_weekdayordinal": "3",
"frequencytwicepermonth_secondday_weekday": "friday",
"paydayholidayskippingtype_title_class": "",
"paydayholidayskippingtype": "2",
"name_title_class": "",
"name": "",
"occupation_title_class": "",
"occupation": "",
"shift_title_class": "",
"shift": "",
"dateofhire_title_class": "",
"dateofhire_year": "",
"dateofhire_month": "",
"address_title_class": "",
"address": "",
"city_title_class": "",
"city": "",
"state_title_class": "",
"state": "",
"zip_title_class": "",
"zip": "",
"fax_title_class": "",
"fax_1": "",
"fax_2": "",
"fax_3": "",
"phone_title_class": "",
"phone_1": "",
"phone_2": "",
"phone_3": "",
"phoneext": "",
"cellphone_title_class": "",
"cellphone_1": "",
"cellphone_2": "",
"cellphone_3": "",
"supervisor_title_class": "",
"supervisor": "",
"supervisorphone_title_class": "",
"supervisorphone_1": "",
"supervisorphone_2": "",
"supervisorphone_3": "",
"supervisorphoneext": ""
}], function(el) {
this.id = el.find('input:hidden[name="id"]').val();
this.income = el.find('input[name="income"]').val();
this.obligations = el.find('input[name="obligations"]').val();
this.incometypeid = el.find('select[name="incometypeid"] option:selected').val();
this.incometypetext = el.find('input[name="incometypetext"]').val();
this.payrolltype = el.find('select[name="payrolltype"] option:selected').val();
this.paydayfrequencytype = el.find('select[name="paydayfrequencytype"] option:selected').val();
this.frequencyweekly_weekday = el.find('select[name="frequencyweekly_weekday"] option:selected').val();
this.frequencybiweekly_weekday = el.find('select[name="frequencybiweekly_weekday"] option:selected').val();
this.frequencybiweekly_sampledate = el.find('input:hidden[name="frequencybiweekly_sampledate"]').val();
this.paydaydayinmonthsubtype = el.find('input:hidden[name="paydaydayinmonthsubtype"]').val();
this.frequencymonthly_dayordinal = el.find('select[name="frequencymonthly_dayordinal"] option:selected').val();
this.frequencytwicepermonth_firstday_dayordinal = el.find('select[name="frequencytwicepermonth_firstday_dayordinal"] option:selected').val();
this.frequencytwicepermonth_secondday_dayordinal = el.find('select[name="frequencytwicepermonth_secondday_dayordinal"] option:selected').val();
this.frequencymonthly_weekdayordinal = el.find('select[name="frequencymonthly_weekdayordinal"] option:selected').val();
this.frequencytwicepermonth_firstday_weekdayordinal = el.find('select[name="frequencytwicepermonth_firstday_weekdayordinal"] option:selected').val();
this.frequencymonthly_weekday = el.find('select[name="frequencymonthly_weekday"] option:selected').val();
this.frequencytwicepermonth_firstday_weekday = el.find('select[name="frequencytwicepermonth_firstday_weekday"] option:selected').val();
this.frequencytwicepermonth_secondday_weekdayordinal = el.find('select[name="frequencytwicepermonth_secondday_weekdayordinal"] option:selected').val();
this.frequencytwicepermonth_secondday_weekday = el.find('select[name="frequencytwicepermonth_secondday_weekday"] option:selected').val();
this.paydayholidayskippingtype = el.find('input:radio[name^="paydayholidayskippingtype"]:checked').val();
this.name = el.find('input[name="name"]').val();
this.occupation = el.find('input[name="occupation"]').val();
this.shift = el.find('input[name="shift"]').val();
this.dateofhire_year = el.find('select[name="dateofhire_year"] option:selected').val();
this.dateofhire_month = el.find('select[name="dateofhire_month"] option:selected').val();
this.address = el.find('input[name="address"]').val();
this.city = el.find('input[name="city"]').val();
this.state = el.find('select[name="state"] option:selected').val();
this.zip = el.find('input[type=hidden][id^=zip]').val();
this.fax_1 = el.find('input[name="fax_1"]').val();
this.fax_2 = el.find('input[name="fax_2"]').val();
this.fax_3 = el.find('input[name="fax_3"]').val();
this.phone_1 = el.find('input[name="phone_1"]').val();
this.phone_2 = el.find('input[name="phone_2"]').val();
this.phone_3 = el.find('input[name="phone_3"]').val();
this.phoneext = el.find('input[name="phoneext"]').val();
this.cellphone_1 = el.find('input[name="cellphone_1"]').val();
this.cellphone_2 = el.find('input[name="cellphone_2"]').val();
this.cellphone_3 = el.find('input[name="cellphone_3"]').val();
this.supervisor = el.find('input[name="supervisor"]').val();
this.supervisorphone_1 = el.find('input[name="supervisorphone_1"]').val();
this.supervisorphone_2 = el.find('input[name="supervisorphone_2"]').val();
this.supervisorphone_3 = el.find('input[name="supervisorphone_3"]').val();
this.supervisorphoneext = el.find('input[name="supervisorphoneext"]').val();
}, '.empinfo');
</script>
<script type="text/javascript">
(function($) {
$('#Content_Root_MemberPageDispatcher_subpage_applyForLoan_EmpInfo_Div_EmpInfo').find('input[type=hidden][id^=zip]').each(function() {
setZipValue($(this).attr('id'), $(this).val())
});
})(jQuery);
</script>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherIncomeCheckboxDiv">
<div class="SectionCheckbox OtherIncome">
<input id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Emp_HasOtherIncome" type="checkbox" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Emp_HasOtherIncome" onclick="applyVisiblityBindings(this);">
<label for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Emp_HasOtherIncome">
<span class="English">Other Income</span>
<span class="Spanish">Otro tipo de saldo</span>
</label>
</div>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo" style="display: none;">
<div id="empinfo_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class="empinfo"> <input type="hidden" name="id" value="0">
<div class="line">
<div style=""> <label for="income_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Monthly Income</span> <span class="Spanish">Ingresos Mensuales</span> <span
class="RedAsterisk">*</span> </label>
<div> <input type="text" name="income" id="income_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" maxlength="15" size="12" onfocus="filterMoneyInput(this)" step="any" class="number">
</div>
</div>
<div style="display:none;"> <label for="obligations_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Monthly Obligations</span> <span class="Spanish">Monthly
Obligations</span> </label>
<div> <input type="text" name="obligations" id="obligations_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" maxlength="15" size="12" onfocus="filterMoneyInput(this)" step="any"
class="number"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="incometypeid_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Income Type</span> <span class="Spanish">Income Type</span> <span
class="RedAsterisk">*</span> </label>
<div> <select id="incometypeid_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" name="incometypeid" class="SingleDDL"
onchange="incomeTypeChanged('Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', false, 1); showIncomeTypeText('incometypeid_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0','incometypetext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0');">
<option value="">-- Select One --</option>
<option value="1">Employment</option>
<option value="4">Social Security</option>
<option value="5">Disability</option>
<option value="6">Retirement</option>
<option value="7">Self-Employed</option>
<option value="8">Other</option>
<option value="10">Unemployment Benefits</option>
</select> <input type="text" id="incometypetext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" name="incometypetext" value="" size="12" maxlength="255" title="Income Type"
style="display:none !important"> </div>
</div>
<script type="text/javascript">
showIncomeTypeText('incometypeid_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', 'incometypetext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0');
</script>
<div> <label for="payrolltype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Payroll Type</span> <span class="Spanish">Tipo de saldo</span> <span
class="RedAsterisk">*</span> </label>
<div> <select name="payrolltype" id="payrolltype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class="SingleDDL">
<option value="">-- Select One --</option>
<option value="1">Cash</option>
<option value="2">Check</option>
<option value="3">Direct Deposit</option>
</select> </div>
</div>
</div>
<div class="line" style="">
<div> <label for="paydayfrequencytype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Pay Frequency</span> <span class="Spanish">Frecuencia de pago</span> <span
class="RedAsterisk">*</span> </label>
<div>
<script type="text/javascript">
function applyEmpPaydayFrequencyTypesVisibility_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0() {
applyPaymentTypeFrequencyTypesVisibility('paydayfrequencytype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', [
'input_paydaydayinmonthsubtype_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'input_paydaydayinmonthsubtype_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0'
], ['div_frequencyweekly_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', 'div_frequencyweekly_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0'], [
'div_frequencybiweekly_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', 'div_frequencybiweekly_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'div_frequencybiweekly_3_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', 'div_frequencybiweekly_4_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0'
], ['div_frequencymonthbased_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'div_frequencymonthbased_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'span_frequencymonthly_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'span_frequencymonthly_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0'
], ['div_frequencymonthbased_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'div_frequencymonthbased_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'span_frequencytwicepermonth_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'span_frequencytwicepermonth_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0'
], [], []);
}
function applyEmpPaydayDayInMonthSubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0(initFromHidden) {
applyPaymentTypeDayInMonthSubtype('input_paydaydayinmonthsubtype_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'input_paydaydayinmonthsubtype_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', initFromHidden);
applyEmpPaydayDayInMonthSubtypesDimming_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0();
}
function applyEmpPaydayDayInMonthSubtypesDimming_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0() {
applyPaymentTypeDayInMonthSubtypesDimming('paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', [
'span_frequencymonthly_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'span_frequencytwicepermonth_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencymonthly_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_firstday_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_secondday_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0'
], ['span_frequencymonthly_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'span_frequencytwicepermonth_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencymonthly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencymonthly_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_firstday_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_secondday_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_secondday_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencytwicepermonth_firstday_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0'
]);
}
</script> <select id="paydayfrequencytype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" name="paydayfrequencytype" class="SingleDDL"
onchange="applyEmpPaydayFrequencyTypesVisibility_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0();">
<option value="">-- Select One --</option>
<option value="1">Weekly</option>
<option value="2">Bi-weekly</option>
<option value="3">Monthly</option>
<option value="4">Twice per Month</option>
</select>
</div>
</div>
</div>
<div class="line" style="">
<div id="div_frequencyweekly_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <label
for="frequencyweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> Pay Day <span class="RedAsterisk">*</span> </label>
<div id="div_frequencyweekly_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <select
id="frequencyweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" name="frequencyweekly_weekday">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday">Friday</option>
<option value="saturday">Saturday</option>
</select> </div>
</div>
<div id="div_frequencybiweekly_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <label
for="frequencybiweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> Pay Day <span class="RedAsterisk">*</span> </label>
<div id="div_frequencybiweekly_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden">
<script type="text/javascript">
function updateEmpBiWeeklySampleDateSetup_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0(initFromHidden) {
updateBiWeeklySampleDateSetupWithRadio('frequencybiweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'fieldset_frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'input_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'label_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'input_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'label_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'span_frequencybiweekly_noweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', initFromHidden);
}
function applyEmpBiWeeklySampleDate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0() {
applyBiWeeklySampleDateWithRadio('input_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'input_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0',
'frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0');
}
</script> <select id="frequencybiweekly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" name="frequencybiweekly_weekday"
onchange="updateEmpBiWeeklySampleDateSetup_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0(false);">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday">Friday</option>
<option value="saturday">Saturday</option>
</select>
</div>
</div>
<div id="div_frequencybiweekly_3_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <label class=""> Next Pay Date <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencybiweekly_4_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden">
<fieldset id="fieldset_frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input id="input_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" type="radio"
name="name_frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
onclick="applyEmpBiWeeklySampleDate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0();"> <label
for="input_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
id="label_frequencybiweekly_sampledate_first_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0">Sample Date</label> <!-- --> <input
id="input_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" type="radio"
name="name_frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
onclick="applyEmpBiWeeklySampleDate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0();"> <label
for="input_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
id="label_frequencybiweekly_sampledate_second_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0">Sample Date</label> </fieldset> <span
id="span_frequencybiweekly_noweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="">(Select week day)</span> <input type="hidden"
id="frequencybiweekly_sampledate_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" name="frequencybiweekly_sampledate" value="">
<script type="text/javascript">
updateEmpBiWeeklySampleDateSetup_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0(true);
</script>
</div>
</div>
<div id="div_frequencymonthbased_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden"> <label class=""> Pay Day <span class="RedAsterisk">*</span> </label>
<div id="div_frequencymonthbased_2_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;" class=" ForceHidden">
<div> <input type="hidden" id="paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" name="paydaydayinmonthsubtype" value="">
<table>
<tbody>
<tr>
<td> <input id="input_paydaydayinmonthsubtype_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" type="radio"
name="name_paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
onclick="applyEmpPaydayDayInMonthSubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0();" title="Day Of Month" class=" ForceHidden" style="display: none;"> <span> </span>
</td>
<td id="span_frequencymonthly_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none; color: gray;" class=" ForceHidden">
<table>
<tbody>
<tr>
<td> <select id="frequencymonthly_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencymonthly_dayordinal" disabled="" style="color: gray;">
<option value="1">1st</option>
<option value="15">15th</option>
<option value="-1">Last</option>
<option disabled="disabled" value="">----</option>
<option value="1">1st</option>
<option value="2">2nd</option>
<option value="3">3rd</option>
<option value="4">4th</option>
<option value="5">5th</option>
<option value="6">6th</option>
<option value="7">7th</option>
<option value="8">8th</option>
<option value="9">9th</option>
<option value="10">10th</option>
<option value="11">11th</option>
<option value="12">12th</option>
<option value="13">13th</option>
<option value="14">14th</option>
<option value="15">15th</option>
<option value="16">16th</option>
<option value="17">17th</option>
<option value="18">18th</option>
<option value="19">19th</option>
<option value="20">20th</option>
<option value="21">21st</option>
<option value="22">22nd</option>
<option value="23">23rd</option>
<option value="24">24th</option>
<option value="25">25th</option>
<option value="26">26th</option>
<option value="27">27th</option>
<option value="28">28th</option>
<option value="29">29th</option>
<option value="30">30th</option>
<option value="31">31st</option>
</select> </td>
<td>of month</td>
</tr>
</tbody>
</table>
</td>
<td id="span_frequencytwicepermonth_dayofmonth_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none; color: gray;" class=" ForceHidden">
<table>
<tbody>
<tr>
<td> <select id="frequencytwicepermonth_firstday_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencytwicepermonth_firstday_dayordinal"
disabled="" style="color: gray;">
<option value="1">1st</option>
<option value="15">15th</option>
<option value="-1">Last</option>
<option disabled="disabled" value="">----</option>
<option value="1">1st</option>
<option value="2">2nd</option>
<option value="3">3rd</option>
<option value="4">4th</option>
<option value="5">5th</option>
<option value="6">6th</option>
<option value="7">7th</option>
<option value="8">8th</option>
<option value="9">9th</option>
<option value="10">10th</option>
<option value="11">11th</option>
<option value="12">12th</option>
<option value="13">13th</option>
<option value="14">14th</option>
<option value="15">15th</option>
<option value="16">16th</option>
<option value="17">17th</option>
<option value="18">18th</option>
<option value="19">19th</option>
<option value="20">20th</option>
<option value="21">21st</option>
<option value="22">22nd</option>
<option value="23">23rd</option>
<option value="24">24th</option>
<option value="25">25th</option>
<option value="26">26th</option>
<option value="27">27th</option>
<option value="28">28th</option>
<option value="29">29th</option>
<option value="30">30th</option>
<option value="31">31st</option>
</select> </td>
<td><b>and</b></td>
<td> <select id="frequencytwicepermonth_secondday_dayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencytwicepermonth_secondday_dayordinal"
disabled="" style="color: gray;">
<option value="1">1st</option>
<option value="15" selected="">15th</option>
<option value="-1">Last</option>
<option disabled="disabled" value="">----</option>
<option value="1">1st</option>
<option value="2">2nd</option>
<option value="3">3rd</option>
<option value="4">4th</option>
<option value="5">5th</option>
<option value="6">6th</option>
<option value="7">7th</option>
<option value="8">8th</option>
<option value="9">9th</option>
<option value="10">10th</option>
<option value="11">11th</option>
<option value="12">12th</option>
<option value="13">13th</option>
<option value="14">14th</option>
<option value="15" selected="">15th</option>
<option value="16">16th</option>
<option value="17">17th</option>
<option value="18">18th</option>
<option value="19">19th</option>
<option value="20">20th</option>
<option value="21">21st</option>
<option value="22">22nd</option>
<option value="23">23rd</option>
<option value="24">24th</option>
<option value="25">25th</option>
<option value="26">26th</option>
<option value="27">27th</option>
<option value="28">28th</option>
<option value="29">29th</option>
<option value="30">30th</option>
<option value="31">31st</option>
</select> </td>
<td>of month</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div>
<div>
<table>
<tbody>
<tr>
<td> <input id="input_paydaydayinmonthsubtype_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" type="radio"
name="name_paydaydayinmonthsubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
onclick="applyEmpPaydayDayInMonthSubtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0();" title="Day Of Week" class=" ForceHidden" style="display: none;"> <span> </span>
</td>
<td id="span_frequencymonthly_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none; color: gray;" class=" ForceHidden">
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select id="frequencymonthly_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day"
name="frequencymonthly_weekdayordinal" disabled="" style="color: gray;">
<option value="1">First</option>
<option value="2">Second</option>
<option value="3">Third</option>
<option value="4">Fourth</option>
<option value="-1">Last</option>
</select> <!-- --> <select id="frequencymonthly_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencymonthly_weekday" disabled=""
style="color: gray;">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday" selected="">Friday</option>
<option value="saturday">Saturday</option>
</select> </fieldset>
</td>
<td id="span_frequencytwicepermonth_nthweekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" nowrap="nowrap" style="display: none; color: gray;" class=" ForceHidden">
<table>
<tbody>
<tr>
<td>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select
id="frequencytwicepermonth_firstday_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencytwicepermonth_firstday_weekdayordinal"
disabled="" style="color: gray;">
<option value="1">First</option>
<option value="2">Second</option>
<option value="3">Third</option>
<option value="4">Fourth</option>
<option value="-1">Last</option>
</select> <!-- --> <select id="frequencytwicepermonth_firstday_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day"
name="frequencytwicepermonth_firstday_weekday" disabled="" style="color: gray;">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday" selected="">Friday</option>
<option value="saturday">Saturday</option>
</select> </fieldset>
</td>
<td><b>and</b></td>
<td>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select
id="frequencytwicepermonth_secondday_weekdayordinal_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day" name="frequencytwicepermonth_secondday_weekdayordinal"
disabled="" style="color: gray;">
<option value="1">First</option>
<option value="2">Second</option>
<option value="3" selected="">Third</option>
<option value="4">Fourth</option>
<option value="-1">Last</option>
</select> <!-- --> <select id="frequencytwicepermonth_secondday_weekday_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" title="Pay Day"
name="frequencytwicepermonth_secondday_weekday" disabled="" style="color: gray;">
<option value="">-- Select --</option>
<option value="sunday">Sunday</option>
<option value="monday">Monday</option>
<option value="tuesday">Tuesday</option>
<option value="wednesday">Wednesday</option>
<option value="thursday">Thursday</option>
<option value="friday" selected="">Friday</option>
<option value="saturday">Saturday</option>
</select> </fieldset>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<script type="text/javascript">
employmentInfoFrequencyInit('Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0');
</script>
<div class="line" style="">
<div class="single"> <label class=""> <span class="English">If Payday On Bank Holiday</span> <span class="Spanish">If Payday On Bank Holiday</span> </label>
<div class="field"> <input id="paydayholidayskippingtype_none_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" type="radio"
name="paydayholidayskippingtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="1" style="vertical-align: middle;"> <label
for="paydayholidayskippingtype_none_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0">Do Nothing</label> <input
id="paydayholidayskippingtype_moveearlier_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" type="radio"
name="paydayholidayskippingtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="2" checked="" style="vertical-align: middle;"> <label
for="paydayholidayskippingtype_moveearlier_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0">Move To Previous Business Day</label> <input
id="paydayholidayskippingtype_movelater_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" type="radio"
name="paydayholidayskippingtype_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="3" style="vertical-align: middle;"> <label
for="paydayholidayskippingtype_movelater_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0">Move To Next Business Day</label> </div>
</div>
</div>
<div style="clear: both;"></div>
<div id="div_employmentinfo_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: none;">
<div class="line">
<div style=""> <label for="name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer</span> <span class="Spanish">Empleador</span> </label>
<div> <input type="text" name="name" id="name_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" size="12" maxlength="255"> </div>
</div>
<div style="display:none;"> <label for="occupation_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Occupation</span> <span class="Spanish">Posición / Título</span>
</label>
<div> <input type="text" name="occupation" id="occupation_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" size="20" maxlength="255"> </div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="dateofhire_year_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Date Of Hire</span> <span class="Spanish">Fecha de
contratación</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <select name="dateofhire_year" id="dateofhire_year_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class="tel">
<option value="">Year</option>
<option value="1900">1900</option>
<option value="1901">1901</option>
<option value="1902">1902</option>
<option value="1903">1903</option>
<option value="1904">1904</option>
<option value="1905">1905</option>
<option value="1906">1906</option>
<option value="1907">1907</option>
<option value="1908">1908</option>
<option value="1909">1909</option>
<option value="1910">1910</option>
<option value="1911">1911</option>
<option value="1912">1912</option>
<option value="1913">1913</option>
<option value="1914">1914</option>
<option value="1915">1915</option>
<option value="1916">1916</option>
<option value="1917">1917</option>
<option value="1918">1918</option>
<option value="1919">1919</option>
<option value="1920">1920</option>
<option value="1921">1921</option>
<option value="1922">1922</option>
<option value="1923">1923</option>
<option value="1924">1924</option>
<option value="1925">1925</option>
<option value="1926">1926</option>
<option value="1927">1927</option>
<option value="1928">1928</option>
<option value="1929">1929</option>
<option value="1930">1930</option>
<option value="1931">1931</option>
<option value="1932">1932</option>
<option value="1933">1933</option>
<option value="1934">1934</option>
<option value="1935">1935</option>
<option value="1936">1936</option>
<option value="1937">1937</option>
<option value="1938">1938</option>
<option value="1939">1939</option>
<option value="1940">1940</option>
<option value="1941">1941</option>
<option value="1942">1942</option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</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="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>
</select> <!-- --> <select name="dateofhire_month" title="Month" class="tel">
<option value="">Month</option>
<option value="1">Jan</option>
<option value="2">Feb</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</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> </fieldset>
</div>
</div>
<div style="display:none;"> <label for="shift_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Shift</span> <span class="Spanish">Horario</span> </label>
<div> <input type="text" name="shift" id="shift_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" size="20" maxlength="255"> </div>
</div>
</div>
<div class="line">
<div style=""> <label for="phone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Work Phone</span> <span class="Spanish">Numero del teléfono del empleo</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="phone_1" id="phone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value=""
class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"> <!-- --> <input type="text" name="phone_2" value="" class="tel noblock FourBox"
maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"> <!-- --> <input type="text" name="phone_3" value="" class="tel noblock FourBox" maxlength="4" size="4"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"> <!-- --> <label for="phoneext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
style="display: inline;"><span class="English">Ext.:</span><span class="Spanish">Extensión:</span></label> <input type="text" name="phoneext"
id="phoneext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" class="tel noblock FourBox" size="12" maxlength="40" onfocus="filterNumericInput(this)"> </fieldset>
</div>
</div>
<div style="display:none;"> <label for="fax_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Work Fax</span> <span class="Spanish">Fax del trabajo</span>:
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="fax_1" id="fax_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value=""
class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"> <!-- --> <input type="text" name="fax_2" value="" class="tel noblock" maxlength="3" size="3"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"> <!-- --> <input type="text" name="fax_3" value="" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)"
onkeyup="moveToNextIfFull(this)" title="Work Fax"> </fieldset>
</div>
</div>
</div>
<div class="line" style="display:none;">
<div> <label for="cellphone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Cell Phone (Work)</span> <span class="Spanish">Numero de celular del empleo</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="cellphone_1" id="cellphone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value=""
class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"> <!-- --> <input type="text" name="cellphone_2" value="" class="tel noblock"
maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"> <!-- --> <input type="text" name="cellphone_3" value="" class="tel noblock" maxlength="4" size="4"
onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"> </fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="address_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer Address</span> <span class="Spanish">Dirección de
empleo</span> </label>
<div> <input type="text" name="address" id="address_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" size="20" maxlength="255"> </div>
</div>
<div style="display:none;"> <label for="city_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer City</span> <span class="Spanish">Ciudad de empleo</span>
</label>
<div> <input type="text" name="city" id="city_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" size="12" maxlength="255"> </div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="state_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer State</span> <span class="Spanish">Estado</span> </label>
<div> <select id="state_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" name="state">
<option value="">-- Choose --</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select> </div>
</div>
<div style="display:none;"> <label for="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Employer Zip</span> <span class="Spanish">Código postal</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" maxlength="5" size="8" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onfocus="filterNumericInput(this)"
data-relatedhiddenfieldid="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
id="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0_ZIP_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
name="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0_ZIP_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" title="Zip"><input
type="hidden" id="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
name="zip_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0_ZIPValue_Single_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value=""> </fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;"> <label for="supervisor_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Supervisor</span> <span class="Spanish">Supervisor</span>
</label>
<div> <input type="text" name="supervisor" id="supervisor_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" size="12" maxlength="255"> </div>
</div>
<div style="display:none;"> <label for="supervisorphone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" class=""> <span class="English">Supervisor Phone</span> <span class="Spanish">Numero de
teléfono</span> </label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap"> <input type="text" name="supervisorphone_1" id="supervisorphone_1_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0"
value="" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"> <!-- --> <input type="text" name="supervisorphone_2" value=""
class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"> <!-- --> <input type="text" name="supervisorphone_3" value=""
class="tel noblock FourBox" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"> <!-- --> <label
for="supervisorphoneext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" style="display: inline;"><span class="English">Ext.:</span><span class="Spanish">Extensión:</span></label> <input
type="text" name="supervisorphoneext" id="supervisorphoneext_Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0" value="" class="tel noblock FourBox" size="12" maxlength="40"> </fieldset>
</div>
</div>
</div>
</div>
<script type="text/javascript">
employmentInfoInit('Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_0', false, 1, false, 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo');
</script>
<div style="clear: both;"></div>
</div>
</div><input type="hidden" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_json" name="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_json" value="">
<script type="text/javascript">
(function($) {
window.incomeTypeChanged = function(unique, showEmploymentFieldsForAllIncomeTypes, incomeTypeEmploymentId) {
if (showEmploymentFieldsForAllIncomeTypes) return;
var incomeType = $('#incometypeid_' + unique).val();
var required = incomeType == incomeTypeEmploymentId;
$('#div_employmentinfo_' + unique).toggle(required);
};
window.employmentInfoInit = function(unique, showEmploymentFieldsForAllIncomeTypes, incomeTypeEmploymentId, isMainEmpInfo, empInfoDivId) {
if (!isMainEmpInfo && $('#' + empInfoDivId + ' div:first-child').attr('id') != 'empinfo_' + unique) {
$('#empinfo_' + unique).css("border-top", "solid 1px #ccc");
$('#empinfo_' + unique).css("margin-top", "4px");
}
incomeTypeChanged(unique, showEmploymentFieldsForAllIncomeTypes, incomeTypeEmploymentId);
if ($.mobile) {
$('#empinfo_' + unique).trigger('create');
}
};
window.employmentInfoFrequencyInit = function(unique) {
if ($.mobile) {
$('#frequencymonthly_dayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_firstday_dayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_secondday_dayordinal_' + unique).selectmenu();
$('#frequencymonthly_weekday_' + unique).selectmenu();
$('#frequencymonthly_weekdayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_firstday_weekdayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_secondday_weekdayordinal_' + unique).selectmenu();
$('#frequencytwicepermonth_secondday_weekday_' + unique).selectmenu();
$('#frequencytwicepermonth_firstday_weekday_' + unique).selectmenu();
}
eval('applyEmpPaydayFrequencyTypesVisibility_' + unique + '()');
eval('applyEmpPaydayDayInMonthSubtype_' + unique + '(true)');
};
})(jQuery);
</script>
<script id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo_template" type="text/x-jquery-tmpl"> <div id="empinfo_${$unique}" class="empinfo">
<input type="hidden" name="id" value="${id}"/>
<div class="line">
<div style="">
<label for="income_${$unique}" class="${income_title_class}">
<span class="English">Monthly Income</span> <span class="Spanish">Ingresos Mensuales</span> <span class="RedAsterisk">*</span>
</label>
<div>
<input type="text" name="income" id="income_${$unique}" value="${income}" maxlength="15" size="12" onfocus="filterMoneyInput(this)" step="any" class="number" />
</div>
</div>
<div style="display:none;">
<label for="obligations_${$unique}" class="${obligations_title_class}">
<span class="English">Monthly Obligations</span> <span class="Spanish">Monthly Obligations</span>
</label>
<div>
<input type="text" name="obligations" id="obligations_${$unique}" value="${obligations}" maxlength="15" size="12" onfocus="filterMoneyInput(this)" step="any" class="number" />
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="incometypeid_${$unique}" class="${incometypeid_title_class}">
<span class="English">Income Type</span> <span class="Spanish">Income Type</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select id="incometypeid_${$unique}" name="incometypeid" class="SingleDDL" onchange="incomeTypeChanged('${$unique}', false, 1); showIncomeTypeText('incometypeid_${$unique}','incometypetext_${$unique}');">
<option value="">-- Select One --</option>
<option value="1" ${incometypeid == '1' ? 'selected' : ''}>Employment</option>
<option value="4" ${incometypeid == '4' ? 'selected' : ''}>Social Security</option>
<option value="5" ${incometypeid == '5' ? 'selected' : ''}>Disability</option>
<option value="6" ${incometypeid == '6' ? 'selected' : ''}>Retirement</option>
<option value="7" ${incometypeid == '7' ? 'selected' : ''}>Self-Employed</option>
<option value="8" ${incometypeid == '8' ? 'selected' : ''}>Other</option>
<option value="10" ${incometypeid == '10' ? 'selected' : ''}>Unemployment Benefits</option>
</select>
<input type="text" id="incometypetext_${$unique}" name="incometypetext" value="${incometypetext}" size="12" maxlength="255" title="Income Type" />
</div>
</div>
<scr{{= ""}}ipt type="text/javascript">showIncomeTypeText('incometypeid_${$unique}', 'incometypetext_${$unique}');</scr{{= ""}}ipt>
<div>
<label for="payrolltype_${$unique}" class="${payrolltype_title_class}">
<span class="English">Payroll Type</span> <span class="Spanish">Tipo de saldo</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="payrolltype" id="payrolltype_${$unique}" class="SingleDDL">
<option value="">-- Select One --</option>
<option value="1" ${payrolltype == '1' ? 'selected' : ''}>Cash</option>
<option value="2" ${payrolltype == '2' ? 'selected' : ''}>Check</option>
<option value="3" ${payrolltype == '3' ? 'selected' : ''}>Direct Deposit</option>
</select>
</div>
</div>
</div>
<div class="line" style="">
<div>
<label for="paydayfrequencytype_${$unique}" class="${paydayfrequencytype_title_class}">
<span class="English">Pay Frequency</span> <span class="Spanish">Frecuencia de pago</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<scr{{= ""}}ipt type="text/javascript">
function applyEmpPaydayFrequencyTypesVisibility_${$unique}()
{
applyPaymentTypeFrequencyTypesVisibility(
'paydayfrequencytype_${$unique}',
['input_paydaydayinmonthsubtype_dayofmonth_${$unique}', 'input_paydaydayinmonthsubtype_nthweekday_${$unique}'],
['div_frequencyweekly_1_${$unique}', 'div_frequencyweekly_2_${$unique}'],
['div_frequencybiweekly_1_${$unique}', 'div_frequencybiweekly_2_${$unique}', 'div_frequencybiweekly_3_${$unique}', 'div_frequencybiweekly_4_${$unique}'],
['div_frequencymonthbased_1_${$unique}', 'div_frequencymonthbased_2_${$unique}', 'span_frequencymonthly_dayofmonth_${$unique}', 'span_frequencymonthly_nthweekday_${$unique}'],
['div_frequencymonthbased_1_${$unique}', 'div_frequencymonthbased_2_${$unique}', 'span_frequencytwicepermonth_dayofmonth_${$unique}', 'span_frequencytwicepermonth_nthweekday_${$unique}'],
[],
[]
);
}
function applyEmpPaydayDayInMonthSubtype_${$unique}(initFromHidden)
{
applyPaymentTypeDayInMonthSubtype('input_paydaydayinmonthsubtype_dayofmonth_${$unique}', 'input_paydaydayinmonthsubtype_nthweekday_${$unique}', 'paydaydayinmonthsubtype_${$unique}', initFromHidden);
applyEmpPaydayDayInMonthSubtypesDimming_${$unique}();
}
function applyEmpPaydayDayInMonthSubtypesDimming_${$unique}()
{
applyPaymentTypeDayInMonthSubtypesDimming(
'paydaydayinmonthsubtype_${$unique}',
['span_frequencymonthly_dayofmonth_${$unique}', 'span_frequencytwicepermonth_dayofmonth_${$unique}', 'frequencymonthly_dayordinal_${$unique}', 'frequencytwicepermonth_firstday_dayordinal_${$unique}', 'frequencytwicepermonth_secondday_dayordinal_${$unique}'],
['span_frequencymonthly_nthweekday_${$unique}', 'span_frequencytwicepermonth_nthweekday_${$unique}', 'frequencymonthly_weekday_${$unique}', 'frequencymonthly_weekdayordinal_${$unique}', 'frequencytwicepermonth_firstday_weekdayordinal_${$unique}', 'frequencytwicepermonth_secondday_weekdayordinal_${$unique}', 'frequencytwicepermonth_secondday_weekday_${$unique}', 'frequencytwicepermonth_firstday_weekday_${$unique}']);
}
</scr{{= ""}}ipt>
<select id="paydayfrequencytype_${$unique}" name="paydayfrequencytype" class="SingleDDL" onchange="applyEmpPaydayFrequencyTypesVisibility_${$unique}();">
<option value="">-- Select One --</option>
<option value="1" ${paydayfrequencytype == '1' ? 'selected' : ''}>Weekly</option>
<option value="2" ${paydayfrequencytype == '2' ? 'selected' : ''}>Bi-weekly</option>
<option value="3" ${paydayfrequencytype == '3' ? 'selected' : ''}>Monthly</option>
<option value="4" ${paydayfrequencytype == '4' ? 'selected' : ''}>Twice per Month</option>
</select>
</div>
</div>
</div>
<div class="line" style="">
<div id="div_frequencyweekly_1_${$unique}" style="display: none;">
<label for="frequencyweekly_weekday_${$unique}" class="${frequencyweekly_weekday_title_class}">
Pay Day <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencyweekly_2_${$unique}" style="display: none;">
<select id="frequencyweekly_weekday_${$unique}" name="frequencyweekly_weekday">
<option value="">-- Select --</option>
<option value="sunday" ${frequencyweekly_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencyweekly_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencyweekly_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencyweekly_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencyweekly_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencyweekly_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencyweekly_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</div>
</div>
<div id="div_frequencybiweekly_1_${$unique}" style="display: none;">
<label for="frequencybiweekly_weekday_${$unique}" class="${frequencybiweekly_weekday_title_class}">
Pay Day <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencybiweekly_2_${$unique}" style="display: none;">
<scr{{= ""}}ipt type="text/javascript">
function updateEmpBiWeeklySampleDateSetup_${$unique}(initFromHidden)
{ updateBiWeeklySampleDateSetupWithRadio('frequencybiweekly_weekday_${$unique}', 'fieldset_frequencybiweekly_sampledate_${$unique}', 'input_frequencybiweekly_sampledate_first_${$unique}', 'label_frequencybiweekly_sampledate_first_${$unique}', 'input_frequencybiweekly_sampledate_second_${$unique}', 'label_frequencybiweekly_sampledate_second_${$unique}', 'span_frequencybiweekly_noweekday_${$unique}', 'frequencybiweekly_sampledate_${$unique}', initFromHidden); }
function applyEmpBiWeeklySampleDate_${$unique}()
{ applyBiWeeklySampleDateWithRadio('input_frequencybiweekly_sampledate_first_${$unique}', 'input_frequencybiweekly_sampledate_second_${$unique}', 'frequencybiweekly_sampledate_${$unique}'); }
</scr{{= ""}}ipt>
<select id="frequencybiweekly_weekday_${$unique}" name="frequencybiweekly_weekday" onchange="updateEmpBiWeeklySampleDateSetup_${$unique}(false);">
<option value="">-- Select --</option>
<option value="sunday" ${frequencybiweekly_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencybiweekly_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencybiweekly_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencybiweekly_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencybiweekly_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencybiweekly_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencybiweekly_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</div>
</div>
<div id="div_frequencybiweekly_3_${$unique}" style="display: none;">
<label class="${frequencybiweekly_sampledate_title_class}">
Next Pay Date <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencybiweekly_4_${$unique}" style="display: none;">
<fieldset id="fieldset_frequencybiweekly_sampledate_${$unique}" style="display: none;" data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input id="input_frequencybiweekly_sampledate_first_${$unique}" type="radio" name="name_frequencybiweekly_sampledate_${$unique}" onclick="applyEmpBiWeeklySampleDate_${$unique}();" />
<label for="input_frequencybiweekly_sampledate_first_${$unique}" id="label_frequencybiweekly_sampledate_first_${$unique}">Sample Date</label>
<!-- -->
<input id="input_frequencybiweekly_sampledate_second_${$unique}" type="radio" name="name_frequencybiweekly_sampledate_${$unique}" onclick="applyEmpBiWeeklySampleDate_${$unique}();"/>
<label for="input_frequencybiweekly_sampledate_second_${$unique}" id="label_frequencybiweekly_sampledate_second_${$unique}">Sample Date</label>
</fieldset>
<span id="span_frequencybiweekly_noweekday_${$unique}" style="display: none;">(Select week day)</span>
<input type="hidden" id="frequencybiweekly_sampledate_${$unique}" name="frequencybiweekly_sampledate" value="${frequencybiweekly_sampledate}" />
<scr{{= ""}}ipt type="text/javascript">updateEmpBiWeeklySampleDateSetup_${$unique}(true);</scr{{= ""}}ipt>
</div>
</div>
<div id="div_frequencymonthbased_1_${$unique}" style="display: none;">
<label class="${frequencymonthbased_title_class}">
Pay Day <span class="RedAsterisk">*</span>
</label>
<div id="div_frequencymonthbased_2_${$unique}" style="display: none;">
<div>
<input type="hidden" id="paydaydayinmonthsubtype_${$unique}" name="paydaydayinmonthsubtype" value="${paydaydayinmonthsubtype}"/>
<table>
<tr>
<td>
<input id="input_paydaydayinmonthsubtype_dayofmonth_${$unique}" type="radio" name="name_paydaydayinmonthsubtype_${$unique}" onclick="applyEmpPaydayDayInMonthSubtype_${$unique}();" title="Day Of Month" />
<span> </span>
</td>
<td id="span_frequencymonthly_dayofmonth_${$unique}" style="display: none;">
<table>
<tr>
<td>
<select id="frequencymonthly_dayordinal_${$unique}" title="Pay Day" name="frequencymonthly_dayordinal">
<option value="1" ${frequencymonthly_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="15" ${frequencymonthly_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="-1" ${frequencymonthly_dayordinal == '-1' ? 'selected' : ''}>Last</option>
<option disabled="disabled" value="">----</option>
<option value="1" ${frequencymonthly_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="2" ${frequencymonthly_dayordinal == '2' ? 'selected' : ''}>2nd</option>
<option value="3" ${frequencymonthly_dayordinal == '3' ? 'selected' : ''}>3rd</option>
<option value="4" ${frequencymonthly_dayordinal == '4' ? 'selected' : ''}>4th</option>
<option value="5" ${frequencymonthly_dayordinal == '5' ? 'selected' : ''}>5th</option>
<option value="6" ${frequencymonthly_dayordinal == '6' ? 'selected' : ''}>6th</option>
<option value="7" ${frequencymonthly_dayordinal == '7' ? 'selected' : ''}>7th</option>
<option value="8" ${frequencymonthly_dayordinal == '8' ? 'selected' : ''}>8th</option>
<option value="9" ${frequencymonthly_dayordinal == '9' ? 'selected' : ''}>9th</option>
<option value="10" ${frequencymonthly_dayordinal == '10' ? 'selected' : ''}>10th</option>
<option value="11" ${frequencymonthly_dayordinal == '11' ? 'selected' : ''}>11th</option>
<option value="12" ${frequencymonthly_dayordinal == '12' ? 'selected' : ''}>12th</option>
<option value="13" ${frequencymonthly_dayordinal == '13' ? 'selected' : ''}>13th</option>
<option value="14" ${frequencymonthly_dayordinal == '14' ? 'selected' : ''}>14th</option>
<option value="15" ${frequencymonthly_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="16" ${frequencymonthly_dayordinal == '16' ? 'selected' : ''}>16th</option>
<option value="17" ${frequencymonthly_dayordinal == '17' ? 'selected' : ''}>17th</option>
<option value="18" ${frequencymonthly_dayordinal == '18' ? 'selected' : ''}>18th</option>
<option value="19" ${frequencymonthly_dayordinal == '19' ? 'selected' : ''}>19th</option>
<option value="20" ${frequencymonthly_dayordinal == '20' ? 'selected' : ''}>20th</option>
<option value="21" ${frequencymonthly_dayordinal == '21' ? 'selected' : ''}>21st</option>
<option value="22" ${frequencymonthly_dayordinal == '22' ? 'selected' : ''}>22nd</option>
<option value="23" ${frequencymonthly_dayordinal == '23' ? 'selected' : ''}>23rd</option>
<option value="24" ${frequencymonthly_dayordinal == '24' ? 'selected' : ''}>24th</option>
<option value="25" ${frequencymonthly_dayordinal == '25' ? 'selected' : ''}>25th</option>
<option value="26" ${frequencymonthly_dayordinal == '26' ? 'selected' : ''}>26th</option>
<option value="27" ${frequencymonthly_dayordinal == '27' ? 'selected' : ''}>27th</option>
<option value="28" ${frequencymonthly_dayordinal == '28' ? 'selected' : ''}>28th</option>
<option value="29" ${frequencymonthly_dayordinal == '29' ? 'selected' : ''}>29th</option>
<option value="30" ${frequencymonthly_dayordinal == '30' ? 'selected' : ''}>30th</option>
<option value="31" ${frequencymonthly_dayordinal == '31' ? 'selected' : ''}>31st</option>
</select>
</td>
<td>of month</td>
</tr>
</table>
</td>
<td id="span_frequencytwicepermonth_dayofmonth_${$unique}" style="display: none;">
<table>
<tr>
<td>
<select id="frequencytwicepermonth_firstday_dayordinal_${$unique}" title="Pay Day" name="frequencytwicepermonth_firstday_dayordinal">
<option value="1" ${frequencytwicepermonth_firstday_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="15" ${frequencytwicepermonth_firstday_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="-1" ${frequencytwicepermonth_firstday_dayordinal == '-1' ? 'selected' : ''}>Last</option>
<option disabled="disabled" value="">----</option>
<option value="1" ${frequencytwicepermonth_firstday_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="2" ${frequencytwicepermonth_firstday_dayordinal == '2' ? 'selected' : ''}>2nd</option>
<option value="3" ${frequencytwicepermonth_firstday_dayordinal == '3' ? 'selected' : ''}>3rd</option>
<option value="4" ${frequencytwicepermonth_firstday_dayordinal == '4' ? 'selected' : ''}>4th</option>
<option value="5" ${frequencytwicepermonth_firstday_dayordinal == '5' ? 'selected' : ''}>5th</option>
<option value="6" ${frequencytwicepermonth_firstday_dayordinal == '6' ? 'selected' : ''}>6th</option>
<option value="7" ${frequencytwicepermonth_firstday_dayordinal == '7' ? 'selected' : ''}>7th</option>
<option value="8" ${frequencytwicepermonth_firstday_dayordinal == '8' ? 'selected' : ''}>8th</option>
<option value="9" ${frequencytwicepermonth_firstday_dayordinal == '9' ? 'selected' : ''}>9th</option>
<option value="10" ${frequencytwicepermonth_firstday_dayordinal == '10' ? 'selected' : ''}>10th</option>
<option value="11" ${frequencytwicepermonth_firstday_dayordinal == '11' ? 'selected' : ''}>11th</option>
<option value="12" ${frequencytwicepermonth_firstday_dayordinal == '12' ? 'selected' : ''}>12th</option>
<option value="13" ${frequencytwicepermonth_firstday_dayordinal == '13' ? 'selected' : ''}>13th</option>
<option value="14" ${frequencytwicepermonth_firstday_dayordinal == '14' ? 'selected' : ''}>14th</option>
<option value="15" ${frequencytwicepermonth_firstday_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="16" ${frequencytwicepermonth_firstday_dayordinal == '16' ? 'selected' : ''}>16th</option>
<option value="17" ${frequencytwicepermonth_firstday_dayordinal == '17' ? 'selected' : ''}>17th</option>
<option value="18" ${frequencytwicepermonth_firstday_dayordinal == '18' ? 'selected' : ''}>18th</option>
<option value="19" ${frequencytwicepermonth_firstday_dayordinal == '19' ? 'selected' : ''}>19th</option>
<option value="20" ${frequencytwicepermonth_firstday_dayordinal == '20' ? 'selected' : ''}>20th</option>
<option value="21" ${frequencytwicepermonth_firstday_dayordinal == '21' ? 'selected' : ''}>21st</option>
<option value="22" ${frequencytwicepermonth_firstday_dayordinal == '22' ? 'selected' : ''}>22nd</option>
<option value="23" ${frequencytwicepermonth_firstday_dayordinal == '23' ? 'selected' : ''}>23rd</option>
<option value="24" ${frequencytwicepermonth_firstday_dayordinal == '24' ? 'selected' : ''}>24th</option>
<option value="25" ${frequencytwicepermonth_firstday_dayordinal == '25' ? 'selected' : ''}>25th</option>
<option value="26" ${frequencytwicepermonth_firstday_dayordinal == '26' ? 'selected' : ''}>26th</option>
<option value="27" ${frequencytwicepermonth_firstday_dayordinal == '27' ? 'selected' : ''}>27th</option>
<option value="28" ${frequencytwicepermonth_firstday_dayordinal == '28' ? 'selected' : ''}>28th</option>
<option value="29" ${frequencytwicepermonth_firstday_dayordinal == '29' ? 'selected' : ''}>29th</option>
<option value="30" ${frequencytwicepermonth_firstday_dayordinal == '30' ? 'selected' : ''}>30th</option>
<option value="31" ${frequencytwicepermonth_firstday_dayordinal == '31' ? 'selected' : ''}>31st</option>
</select>
</td>
<td><b>and</b></td>
<td>
<select id="frequencytwicepermonth_secondday_dayordinal_${$unique}" title="Pay Day" name="frequencytwicepermonth_secondday_dayordinal">
<option value="1" ${frequencytwicepermonth_secondday_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="15" ${frequencytwicepermonth_secondday_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="-1" ${frequencytwicepermonth_secondday_dayordinal == '-1' ? 'selected' : ''}>Last</option>
<option disabled="disabled" value="">----</option>
<option value="1" ${frequencytwicepermonth_secondday_dayordinal == '1' ? 'selected' : ''}>1st</option>
<option value="2" ${frequencytwicepermonth_secondday_dayordinal == '2' ? 'selected' : ''}>2nd</option>
<option value="3" ${frequencytwicepermonth_secondday_dayordinal == '3' ? 'selected' : ''}>3rd</option>
<option value="4" ${frequencytwicepermonth_secondday_dayordinal == '4' ? 'selected' : ''}>4th</option>
<option value="5" ${frequencytwicepermonth_secondday_dayordinal == '5' ? 'selected' : ''}>5th</option>
<option value="6" ${frequencytwicepermonth_secondday_dayordinal == '6' ? 'selected' : ''}>6th</option>
<option value="7" ${frequencytwicepermonth_secondday_dayordinal == '7' ? 'selected' : ''}>7th</option>
<option value="8" ${frequencytwicepermonth_secondday_dayordinal == '8' ? 'selected' : ''}>8th</option>
<option value="9" ${frequencytwicepermonth_secondday_dayordinal == '9' ? 'selected' : ''}>9th</option>
<option value="10" ${frequencytwicepermonth_secondday_dayordinal == '10' ? 'selected' : ''}>10th</option>
<option value="11" ${frequencytwicepermonth_secondday_dayordinal == '11' ? 'selected' : ''}>11th</option>
<option value="12" ${frequencytwicepermonth_secondday_dayordinal == '12' ? 'selected' : ''}>12th</option>
<option value="13" ${frequencytwicepermonth_secondday_dayordinal == '13' ? 'selected' : ''}>13th</option>
<option value="14" ${frequencytwicepermonth_secondday_dayordinal == '14' ? 'selected' : ''}>14th</option>
<option value="15" ${frequencytwicepermonth_secondday_dayordinal == '15' ? 'selected' : ''}>15th</option>
<option value="16" ${frequencytwicepermonth_secondday_dayordinal == '16' ? 'selected' : ''}>16th</option>
<option value="17" ${frequencytwicepermonth_secondday_dayordinal == '17' ? 'selected' : ''}>17th</option>
<option value="18" ${frequencytwicepermonth_secondday_dayordinal == '18' ? 'selected' : ''}>18th</option>
<option value="19" ${frequencytwicepermonth_secondday_dayordinal == '19' ? 'selected' : ''}>19th</option>
<option value="20" ${frequencytwicepermonth_secondday_dayordinal == '20' ? 'selected' : ''}>20th</option>
<option value="21" ${frequencytwicepermonth_secondday_dayordinal == '21' ? 'selected' : ''}>21st</option>
<option value="22" ${frequencytwicepermonth_secondday_dayordinal == '22' ? 'selected' : ''}>22nd</option>
<option value="23" ${frequencytwicepermonth_secondday_dayordinal == '23' ? 'selected' : ''}>23rd</option>
<option value="24" ${frequencytwicepermonth_secondday_dayordinal == '24' ? 'selected' : ''}>24th</option>
<option value="25" ${frequencytwicepermonth_secondday_dayordinal == '25' ? 'selected' : ''}>25th</option>
<option value="26" ${frequencytwicepermonth_secondday_dayordinal == '26' ? 'selected' : ''}>26th</option>
<option value="27" ${frequencytwicepermonth_secondday_dayordinal == '27' ? 'selected' : ''}>27th</option>
<option value="28" ${frequencytwicepermonth_secondday_dayordinal == '28' ? 'selected' : ''}>28th</option>
<option value="29" ${frequencytwicepermonth_secondday_dayordinal == '29' ? 'selected' : ''}>29th</option>
<option value="30" ${frequencytwicepermonth_secondday_dayordinal == '30' ? 'selected' : ''}>30th</option>
<option value="31" ${frequencytwicepermonth_secondday_dayordinal == '31' ? 'selected' : ''}>31st</option>
</select>
</td>
<td>of month</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
<div>
<table>
<tr>
<td>
<input id="input_paydaydayinmonthsubtype_nthweekday_${$unique}" type="radio" name="name_paydaydayinmonthsubtype_${$unique}" onclick="applyEmpPaydayDayInMonthSubtype_${$unique}();" title="Day Of Week"/>
<span> </span>
</td>
<td id="span_frequencymonthly_nthweekday_${$unique}" style="display: none;">
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select id="frequencymonthly_weekdayordinal_${$unique}" title="Pay Day" name="frequencymonthly_weekdayordinal">
<option value="1" ${frequencymonthly_weekdayordinal == '1' ? 'selected' : ''}>First</option>
<option value="2" ${frequencymonthly_weekdayordinal == '2' ? 'selected' : ''}>Second</option>
<option value="3" ${frequencymonthly_weekdayordinal == '3' ? 'selected' : ''}>Third</option>
<option value="4" ${frequencymonthly_weekdayordinal == '4' ? 'selected' : ''}>Fourth</option>
<option value="-1" ${frequencymonthly_weekdayordinal == '-1' ? 'selected' : ''}>Last</option>
</select>
<!-- -->
<select id="frequencymonthly_weekday_${$unique}" title="Pay Day" name="frequencymonthly_weekday">
<option value="">-- Select --</option>
<option value="sunday" ${frequencymonthly_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencymonthly_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencymonthly_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencymonthly_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencymonthly_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencymonthly_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencymonthly_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</fieldset>
</td>
<td id="span_frequencytwicepermonth_nthweekday_${$unique}" nowrap="nowrap" style="display: none;">
<table>
<tr>
<td>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select id="frequencytwicepermonth_firstday_weekdayordinal_${$unique}" title="Pay Day" name="frequencytwicepermonth_firstday_weekdayordinal">
<option value="1" ${frequencytwicepermonth_firstday_weekdayordinal == '1' ? 'selected' : ''}>First</option>
<option value="2" ${frequencytwicepermonth_firstday_weekdayordinal == '2' ? 'selected' : ''}>Second</option>
<option value="3" ${frequencytwicepermonth_firstday_weekdayordinal == '3' ? 'selected' : ''}>Third</option>
<option value="4" ${frequencytwicepermonth_firstday_weekdayordinal == '4' ? 'selected' : ''}>Fourth</option>
<option value="-1" ${frequencytwicepermonth_firstday_weekdayordinal == '-1' ? 'selected' : ''}>Last</option>
</select>
<!-- -->
<select id="frequencytwicepermonth_firstday_weekday_${$unique}" title="Pay Day" name="frequencytwicepermonth_firstday_weekday">
<option value="">-- Select --</option>
<option value="sunday" ${frequencytwicepermonth_firstday_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencytwicepermonth_firstday_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencytwicepermonth_firstday_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencytwicepermonth_firstday_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencytwicepermonth_firstday_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencytwicepermonth_firstday_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencytwicepermonth_firstday_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</fieldset>
</td>
<td><b>and</b></td>
<td>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select id="frequencytwicepermonth_secondday_weekdayordinal_${$unique}" title="Pay Day" name="frequencytwicepermonth_secondday_weekdayordinal">
<option value="1" ${frequencytwicepermonth_secondday_weekdayordinal == '1' ? 'selected' : ''}>First</option>
<option value="2" ${frequencytwicepermonth_secondday_weekdayordinal == '2' ? 'selected' : ''}>Second</option>
<option value="3" ${frequencytwicepermonth_secondday_weekdayordinal == '3' ? 'selected' : ''}>Third</option>
<option value="4" ${frequencytwicepermonth_secondday_weekdayordinal == '4' ? 'selected' : ''}>Fourth</option>
<option value="-1" ${frequencytwicepermonth_secondday_weekdayordinal == '-1' ? 'selected' : ''}>Last</option>
</select>
<!-- -->
<select id="frequencytwicepermonth_secondday_weekday_${$unique}" title="Pay Day" name="frequencytwicepermonth_secondday_weekday">
<option value="">-- Select --</option>
<option value="sunday" ${frequencytwicepermonth_secondday_weekday == 'sunday' ? 'selected' : ''}>Sunday</option>
<option value="monday" ${frequencytwicepermonth_secondday_weekday == 'monday' ? 'selected' : ''}>Monday</option>
<option value="tuesday" ${frequencytwicepermonth_secondday_weekday == 'tuesday' ? 'selected' : ''}>Tuesday</option>
<option value="wednesday" ${frequencytwicepermonth_secondday_weekday == 'wednesday' ? 'selected' : ''}>Wednesday</option>
<option value="thursday" ${frequencytwicepermonth_secondday_weekday == 'thursday' ? 'selected' : ''}>Thursday</option>
<option value="friday" ${frequencytwicepermonth_secondday_weekday == 'friday' ? 'selected' : ''}>Friday</option>
<option value="saturday" ${frequencytwicepermonth_secondday_weekday == 'saturday' ? 'selected' : ''}>Saturday</option>
</select>
</fieldset>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</div>
</div>
<scr{{= ""}}ipt type="text/javascript">
employmentInfoFrequencyInit('${$unique}');
</scr{{= ""}}ipt>
<div class="line" style="">
<div class="single">
<label class="${paydayholidayskippingtype_title_class}">
<span class="English">If Payday On Bank Holiday</span> <span class="Spanish">If Payday On Bank Holiday</span>
</label>
<div class="field">
<input id="paydayholidayskippingtype_none_${$unique}" type="radio" name="paydayholidayskippingtype_${$unique}" value="1" ${paydayholidayskippingtype == '1' ? 'checked' : ''} style="vertical-align: middle;"/>
<label for="paydayholidayskippingtype_none_${$unique}">Do Nothing</label>
<input id="paydayholidayskippingtype_moveearlier_${$unique}" type="radio" name="paydayholidayskippingtype_${$unique}" value="2" ${paydayholidayskippingtype == '2' ? 'checked' : ''} style="vertical-align: middle;"/>
<label for="paydayholidayskippingtype_moveearlier_${$unique}">Move To Previous Business Day</label>
<input id="paydayholidayskippingtype_movelater_${$unique}" type="radio" name="paydayholidayskippingtype_${$unique}" value="3" ${paydayholidayskippingtype == '3' ? 'checked' : ''} style="vertical-align: middle;"/>
<label for="paydayholidayskippingtype_movelater_${$unique}">Move To Next Business Day</label>
</div>
</div>
</div>
<div style="clear: both;"></div>
<div id="div_employmentinfo_${$unique}">
<div class="line">
<div style="">
<label for="name_${$unique}" class="${name_title_class}">
<span class="English">Employer</span> <span class="Spanish">Empleador</span>
</label>
<div>
<input type="text" name="name" id="name_${$unique}" value="${name}" size="12" maxlength="255" />
</div>
</div>
<div style="display:none;">
<label for="occupation_${$unique}" class="${occupation_title_class}">
<span class="English">Occupation</span> <span class="Spanish">Posición / Título</span>
</label>
<div>
<input type="text" name="occupation" id="occupation_${$unique}" value="${occupation}" size="20" maxlength="255" />
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="dateofhire_year_${$unique}" class="${dateofhire_title_class}">
<span class="English">Date Of Hire</span> <span class="Spanish">Fecha de contratación</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<select name="dateofhire_year" id="dateofhire_year_${$unique}" class="tel">
<option value="">Year</option>
<option value="1900" ${dateofhire_year == '1900' ? 'selected' : ''}>1900</option>
<option value="1901" ${dateofhire_year == '1901' ? 'selected' : ''}>1901</option>
<option value="1902" ${dateofhire_year == '1902' ? 'selected' : ''}>1902</option>
<option value="1903" ${dateofhire_year == '1903' ? 'selected' : ''}>1903</option>
<option value="1904" ${dateofhire_year == '1904' ? 'selected' : ''}>1904</option>
<option value="1905" ${dateofhire_year == '1905' ? 'selected' : ''}>1905</option>
<option value="1906" ${dateofhire_year == '1906' ? 'selected' : ''}>1906</option>
<option value="1907" ${dateofhire_year == '1907' ? 'selected' : ''}>1907</option>
<option value="1908" ${dateofhire_year == '1908' ? 'selected' : ''}>1908</option>
<option value="1909" ${dateofhire_year == '1909' ? 'selected' : ''}>1909</option>
<option value="1910" ${dateofhire_year == '1910' ? 'selected' : ''}>1910</option>
<option value="1911" ${dateofhire_year == '1911' ? 'selected' : ''}>1911</option>
<option value="1912" ${dateofhire_year == '1912' ? 'selected' : ''}>1912</option>
<option value="1913" ${dateofhire_year == '1913' ? 'selected' : ''}>1913</option>
<option value="1914" ${dateofhire_year == '1914' ? 'selected' : ''}>1914</option>
<option value="1915" ${dateofhire_year == '1915' ? 'selected' : ''}>1915</option>
<option value="1916" ${dateofhire_year == '1916' ? 'selected' : ''}>1916</option>
<option value="1917" ${dateofhire_year == '1917' ? 'selected' : ''}>1917</option>
<option value="1918" ${dateofhire_year == '1918' ? 'selected' : ''}>1918</option>
<option value="1919" ${dateofhire_year == '1919' ? 'selected' : ''}>1919</option>
<option value="1920" ${dateofhire_year == '1920' ? 'selected' : ''}>1920</option>
<option value="1921" ${dateofhire_year == '1921' ? 'selected' : ''}>1921</option>
<option value="1922" ${dateofhire_year == '1922' ? 'selected' : ''}>1922</option>
<option value="1923" ${dateofhire_year == '1923' ? 'selected' : ''}>1923</option>
<option value="1924" ${dateofhire_year == '1924' ? 'selected' : ''}>1924</option>
<option value="1925" ${dateofhire_year == '1925' ? 'selected' : ''}>1925</option>
<option value="1926" ${dateofhire_year == '1926' ? 'selected' : ''}>1926</option>
<option value="1927" ${dateofhire_year == '1927' ? 'selected' : ''}>1927</option>
<option value="1928" ${dateofhire_year == '1928' ? 'selected' : ''}>1928</option>
<option value="1929" ${dateofhire_year == '1929' ? 'selected' : ''}>1929</option>
<option value="1930" ${dateofhire_year == '1930' ? 'selected' : ''}>1930</option>
<option value="1931" ${dateofhire_year == '1931' ? 'selected' : ''}>1931</option>
<option value="1932" ${dateofhire_year == '1932' ? 'selected' : ''}>1932</option>
<option value="1933" ${dateofhire_year == '1933' ? 'selected' : ''}>1933</option>
<option value="1934" ${dateofhire_year == '1934' ? 'selected' : ''}>1934</option>
<option value="1935" ${dateofhire_year == '1935' ? 'selected' : ''}>1935</option>
<option value="1936" ${dateofhire_year == '1936' ? 'selected' : ''}>1936</option>
<option value="1937" ${dateofhire_year == '1937' ? 'selected' : ''}>1937</option>
<option value="1938" ${dateofhire_year == '1938' ? 'selected' : ''}>1938</option>
<option value="1939" ${dateofhire_year == '1939' ? 'selected' : ''}>1939</option>
<option value="1940" ${dateofhire_year == '1940' ? 'selected' : ''}>1940</option>
<option value="1941" ${dateofhire_year == '1941' ? 'selected' : ''}>1941</option>
<option value="1942" ${dateofhire_year == '1942' ? 'selected' : ''}>1942</option>
<option value="1943" ${dateofhire_year == '1943' ? 'selected' : ''}>1943</option>
<option value="1944" ${dateofhire_year == '1944' ? 'selected' : ''}>1944</option>
<option value="1945" ${dateofhire_year == '1945' ? 'selected' : ''}>1945</option>
<option value="1946" ${dateofhire_year == '1946' ? 'selected' : ''}>1946</option>
<option value="1947" ${dateofhire_year == '1947' ? 'selected' : ''}>1947</option>
<option value="1948" ${dateofhire_year == '1948' ? 'selected' : ''}>1948</option>
<option value="1949" ${dateofhire_year == '1949' ? 'selected' : ''}>1949</option>
<option value="1950" ${dateofhire_year == '1950' ? 'selected' : ''}>1950</option>
<option value="1951" ${dateofhire_year == '1951' ? 'selected' : ''}>1951</option>
<option value="1952" ${dateofhire_year == '1952' ? 'selected' : ''}>1952</option>
<option value="1953" ${dateofhire_year == '1953' ? 'selected' : ''}>1953</option>
<option value="1954" ${dateofhire_year == '1954' ? 'selected' : ''}>1954</option>
<option value="1955" ${dateofhire_year == '1955' ? 'selected' : ''}>1955</option>
<option value="1956" ${dateofhire_year == '1956' ? 'selected' : ''}>1956</option>
<option value="1957" ${dateofhire_year == '1957' ? 'selected' : ''}>1957</option>
<option value="1958" ${dateofhire_year == '1958' ? 'selected' : ''}>1958</option>
<option value="1959" ${dateofhire_year == '1959' ? 'selected' : ''}>1959</option>
<option value="1960" ${dateofhire_year == '1960' ? 'selected' : ''}>1960</option>
<option value="1961" ${dateofhire_year == '1961' ? 'selected' : ''}>1961</option>
<option value="1962" ${dateofhire_year == '1962' ? 'selected' : ''}>1962</option>
<option value="1963" ${dateofhire_year == '1963' ? 'selected' : ''}>1963</option>
<option value="1964" ${dateofhire_year == '1964' ? 'selected' : ''}>1964</option>
<option value="1965" ${dateofhire_year == '1965' ? 'selected' : ''}>1965</option>
<option value="1966" ${dateofhire_year == '1966' ? 'selected' : ''}>1966</option>
<option value="1967" ${dateofhire_year == '1967' ? 'selected' : ''}>1967</option>
<option value="1968" ${dateofhire_year == '1968' ? 'selected' : ''}>1968</option>
<option value="1969" ${dateofhire_year == '1969' ? 'selected' : ''}>1969</option>
<option value="1970" ${dateofhire_year == '1970' ? 'selected' : ''}>1970</option>
<option value="1971" ${dateofhire_year == '1971' ? 'selected' : ''}>1971</option>
<option value="1972" ${dateofhire_year == '1972' ? 'selected' : ''}>1972</option>
<option value="1973" ${dateofhire_year == '1973' ? 'selected' : ''}>1973</option>
<option value="1974" ${dateofhire_year == '1974' ? 'selected' : ''}>1974</option>
<option value="1975" ${dateofhire_year == '1975' ? 'selected' : ''}>1975</option>
<option value="1976" ${dateofhire_year == '1976' ? 'selected' : ''}>1976</option>
<option value="1977" ${dateofhire_year == '1977' ? 'selected' : ''}>1977</option>
<option value="1978" ${dateofhire_year == '1978' ? 'selected' : ''}>1978</option>
<option value="1979" ${dateofhire_year == '1979' ? 'selected' : ''}>1979</option>
<option value="1980" ${dateofhire_year == '1980' ? 'selected' : ''}>1980</option>
<option value="1981" ${dateofhire_year == '1981' ? 'selected' : ''}>1981</option>
<option value="1982" ${dateofhire_year == '1982' ? 'selected' : ''}>1982</option>
<option value="1983" ${dateofhire_year == '1983' ? 'selected' : ''}>1983</option>
<option value="1984" ${dateofhire_year == '1984' ? 'selected' : ''}>1984</option>
<option value="1985" ${dateofhire_year == '1985' ? 'selected' : ''}>1985</option>
<option value="1986" ${dateofhire_year == '1986' ? 'selected' : ''}>1986</option>
<option value="1987" ${dateofhire_year == '1987' ? 'selected' : ''}>1987</option>
<option value="1988" ${dateofhire_year == '1988' ? 'selected' : ''}>1988</option>
<option value="1989" ${dateofhire_year == '1989' ? 'selected' : ''}>1989</option>
<option value="1990" ${dateofhire_year == '1990' ? 'selected' : ''}>1990</option>
<option value="1991" ${dateofhire_year == '1991' ? 'selected' : ''}>1991</option>
<option value="1992" ${dateofhire_year == '1992' ? 'selected' : ''}>1992</option>
<option value="1993" ${dateofhire_year == '1993' ? 'selected' : ''}>1993</option>
<option value="1994" ${dateofhire_year == '1994' ? 'selected' : ''}>1994</option>
<option value="1995" ${dateofhire_year == '1995' ? 'selected' : ''}>1995</option>
<option value="1996" ${dateofhire_year == '1996' ? 'selected' : ''}>1996</option>
<option value="1997" ${dateofhire_year == '1997' ? 'selected' : ''}>1997</option>
<option value="1998" ${dateofhire_year == '1998' ? 'selected' : ''}>1998</option>
<option value="1999" ${dateofhire_year == '1999' ? 'selected' : ''}>1999</option>
<option value="2000" ${dateofhire_year == '2000' ? 'selected' : ''}>2000</option>
<option value="2001" ${dateofhire_year == '2001' ? 'selected' : ''}>2001</option>
<option value="2002" ${dateofhire_year == '2002' ? 'selected' : ''}>2002</option>
<option value="2003" ${dateofhire_year == '2003' ? 'selected' : ''}>2003</option>
<option value="2004" ${dateofhire_year == '2004' ? 'selected' : ''}>2004</option>
<option value="2005" ${dateofhire_year == '2005' ? 'selected' : ''}>2005</option>
<option value="2006" ${dateofhire_year == '2006' ? 'selected' : ''}>2006</option>
<option value="2007" ${dateofhire_year == '2007' ? 'selected' : ''}>2007</option>
<option value="2008" ${dateofhire_year == '2008' ? 'selected' : ''}>2008</option>
<option value="2009" ${dateofhire_year == '2009' ? 'selected' : ''}>2009</option>
<option value="2010" ${dateofhire_year == '2010' ? 'selected' : ''}>2010</option>
<option value="2011" ${dateofhire_year == '2011' ? 'selected' : ''}>2011</option>
<option value="2012" ${dateofhire_year == '2012' ? 'selected' : ''}>2012</option>
<option value="2013" ${dateofhire_year == '2013' ? 'selected' : ''}>2013</option>
<option value="2014" ${dateofhire_year == '2014' ? 'selected' : ''}>2014</option>
<option value="2015" ${dateofhire_year == '2015' ? 'selected' : ''}>2015</option>
<option value="2016" ${dateofhire_year == '2016' ? 'selected' : ''}>2016</option>
<option value="2017" ${dateofhire_year == '2017' ? 'selected' : ''}>2017</option>
<option value="2018" ${dateofhire_year == '2018' ? 'selected' : ''}>2018</option>
<option value="2019" ${dateofhire_year == '2019' ? 'selected' : ''}>2019</option>
<option value="2020" ${dateofhire_year == '2020' ? 'selected' : ''}>2020</option>
<option value="2021" ${dateofhire_year == '2021' ? 'selected' : ''}>2021</option>
<option value="2022" ${dateofhire_year == '2022' ? 'selected' : ''}>2022</option>
<option value="2023" ${dateofhire_year == '2023' ? 'selected' : ''}>2023</option>
</select>
<!-- -->
<select name="dateofhire_month" title="Month" class="tel">
<option value="">Month</option>
<option value="1" ${dateofhire_month == '1' ? 'selected' : ''}>Jan</option>
<option value="2" ${dateofhire_month == '2' ? 'selected' : ''}>Feb</option>
<option value="3" ${dateofhire_month == '3' ? 'selected' : ''}>March</option>
<option value="4" ${dateofhire_month == '4' ? 'selected' : ''}>April</option>
<option value="5" ${dateofhire_month == '5' ? 'selected' : ''}>May</option>
<option value="6" ${dateofhire_month == '6' ? 'selected' : ''}>June</option>
<option value="7" ${dateofhire_month == '7' ? 'selected' : ''}>July</option>
<option value="8" ${dateofhire_month == '8' ? 'selected' : ''}>Aug</option>
<option value="9" ${dateofhire_month == '9' ? 'selected' : ''}>Sep</option>
<option value="10" ${dateofhire_month == '10' ? 'selected' : ''}>Oct</option>
<option value="11" ${dateofhire_month == '11' ? 'selected' : ''}>Nov</option>
<option value="12" ${dateofhire_month == '12' ? 'selected' : ''}>Dec</option>
</select>
</fieldset>
</div>
</div>
<div style="display:none;">
<label for="shift_${$unique}" class="${shift_title_class}">
<span class="English">Shift</span> <span class="Spanish">Horario</span>
</label>
<div>
<input type="text" name="shift" id="shift_${$unique}" value="${shift}" size="20" maxlength="255" />
</div>
</div>
</div>
<div class="line">
<div style="">
<label for="phone_1_${$unique}" class="${phone_title_class}">
<span class="English">Work Phone</span> <span class="Spanish">Numero del teléfono del empleo</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="phone_1" id="phone_1_${$unique}" value="${phone_1}" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"/>
<!-- -->
<input type="text" name="phone_2" value="${phone_2}" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"/>
<!-- -->
<input type="text" name="phone_3" value="${phone_3}" class="tel noblock FourBox" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Phone"/>
<!-- -->
<label for="phoneext_${$unique}" style="display: inline;"><span class="English">Ext.:</span><span class="Spanish">Extensión:</span></label>
<input type="text" name="phoneext" id="phoneext_${$unique}" value="${phoneext}" class="tel noblock FourBox" size="12" maxlength="40" onfocus="filterNumericInput(this)" />
</fieldset>
</div>
</div>
<div style="display:none;">
<label for="fax_1_${$unique}" class="${fax_title_class}">
<span class="English">Work Fax</span> <span class="Spanish">Fax del trabajo</span>:
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="fax_1" id="fax_1_${$unique}" value="${fax_1}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"/>
<!-- -->
<input type="text" name="fax_2" value="${fax_2}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"/>
<!-- -->
<input type="text" name="fax_3" value="${fax_3}" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Work Fax"/>
</fieldset>
</div>
</div>
</div>
<div class="line" style="display:none;">
<div>
<label for="cellphone_1_${$unique}" class="${cellphone_title_class}">
<span class="English">Cell Phone (Work)</span> <span class="Spanish">Numero de celular del empleo</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="cellphone_1" id="cellphone_1_${$unique}" value="${cellphone_1}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"/>
<!-- -->
<input type="text" name="cellphone_2" value="${cellphone_2}" class="tel noblock" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"/>
<!-- -->
<input type="text" name="cellphone_3" value="${cellphone_3}" class="tel noblock" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Cell Phone (Work)"/>
</fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="address_${$unique}" class="${address_title_class}">
<span class="English">Employer Address</span> <span class="Spanish">Dirección de empleo</span>
</label>
<div>
<input type="text" name="address" id="address_${$unique}" value="${address}" size="20" maxlength="255" />
</div>
</div>
<div style="display:none;">
<label for="city_${$unique}" class="${city_title_class}">
<span class="English">Employer City</span> <span class="Spanish">Ciudad de empleo</span>
</label>
<div>
<input type="text" name="city" id="city_${$unique}" value="${city}" size="12" maxlength="255" />
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="state_${$unique}" class="${state_title_class}">
<span class="English">Employer State</span>
<span class="Spanish">Estado</span>
</label>
<div>
<select id="state_${$unique}" name="state" ><option value="">-- Choose --</option><option value="AK" ${state == 'AK' ? 'selected' : ''}>AK</option><option value="AL" ${state == 'AL' ? 'selected' : ''}>AL</option><option value="AR" ${state == 'AR' ? 'selected' : ''}>AR</option><option value="AS" ${state == 'AS' ? 'selected' : ''}>AS</option><option value="AZ" ${state == 'AZ' ? 'selected' : ''}>AZ</option><option value="CA" ${state == 'CA' ? 'selected' : ''}>CA</option><option value="CO" ${state == 'CO' ? 'selected' : ''}>CO</option><option value="CT" ${state == 'CT' ? 'selected' : ''}>CT</option><option value="DC" ${state == 'DC' ? 'selected' : ''}>DC</option><option value="DE" ${state == 'DE' ? 'selected' : ''}>DE</option><option value="FL" ${state == 'FL' ? 'selected' : ''}>FL</option><option value="FM" ${state == 'FM' ? 'selected' : ''}>FM</option><option value="GA" ${state == 'GA' ? 'selected' : ''}>GA</option><option value="GU" ${state == 'GU' ? 'selected' : ''}>GU</option><option value="HI" ${state == 'HI' ? 'selected' : ''}>HI</option><option value="IA" ${state == 'IA' ? 'selected' : ''}>IA</option><option value="ID" ${state == 'ID' ? 'selected' : ''}>ID</option><option value="IL" ${state == 'IL' ? 'selected' : ''}>IL</option><option value="IN" ${state == 'IN' ? 'selected' : ''}>IN</option><option value="KS" ${state == 'KS' ? 'selected' : ''}>KS</option><option value="KY" ${state == 'KY' ? 'selected' : ''}>KY</option><option value="LA" ${state == 'LA' ? 'selected' : ''}>LA</option><option value="MA" ${state == 'MA' ? 'selected' : ''}>MA</option><option value="MD" ${state == 'MD' ? 'selected' : ''}>MD</option><option value="ME" ${state == 'ME' ? 'selected' : ''}>ME</option><option value="MH" ${state == 'MH' ? 'selected' : ''}>MH</option><option value="MI" ${state == 'MI' ? 'selected' : ''}>MI</option><option value="MN" ${state == 'MN' ? 'selected' : ''}>MN</option><option value="MO" ${state == 'MO' ? 'selected' : ''}>MO</option><option value="MP" ${state == 'MP' ? 'selected' : ''}>MP</option><option value="MS" ${state == 'MS' ? 'selected' : ''}>MS</option><option value="MT" ${state == 'MT' ? 'selected' : ''}>MT</option><option value="NC" ${state == 'NC' ? 'selected' : ''}>NC</option><option value="ND" ${state == 'ND' ? 'selected' : ''}>ND</option><option value="NE" ${state == 'NE' ? 'selected' : ''}>NE</option><option value="NH" ${state == 'NH' ? 'selected' : ''}>NH</option><option value="NJ" ${state == 'NJ' ? 'selected' : ''}>NJ</option><option value="NM" ${state == 'NM' ? 'selected' : ''}>NM</option><option value="NV" ${state == 'NV' ? 'selected' : ''}>NV</option><option value="NY" ${state == 'NY' ? 'selected' : ''}>NY</option><option value="OH" ${state == 'OH' ? 'selected' : ''}>OH</option><option value="OK" ${state == 'OK' ? 'selected' : ''}>OK</option><option value="OR" ${state == 'OR' ? 'selected' : ''}>OR</option><option value="PA" ${state == 'PA' ? 'selected' : ''}>PA</option><option value="PR" ${state == 'PR' ? 'selected' : ''}>PR</option><option value="PW" ${state == 'PW' ? 'selected' : ''}>PW</option><option value="RI" ${state == 'RI' ? 'selected' : ''}>RI</option><option value="SC" ${state == 'SC' ? 'selected' : ''}>SC</option><option value="SD" ${state == 'SD' ? 'selected' : ''}>SD</option><option value="TN" ${state == 'TN' ? 'selected' : ''}>TN</option><option value="TX" ${state == 'TX' ? 'selected' : ''}>TX</option><option value="UT" ${state == 'UT' ? 'selected' : ''}>UT</option><option value="VA" ${state == 'VA' ? 'selected' : ''}>VA</option><option value="VI" ${state == 'VI' ? 'selected' : ''}>VI</option><option value="VT" ${state == 'VT' ? 'selected' : ''}>VT</option><option value="WA" ${state == 'WA' ? 'selected' : ''}>WA</option><option value="WI" ${state == 'WI' ? 'selected' : ''}>WI</option><option value="WV" ${state == 'WV' ? 'selected' : ''}>WV</option><option value="WY" ${state == 'WY' ? 'selected' : ''}>WY</option></select>
</div>
</div>
<div style="display:none;">
<label for="zip_${$unique}" class="${zip_title_class}">
<span class="English">Employer Zip</span>
<span class="Spanish">Código postal</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" maxlength="5" size="8" onchange="syncHiddenFieldWithTextboxes(this, ' ')" onfocus="filterNumericInput(this)" data-relatedhiddenfieldid="zip_${$unique}_ZIPValue_Single_${$unique}" id="zip_${$unique}_ZIP_Single_${$unique}" name="zip_${$unique}_ZIP_Single_${$unique}" value="" title="Zip" /><input type="hidden" id="zip_${$unique}_ZIPValue_Single_${$unique}" name="zip_${$unique}_ZIPValue_Single_${$unique}" value="${zip}" />
</fieldset>
</div>
</div>
</div>
<div class="line">
<div style="display:none;">
<label for="supervisor_${$unique}" class="${supervisor_title_class}">
<span class="English">Supervisor</span> <span class="Spanish">Supervisor</span>
</label>
<div>
<input type="text" name="supervisor" id="supervisor_${$unique}" value="${supervisor}" size="12" maxlength="255" />
</div>
</div>
<div style="display:none;">
<label for="supervisorphone_1_${$unique}" class="${supervisorphone_title_class}">
<span class="English">Supervisor Phone</span> <span class="Spanish">Numero de teléfono</span>
</label>
<div>
<fieldset data-role="controlgroup" data-type="horizontal" nowrap="nowrap">
<input type="text" name="supervisorphone_1" id="supervisorphone_1_${$unique}" value="${supervisorphone_1}" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"/>
<!-- -->
<input type="text" name="supervisorphone_2" value="${supervisorphone_2}" class="tel noblock FourBox" maxlength="3" size="3" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"/>
<!-- -->
<input type="text" name="supervisorphone_3" value="${supervisorphone_3}" class="tel noblock FourBox" maxlength="4" size="4" onfocus="filterNumericInput(this)" onkeyup="moveToNextIfFull(this)" title="Supervisor Phone"/>
<!-- -->
<label for="supervisorphoneext_${$unique}" style="display: inline;"><span class="English">Ext.:</span><span class="Spanish">Extensión:</span></label>
<input type="text" name="supervisorphoneext" id="supervisorphoneext_${$unique}" value="${supervisorphoneext}" class="tel noblock FourBox" size="12" maxlength="40" />
</fieldset>
</div>
</div>
</div>
</div>
<scr{{= ""}}ipt type="text/javascript">
employmentInfoInit('${$unique}', false, 1, false, 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo');
</scr{{= ""}}ipt>
<div style="clear: both;"></div>
</div>
</script>
<script type="text/javascript">
jstemplatetable_initialize('ctl00', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo', [{
"id": "0",
"income_title_class": "",
"income": "",
"obligations_title_class": "",
"obligations": "",
"incometypeid_title_class": "",
"incometypeid": "",
"incometypetext": "",
"payrolltype_title_class": "",
"payrolltype": "",
"paydayfrequencytype_title_class": "",
"paydayfrequencytype": "",
"frequencyweekly_weekday_title_class": "",
"frequencyweekly_weekday": "",
"frequencybiweekly_weekday_title_class": "",
"frequencybiweekly_weekday": "",
"frequencybiweekly_sampledate_title_class": "",
"frequencybiweekly_sampledate": "",
"paydaydayinmonthsubtype": "",
"frequencymonthbased_title_class": "",
"frequencymonthly_dayordinal": "",
"frequencytwicepermonth_firstday_dayordinal": "",
"frequencytwicepermonth_secondday_dayordinal": "15",
"frequencymonthly_weekdayordinal": "",
"frequencytwicepermonth_firstday_weekdayordinal": "",
"frequencymonthly_weekday": "friday",
"frequencytwicepermonth_firstday_weekday": "friday",
"frequencytwicepermonth_secondday_weekdayordinal": "3",
"frequencytwicepermonth_secondday_weekday": "friday",
"paydayholidayskippingtype_title_class": "",
"paydayholidayskippingtype": "2",
"name_title_class": "",
"name": "",
"occupation_title_class": "",
"occupation": "",
"shift_title_class": "",
"shift": "",
"dateofhire_title_class": "",
"dateofhire_year": "",
"dateofhire_month": "",
"address_title_class": "",
"address": "",
"city_title_class": "",
"city": "",
"state_title_class": "",
"state": "",
"zip_title_class": "",
"zip": "",
"fax_title_class": "",
"fax_1": "",
"fax_2": "",
"fax_3": "",
"phone_title_class": "",
"phone_1": "",
"phone_2": "",
"phone_3": "",
"phoneext": "",
"cellphone_title_class": "",
"cellphone_1": "",
"cellphone_2": "",
"cellphone_3": "",
"supervisor_title_class": "",
"supervisor": "",
"supervisorphone_title_class": "",
"supervisorphone_1": "",
"supervisorphone_2": "",
"supervisorphone_3": "",
"supervisorphoneext": ""
}], function(el) {
this.id = el.find('input:hidden[name="id"]').val();
this.income = el.find('input[name="income"]').val();
this.obligations = el.find('input[name="obligations"]').val();
this.incometypeid = el.find('select[name="incometypeid"] option:selected').val();
this.incometypetext = el.find('input[name="incometypetext"]').val();
this.payrolltype = el.find('select[name="payrolltype"] option:selected').val();
this.paydayfrequencytype = el.find('select[name="paydayfrequencytype"] option:selected').val();
this.frequencyweekly_weekday = el.find('select[name="frequencyweekly_weekday"] option:selected').val();
this.frequencybiweekly_weekday = el.find('select[name="frequencybiweekly_weekday"] option:selected').val();
this.frequencybiweekly_sampledate = el.find('input:hidden[name="frequencybiweekly_sampledate"]').val();
this.paydaydayinmonthsubtype = el.find('input:hidden[name="paydaydayinmonthsubtype"]').val();
this.frequencymonthly_dayordinal = el.find('select[name="frequencymonthly_dayordinal"] option:selected').val();
this.frequencytwicepermonth_firstday_dayordinal = el.find('select[name="frequencytwicepermonth_firstday_dayordinal"] option:selected').val();
this.frequencytwicepermonth_secondday_dayordinal = el.find('select[name="frequencytwicepermonth_secondday_dayordinal"] option:selected').val();
this.frequencymonthly_weekdayordinal = el.find('select[name="frequencymonthly_weekdayordinal"] option:selected').val();
this.frequencytwicepermonth_firstday_weekdayordinal = el.find('select[name="frequencytwicepermonth_firstday_weekdayordinal"] option:selected').val();
this.frequencymonthly_weekday = el.find('select[name="frequencymonthly_weekday"] option:selected').val();
this.frequencytwicepermonth_firstday_weekday = el.find('select[name="frequencytwicepermonth_firstday_weekday"] option:selected').val();
this.frequencytwicepermonth_secondday_weekdayordinal = el.find('select[name="frequencytwicepermonth_secondday_weekdayordinal"] option:selected').val();
this.frequencytwicepermonth_secondday_weekday = el.find('select[name="frequencytwicepermonth_secondday_weekday"] option:selected').val();
this.paydayholidayskippingtype = el.find('input:radio[name^="paydayholidayskippingtype"]:checked').val();
this.name = el.find('input[name="name"]').val();
this.occupation = el.find('input[name="occupation"]').val();
this.shift = el.find('input[name="shift"]').val();
this.dateofhire_year = el.find('select[name="dateofhire_year"] option:selected').val();
this.dateofhire_month = el.find('select[name="dateofhire_month"] option:selected').val();
this.address = el.find('input[name="address"]').val();
this.city = el.find('input[name="city"]').val();
this.state = el.find('select[name="state"] option:selected').val();
this.zip = el.find('input[type=hidden][id^=zip]').val();
this.fax_1 = el.find('input[name="fax_1"]').val();
this.fax_2 = el.find('input[name="fax_2"]').val();
this.fax_3 = el.find('input[name="fax_3"]').val();
this.phone_1 = el.find('input[name="phone_1"]').val();
this.phone_2 = el.find('input[name="phone_2"]').val();
this.phone_3 = el.find('input[name="phone_3"]').val();
this.phoneext = el.find('input[name="phoneext"]').val();
this.cellphone_1 = el.find('input[name="cellphone_1"]').val();
this.cellphone_2 = el.find('input[name="cellphone_2"]').val();
this.cellphone_3 = el.find('input[name="cellphone_3"]').val();
this.supervisor = el.find('input[name="supervisor"]').val();
this.supervisorphone_1 = el.find('input[name="supervisorphone_1"]').val();
this.supervisorphone_2 = el.find('input[name="supervisorphone_2"]').val();
this.supervisorphone_3 = el.find('input[name="supervisorphone_3"]').val();
this.supervisorphoneext = el.find('input[name="supervisorphoneext"]').val();
}, '.empinfo');
</script>
<script type="text/javascript">
(function($) {
$('#Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo').find('input[type=hidden][id^=zip]').each(function() {
setZipValue($(this).attr('id'), $(this).val())
});
addVisiblityBinding('Content_Root_MemberPageDispatcher_subpage_applyForLoan_Emp_HasOtherIncome', 'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_AddMore',
'Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo');
})(jQuery);
</script>
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_AddMore" style="display: none;">
<span style="cursor: pointer; font-weight: bold; FONT-SIZE: 12px; color: #333333" onclick="jstemplatetable_additem('Content_Root_MemberPageDispatcher_subpage_applyForLoan_OtherEmpInfo_Div_EmpInfo', null,
{
id:'0',
income_title_class:'',
income:'',
obligations_title_class:'',
obligations:'',
incometypeid_title_class:'',
incometypeid:'',
incometypetext:'',
payrolltype_title_class:'',
payrolltype:'',
paydayfrequencytype_title_class:'',
paydayfrequencytype:'',
frequencyweekly_weekday_title_class:'',
frequencyweekly_weekday:'',
frequencybiweekly_weekday_title_class:'',
frequencybiweekly_weekday:'',
frequencybiweekly_sampledate_title_class:'',
frequencybiweekly_sampledate:'',
paydaydayinmonthsubtype:'',
frequencymonthbased_title_class:'',
frequencymonthly_dayordinal:'',
frequencytwicepermonth_firstday_dayordinal:'',
frequencytwicepermonth_secondday_dayordinal:'15',
frequencymonthly_weekdayordinal:'',
frequencytwicepermonth_firstday_weekdayordinal:'',
frequencymonthly_weekday:'friday',
frequencytwicepermonth_firstday_weekday:'friday',
frequencytwicepermonth_secondday_weekdayordinal:'3',
frequencytwicepermonth_secondday_weekday:'friday',
paydayholidayskippingtype_title_class:'',
paydayholidayskippingtype:'2',
name_title_class:'',
name:'',
occupation_title_class:'',
occupation:'',
shift_title_class:'',
shift:'',
dateofhire_title_class:'',
dateofhire_year:'',
dateofhire_month:'',
address_title_class:'',
address:'',
city_title_class:'',
city:'',
state_title_class:'',
state:'',
zip_title_class:'',
zip:'',
fax_title_class:'',
fax_1:'',
fax_2:'',
fax_3:'',
phone_title_class:'',
phone_1:'',
phone_2:'',
phone_3:'',
phoneext:'',
cellphone_title_class:'',
cellphone_1:'',
cellphone_2:'',
cellphone_3:'',
supervisor_title_class:'',
supervisor:'',
supervisorphone_title_class:'',
supervisorphone_1:'',
supervisorphone_2:'',
supervisorphone_3:'',
supervisorphoneext:''
});">
<span class="English">[Add More]</span>
<span class="Spanish">[Liste más]</span>
</span>
</div>
<script type="text/javascript">
applyVisiblityBindings($('#Content_Root_MemberPageDispatcher_subpage_applyForLoan_Emp_HasOtherIncome')[0]);
</script>
</div>
<div style="clear: both;"></div>
</div>
</div>
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">MILITARY</span>
<span class="Spanish">Militar</span>
</div>
<div class="SectionMessage">
<span id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_Military">
<span class="English"> Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to sign one of the
following statements as applicable: </span>
<span class="Spanish"> La ley federal ofrece protections importantes a los miembros activos de las fuerzas armadas y sus dependientes. Para aseguramos de que estas protectiones sean dadas a aplicantes elegibles, requerimos que firme una de
las siguientes lineas: </span>
<span class="RedAsterisk">*</span>
</span>
</div>
<div class="SectionTable">
<div class="line">
<div class="single">
<label for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Military_Yes">
<input id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Military_Yes" type="radio" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Military" value="Military_Yes">
<span>Yes</span>
</label>
<div class="field">
<div id="Div1" class="English"> I <b>AM</b> a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer. </div>
<div id="Div2" class="Spanish"> Soy un miembro de la reserva de las fuerzas armadas, fuerza naval, cuerpo marinos, fuerza aerea o guarda costera sirviendo actualmente segun sea requerido u orden que no especifica un periodo de 30 dias o
mas. </div>
<div style="font-style: italic;"> - or -</div>
<div id="Div3" class="English"> I <b>AM</b> a dependent of a member of the Armed Forces on active duty as described above, because I am the member's spouse, the member's child under the age of eighteen years old, or I am an individual
for whom the member provided more than one-half of my financial support for 180 days immediately preceding today's date. </div>
<div id="Div4" class="Spanish"> Soy un dependiente de un miembro de las Fuerzas Armadas sirviendo actualmente como lo explique arriba porque soy esposa (o) de un miembro, el hijo del miembro es menor de dieciocho años, o un sujeto para
quien el miembro le mas de la mitad de apoyo financiero por 180 dias a partir de hoy. </div>
</div>
</div>
</div>
<div class="line" style="padding: 0px 10px;">
<table cellspacing="0" cellpadding="0" style="width: 100%;">
<tbody>
<tr>
<td style="width: 50%;">
<hr style="color: #bbbbbb; background-color: #bbbbbb;">
</td>
<td style="white-space: nowrap; font-weight: bold;"> OR </td>
<td style="width: 50%;">
<hr style="color: #bbbbbb; background-color: #bbbbbb;">
</td>
</tr>
</tbody>
</table>
</div>
<div class="line">
<div class="single">
<label for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Military_No">
<input id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Military_No" type="radio" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Military" value="Military_No">
<span>No</span>
</label>
<div class="field">
<div id="Div5" class="English"> I <b>AM NOT</b> a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer (or
a dependent of such a member). </div>
<div id="Div6" class="Spanish"> No soy un miembro de la reserva de las fuerzas armadas, fuerza naval, cuerpo marinos, fuerza aerea o guarda costera sirviendo actualmente segun sea requerido u orden que no especifica un periodo de 30
dias o mas (o un dependiente de tal miembro). </div>
</div>
</div>
</div>
<div style="clear: both"></div>
</div>
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">TEXT MESSAGE COMMUNICATION</span>
<span class="Spanish">Comunicados mediante mensaje de texto</span>
</div>
<div class="SectionMessage">
<span id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_TextMessageCommunication">
<span class="English">Text Message Communication: </span>
<span class="Spanish">Text Message Communication: </span>
<span class="RedAsterisk">*</span>
</span>
</div>
<div class="SectionTable">
<div class="line">
<div class="single">
<label for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_TextMessageCommunication_Yes">
<input id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_TextMessageCommunication_Yes" type="radio" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$TextMessageCommunication" value="TextMessageCommunication_Yes">
<span>Yes</span>
</label>
<div class="field">
<div class="English">I agree to receive notifications regarding my account via text message.</div>
<div class="Spanish">Acepto recibir notificaciones sobre mi cuenta a través mensajes de texto.</div>
</div>
</div>
</div>
<div class="line" style="padding: 0 10px;">
<table cellspacing="0" cellpadding="0" style="width: 100%;">
<tbody>
<tr>
<td style="width: 50%;">
<hr style="color: #bbbbbb; background-color: #bbbbbb;">
</td>
<td style="white-space: nowrap; font-weight: bold;"> OR </td>
<td style="width: 50%;">
<hr style="color: #bbbbbb; background-color: #bbbbbb;">
</td>
</tr>
</tbody>
</table>
</div>
<div class="line">
<div class="single">
<label for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_TextMessageCommunication_No">
<input id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_TextMessageCommunication_No" type="radio" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$TextMessageCommunication" value="TextMessageCommunication_No">
<span>No</span>
</label>
<div class="field">
<div class="English">I do not want to receive notifications regarding my account via text message.</div>
<div class="Spanish">No quiero recibir notificaciones sobre mi cuenta a través de mensajes de texto.</div>
</div>
</div>
</div>
<div style="clear: both">
</div>
</div>
<!-- %/*'''''''''''''''Land lord Information'''''''''''*/% -->
<!-- %/*''''''''''''''''Landlord End''''''''''''''*/% -->
<!-- %/*''''''''''''''''Additional Questions''''''''''''''*/% -->
<!-- %/*''''''''''''''''Additional Questions End''''''''''''''*/% -->
<!-- %/*''''''''''''''Spouse Information''''''''''''''''''''''*/% -->
<!-- %/*''''''''''''''CO-BORROWER Information''''''''''''''''''''''*/% -->
<!-- %/*''''''''References''''''*/% -->
<!-- %/*'''''''''''''''''Refenreces End''''''''''''''''''''*/% -->
<!-- %/*''''''''Advertising Information'''''''''''*/% -->
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">ADVERTISING</span>
<span class="Spanish">PUBLICIDAD</span>
</div>
<div class="SectionTable">
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_AdvertisingMethod" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_AdvertisingMethod">
<span class="English">How did you hear about us?</span>
<span class="Spanish">Como se entero de nosotros?</span>
</label>
<div>
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$AdvertisingMethod" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_AdvertisingMethod" class="SingleDDL" onchange="advertisingMethodChanged()">
<option selected="selected" value="">-- Select One --</option>
<option value="1">Other</option>
<option value="10">Drive by location</option>
<option value="15">Mazuma referral</option>
<option value="21">Pre-approval letter</option>
<option value="22">CraigsList</option>
<option value="23">Grocery Receipt</option>
</select>
</div>
</div>
<div>
<label id="span_advertisingMethodText" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_AdvertisingMethodText" style="visibility: hidden;"> Details </label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$AdvertisingMethodText" type="text" maxlength="255" size="40" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_AdvertisingMethodText"
style="visibility: hidden;">
<script type="text/javascript">
if (!advertisingMethodsWithAdditionalText[""]) {
$("#span_advertisingMethodText").css('visibility', "hidden");
$("#Content_Root_MemberPageDispatcher_subpage_applyForLoan_AdvertisingMethodText").css('visibility', "hidden");
}
</script>
</div>
</div>
</div>
<div style="clear: both;"></div>
</div>
<!-- %/*''''''''Advertising Information End'''''''''''*/% -->
<!-- %/*''''''''Login Information'''''''''''*/% -->
<div id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Div_LoginInfo">
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">LOGIN INFORMATION</span>
<span class="Spanish">Información para entrada</span>
</div>
<div class="SectionMessage">
<span class="English"> To monitor and manage your account, please create a user name and password. </span>
<span class="Spanish"> Para controlar y manejar su cuenta, favor de crear un nombre usuario y contraseña. </span>
<span class="English"> (Username and Password require a minimum of 4 characters.) </span>
<span class="Spanish"> (Usuario y contraseña requiera un mínimo de 4 letras o símbolos) </span>
</div>
<div class="SectionTable">
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_Username" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Username">
<span class="English">User Name</span>
<span class="Spanish">Nombre de usuario</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Username" type="text" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Username">
</div>
</div>
</div>
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_Password" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Password">
<span class="English">Password</span>
<span class="Spanish">Contraseña</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Password" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Password" class="inspectlet-sensitive" type="password"
autocomplete="new-password">
</div>
</div>
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_RepeatPassword" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_PasswordRepeat">
<span class="English">Repeat Password</span>
<span class="Spanish">Repita contraseña</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<input name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$PasswordRepeat" maxlength="255" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_PasswordRepeat" type="password" autocomplete="new-password">
</div>
</div>
</div>
<div style="clear: both;"></div>
</div>
<div style="clear: both;"></div>
</div>
<!-- %/*''''''''Login Information End'''''''''''*/% -->
<!-- %/*''''''''General Authorization'''''''''''*/% -->
<!-- %/*''''''''General Authorization End'''''''''''*/% -->
<!-- %/*''''''''Customer Details Certification'''''''''''*/% -->
<!-- %/*''''''''Customer Details Certification End'''''''''''*/% -->
<!-- %/*''''''''Co-borrower Details Certification'''''''''''*/% -->
<!-- %/*''''''''Co-borrower Details Certification End'''''''''''*/% -->
<!-- %/*''''''''Loan Information'''''''''''*/% -->
<div class="SectionHeader" data-theme="a" data-role="header">
<span class="English">LOAN INFORMATION</span>
<span class="Spanish">Información de solicitud</span>
</div>
<div class="SectionTable">
<div class="line">
<div>
<label id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Title_LoanAmount" for="Content_Root_MemberPageDispatcher_subpage_applyForLoan_LoanAmountDropDown">
<span class="English">Loan Amount</span>
<span class="Spanish">Cantidad que solicita</span>
<span class="RedAsterisk">*</span>
</label>
<div>
<select name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$LoanAmountDropDown" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_LoanAmountDropDown" class="SingleDDL">
<option value="">-- Select Amount --</option>
<option value="200">$200</option>
<option value="250">$250</option>
<option value="300">$300</option>
<option value="350">$350</option>
<option value="400">$400</option>
<option value="450">$450</option>
<option value="500">$500</option>
<option value="600">$600</option>
<option value="700">$700</option>
<option value="750">$750</option>
<option value="800">$800</option>
<option value="900">$900</option>
<option value="1000">$1000</option>
<option value="1100">$1100</option>
<option value="1200">$1200</option>
<option value="1300">$1300</option>
<option value="1400">$1400</option>
<option value="1500">$1500</option>
</select>
</div>
</div>
</div>
<div style="clear: both;"></div>
</div>
<!-- %/*''''''''Loan Information End'''''''''''*/% -->
<!-- %/*''''''''Collateral Information'''''''''''*/% -->
<!-- %/*''''''''Collateral Information End'''''''''''*/% -->
<!-- %/*''''''''Insurance Information'''''''''''*/% -->
<!-- %/*''''''''Insurance Information End'''''''''''*/% -->
<!-- %/*''''''''SellLead Information'''''''''''*/% -->
<!-- %/*''''''''SellLead Information End'''''''''''*/% -->
<div class="SectionButton">
<input type="submit" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$Btn_Submit" value="Continue" onclick="if (!confirmSubmit()) return false; setGoogleAnalytics(); deferredDisable(this);"
id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_Btn_Submit">
</div>
</div>
</div>
<input type="hidden" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$GoogleAnalyticsTrackingId" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_GoogleAnalyticsTrackingId">
<input type="hidden" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$GoogleAnalyticsClientId" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_GoogleAnalyticsClientId">
<input type="hidden" name="Content_Root_MemberPageDispatcher$subpage_applyForLoan$IovationToken" id="Content_Root_MemberPageDispatcher_subpage_applyForLoan_IovationToken">
<script language="javascript" type="text/javascript" src="_Import/Common/_Export/JS/tooltip.js"></script>
<div id="tOoLtIp07" style="position:absolute;z-index:1010;left:0px;top:0px;width:170px;visibility:hidden;">
<table border="0" cellpadding="0" cellspacing="0" bgcolor="#027737" width="170">
<tbody>
<tr>
<td style="padding-left:3px;">
<font color="#FFFFFF" face="arial,helvetica,sans-serif" style="color:#FFFFFF;font-family:arial,helvetica,sans-serif;font-size:11px;"><b>Find Your Routing Number</b></font>
</td>
</tr>
<tr>
<td>
<table border="0" cellpadding="5" cellspacing="1" width="100%">
<tbody>
<tr>
<td bgcolor="#FFFFFF" style="padding:5px;">
<font color="#333333" face="arial,helvetica,sans-serif" style="color:#333333;font-family:arial,helvetica,sans-serif;font-size:11px;font-weight:normal;"><img src="_Import/CustomerSiteProxyControls/_Export/images/check.gif"
id="ttImageId" alt="find your routing number"></font>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div>
<div class="aspNetHidden">
<input type="hidden" name="_VIEWSTATEGENERATOR_" id="_VIEWSTATEGENERATOR_" value="6B1C4B38">
<input type="hidden" name="_EVENTVALIDATION_" id="_EVENTVALIDATION_"
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imLTTvfMBmWMaMfdtLTZB9a9eQYhVRki1/D5e8BcPADRtJCYg0hlURQHEBfmxIYEZ19TdRUZwyui3Sj7Mx2wlzKJF20BnSkgIlDYs0+htZUyLZTTeH5UOMV7GuZPd5VhywaPx6lcm5c1isuZUA5hVqvvWWlNQkf+WNUMnHTuIgML2IU6fnOjVNdIu/n4A9dlEPn1ovdjN8HfQ4ol0KXzpzlNVKeXKc+kN0lkQXOEINdfCdEzwc+P9x0pmePJIKbE5FRs+KZ8+GD7dKAs3/ykdbOaVgw2GyUzJiLDZfjniPuGAypLH3tkVatzyVvOwhliK15TJymbPUKUlEDDzUug4zbH+cVueUZuAVKUS3mfBux+ukr1JmBcG0Jnw6fIthqtwhQx3fwrEA7iZEl44TzlAo2//Yh3yqRsTdNBR/7CcDI19YoMzQaA4DGc7caACN6n6gKBjszVokzC1MrNmo027wVDGtL8ExLFTiKf9LKJ1nN87etNpp5k2oTww7f6kLjppy/s+kWQx4wfJgVpzFkTy8eq8NIRcLfk7B82Dx0ORko0uchyt/fgIaW+MuupBjlHsidrAfo9GOYzX2+PRrg0wkc7ljMseKg8JZ4OE2qgT77EnbmTtawrIi/KGLXb8HsPagT9Asu614L7Hq/PyVvfRop7Bcl6j4tKlq+HlxpIuGPXKqi1NDrveXgLou2AjU3yd8bapr+WsTkUVolo1iyqt2wS1iP2cMHKuUmkXYHfHNr5s6W5ncac6idjk1aEy8a8HvoJpYyslmZvoNyPqcePPoq//K81sXRAuLi7YVR03ZpSqdQIksOUEiVVXycMxeJisTarS9wydFASvug5Ypy+Hdcbs5RAiEDX66V49Ju9PrfR44PWGHfB4IyFx6VChgfelJZm3cI5lJtG7QAM/4WNTiomOY1pwqiqZVsihpm8kK4iHRcFiC4GLyOiLBtK/q5nRrEjZcA+znu0nPMINPEas03eVz1C0/T5DeyHhT7kxJZZ8AIMD+uCA+DjnA5XZHItquMJ4fBOqk37UhoAV6P9smIe8HdJVF9mnebqOxrTadsd1eV9Ja3o/NRv19wNLJdzGyvYuXyGZI7xiKybDizzqA9vFHzKaCdkUH+qnxRS4XQMOUVdU4sM88zwo1pv+4QZewFlrTX9NceYk0UHlI2kDZgkCsBhuxzK+fBF2evaQKPdML7xMLeHF3ddnqAJ9ir0rZx/W+WtxKxrYkA09q5qypvNSHeHWkHsAkGoFY9gozQwGviMp/RWn9YmnERR/tsS5ayTuy3EQhX74cr99U3bWV8q7/7S3C1BIfNdx4dfC9CTBL7LMphWNg1uB1swo+n0VDNTfcXEQVJm8fgR4mj3e4CNRkTXknGPRx5p7qyZIFPzBXjhWiNGBOYzfOL2VE+oEQqhDbl7jSzs9uk844/UTzjStv3Bi39yLRZCpA2XS25tOarCOiJNRKUMBIwoq69+B6okoRkdqDFGB6UU4bLyBxUpkuCVxVIapOuV+tempKF0ZVASZJ4LAl7ECx4BiJe4PezqNn2Wiqt3yTja3cV4kdGOUsF+MxOe5mAzTffR9/RAQGQIFPFQwAvgZ95LcCd2O+NwQ8Huux5oDyyV7PlTohPJhU+woK6plNnWJ+d6tj/JxWb4DGcHXUCaaI56QZv8HVqg8ETTjudYjkMWg9LPXhHIzNH8NTwf4BCURPdWpxTDhU5meLalWFnlMdp1jX07fuUA3/EZ/QG0hl5kjvnq+pnSqHw9KjZwRi9uPLnyfxQ4wDSLeYr7HXp9S8PISTz9OeP+2g9f6pf7RyZi9l4EhozRAdNEKLub5b+mM21ox6XDsQlKDMH1XekP4S3lyG2yTjOa02vF6Z+FlOMRYLiSldf3l1TlUWbP/d9RpII64Wt6vkICNB1M1VGm3M+s5FEDVANIGI4p+99tPiKhhsex7ouKQzniryhT8goZgBbRyeN6JqbMah3dMaDmDyR7AtgOXZGeIeenjzFsRUdnRCufZiqzeRL5P78v/DG7rc9SFjvjyzwupuQGSHzjyOjOKL1O/Z9bmAGpFZiCf3qMkmdSfnYc/o+x+Kw+uHUgAA9i0Nbk7MAeYIjU+eG08a1Mf7EyEqrCv4yaMXFQ0d+mLYFtmz21vuNnC1vaaDWRLs2s5UJ7HpdVkBWuLURHMi8tx8hcC3uaOO4OT+p6vZ+MeEWzFNoO0Gwt67NqKs0rTvuw3i6YQEWCbwL6xT/RcqERCtNuRj3eb6fOp+DEulTSj+jbh6PWsAKWmKbC8aBq8ksKirJKrTi+CkNB2AZgx6kybax4F7ot93aK1hUli9myAcTFa08jJUItLopJ9rmomBJVYpK30dHo2uxm+LtvmtQ7hJvZRE0C1V/NNdoUx0yXycA78eYMpqOvKhNx0nIt2/JLfFCE4jcZWelIhw+p9fSFhpw/+gDA0+/slROuRe/Rezy6MwloHpFJHS0mM4E1S+3WnbuOZmZwFrOMISw+evU9fplts2pFo7IZ+tFv/YweLwL1tEcUHpYOzTERByG996TDO0lokZZXSLSSiGs3XmVoOPEUtDUbAsmONLKAAnDYSLbtru/jOunnxyzkHan+dO5fDXR5DPfF5FL1+ymtJDToaZatYlqIPWtsRB7ghb0EWf8+hhKbIFMoFk9vIoAwWqitOkuF4J5bvSZgrE//p9iGO+19G42Ws0eBEt1wtAdmVTjAsauRPtFx4MY1GQmb3GpDZIIO0DgH9yDcbWfJzzHvk4OqMuZ4jjlpqLVgDY4WEfsHkZNd0PykUDJW8gFNhXCOxRuBzlgHvHMWE50HJMa8Uxld1h66GdchC90G9FEoAXqcvOZe3D+KUmtwUFAsS2tpPX42yfm9+oJVwmsp1odSEobfYLfwJ8fPxbkbWeZnNGRitvyO6R6ZCNpywceVYwasbCxt011ZywK8Y1pUySpHHvuioz3STEjROjPMZnUhNbT0Iz7iKJ7v1L+Legp+6Nclw/MYOvk3O/DjfayGaOBZMR1TWo2CFbxbYGKfY1xqc2yoFOpvKGFR5+6XtYaQXZXp2tmt/6eh8Ocbj+2XOdAgwoMuRj9zNwFhG0k01gZWiyY4KsvZFnqNTsn6rMpsiXm2oqjEBiJkezw0lvzb4vNcc7MunDh1VWNZOYOHYTPfy3Q2lDJ41Zz0jSDViWcYuWwDeHDd7DyVJGUA8uedVbDPchoyup2ac7Y+PRsO3qcC3agLdTXwsU1S9nsNxIHFEMg2T9X9y7qKGahcibicp6KVpn2NphxquXbsBO4i+hoX6NiMeWUBhC1kHQRL9WfmxOKILKKAXsnDib2x3ngep470iBJWwDWgQgLEMYbTI6gs/3Spvn6NJFxjeizgYZ6E2tqDSWREskZPB088qhRv7eqJTLfJCj0k4UM8zUAYAwK+MnRzBeyX3ausYDtxbD8uiroWraHK1VaxAz6AvI4s0A0huqh9mBl3Ygc/MBemj5KBAYiRV3tb7zP7BPGgdRMpyiR7C5YWILP12ntSGodfcN8uThOq1BC5Z00K5Gfe21YukhZYWsjaPrkuqvyy9SwgVvsaJDbygCl+5ko5ICfuVxKQCJ9tsFufHtg1UEWQ8zOP+x4W/me7n2v2UVCYJfrASVWPnlxWatyaW5SMDSDojwQ1oE5mFZRdOWW5J6o9MeXmYAfcJhCnDdFf+ttQXoDICi1MZzsj2PNaM/txWL3F8Ukt2Ja+IBRZgS1kdsnRwRWrnqvhtiLsLKt4nVrkQTuGqC/8UME8O1GPoqlVi9HDm2xoIYqVyzGP+BzoTkE4LbAo4FvzI2FlAhDDpVjj+GIp6zt+Vl0S+wMFU37q397q/w9wGbIIfpmv2E4DW2VOXby9mdtmMuhanrXGog5xTzOgTlHESzwHcQCXp8Wv6pYw6lDK4x++1yj+ZjJgzVDlQdQ+OmCjXqtuUAdx1Jb/xxkhyD3X/2HbLRUKAptZP6CEp9kaEfFaY62jxKclvymRC9lxzM7gbJLPmJWnVmp3jPLykFsKH+zYUihTVbHR7PSTBlFwt/dLLuqpnEp7nVPLtvbc0Njh2otAygUl4cEAcISjQrQtGwk/iSvMUDjnKcT4VaZrMGzkxu9s+wkQ7QR5yQCwzUJAccqpRMhhvQ8Wkt88qltEe5gOmarBk5ZU8cgER7rgA9EZ4sieMV8P+WS6BMASmVFNhRQJUz2LKUYQhhjqNiHc4jVZSok7J8Jx0H95/d+XqXKgn7So19aStpxKN+IGjJiUjGKwwAz7kUOEjd/16ss0vDyobYmsrnHOrkUCaUn6VMezUSrWOQvTsS71VQ7Iy1S9SsJeRpmLGHupCsWH/ZI9yFlUNdJ6PKDFBETN+bW4tj4PGNdALhOALstpSCILQKEJT9UTJhY2nfFLaZyHJp5rXFseFVo0DpXv13V45XZpKQvg6s5LI2KAZL60klWXAoWpnTn6as4Svl1TOyAGDJs+jBGLlxIKFlwcbyA1RCrR5mx2Y0wsE/M/l/eZoe912ieyGMXPUjGWUN6inhIDurilCdo7IMSm6XsfqX1BTzypBaWg16IPZubGOgc7YdLGPXzf3WVmkqQ//XHvE7cLS3HEI/3r1sebcKj9xX1nyr1XTDyw88WNGjWUe2ACMR4uWexbJXHngehlYjyGJxwcUMljOGfvOhI89NM6VX/pVCdXOmZgOHgXuPpXXtcUWAVSN44e8fwMHJlJ+K37wGYX7c0nJUDccc/ID2PFT/QXv3MVP34ZYOuD2/358lFSxZXiOVR6Ur+YaAsvsqI6ya4H12J8T4MxNUryweSTdNys0hNfrrYVBw4TmqHL7DS3R0j1Bg+InTmbcgEVrbSwxnDHGCSfdQq1xRFMCutonk7QBom02VhdpDTIYEamYEfuLtUDGIJwAbi/UXZWTezv4u264jsE3SXma1BJeXudICxcMe6JqO0CdC5Z5t3+Z8/0RyuxYz3PLw49I2qPOGxpXDtksIuM357wQEo376wkKRG0OPwfdITftJEKayEssZep9Qss+fBKIvejjcBHJfDI0GTa+hxFAWP22k1+FxKf+3P/azWbVBy2dnvJo5fKvAtWMJbaLD6vVE+zo8BPPkeWzq4u2jT5QVQBfr3bKfUT+s3+1jgVmRY9E0gOY3VAOWBcaTOLdtLdTa+ANk4Hmm0zHE3+p9QJK14uSXjRmDVBlNgPsiqOpyuupA8OSfBM8rB9xJ41aCCpQ0oWZkQkMC/pMck1Lcs3WoprL8dQskq1bqhwi3hH+uVozK8l9pOzQO8BRVxz8g2R7atXbfj+F34Xh6FxwPMxfyjpVX2x2gN8nJUckUvSRlxXQqACpHTbeK6NyHSyvE1oJ+lCSFnNJyQiM86rODeCxVovWxq4FKpzQp7BImXgagZyGU7nZKthECPk1Ix4gQyNn6M7VWl9ALlHTHHvOopmV9lL2WT/ujaziQ9rP88P+ZZvKhtc4sO+zQlOpFeuqosjbiqikN9GktZf0Qw2SofER0VxuLujbjo4ltme7+3lnWg8PQDMBoe0P+AePj8N2um5nNVRD7NTfktXpFQtlDuX9yRfWCKPKDaugJNDumoZGSU8t56wjsUzVDA+dedLZ8HzjDFN2Wuta+HMr4L4qx7SbvBhm+D+/gggAj8X4zfqdUyidALEgTGLwcyvTY5PuIiyuVSkEpKy8ORumIOc6XEKjVRpuTiNh/66xw/NHjNpRTzXDI4OKU9WyAFu3QyNuTRUhyB7qzHzx7wc/PBD0ovDL9mZ9uIMbpeH1pa7c1E4AGv+TqiyvZfPG+4Brx3j5ecUvj4UbGJBSNBBlTwV+cwvjAhv2Nr0NNEaST2mvkXl2QIU5L+lP5I9dzYTGhFEHScIs9rihRzbuHSrYj1KAcjTmJPrMA2VIGNy5bxWxQBpAmZVhTlGagDfk+5jJZ0S7z9zGivsqnJYGke+U1pj+7Ltl5m0V1+O1IYlk4GwMUQUfM3rpkQhXVfZcIyRUdvjV7BFZaeGVzRvoQSBo+BzKEtrIfd+17w2Df+rMj2wRf76rbmroPJGz7LbAYvWszuYvluVGBfKcfEWOfjLjPdzlWsLtJsxhEDmSHzGFvzEaLS9gInqf+y0k01ZPvs1TKpTc599Kg+8TMk9Pf0GFTBmbU2Z5VmmgazQ4wpNm5E1rlo+XNnSn1C6hpmgsZRUdLpJwsY69PdpO8VcKRxUHjC8xpdRJbfcxXxK8qWubHmMGTVTkiTShBpbQL/ZMjdUHzR388cH4APQBP9HRxigpADIo8VCAbKztcKoNsrc9YG029qvmIT+Byu2ELbmvqGllK9d6YB2HqwH6T0C3/ZeYzO2Yre5XeeFJNISvwZcBZfpBn/m6bj+igRDSZryRjnY/2xGD2uujeVDnHU58GOCiV4SSmfQkhPd39hVV4wsjq8w8KXV7qFq1ra9CHVfw6xtZRpgVPw1ajhFaGgEmGBbiwb/Usqmq2sOFRroMgTy7D1zjOobv901KIdy6SV633TVLMxGJi9cQ==">
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About Us | Contact Us | Requirements | FAQs | Disclaimers Member Area Logout > CUSTOMER INFORMATION Información de solicitante First Name Primer nombre * Last Name Apellido * Jr. Sr. I II III IV V VI VII VIII SSN SSN * - - E-mail Correo electrónico * Birth Date Fecha de nacimiento * Month Jan Feb March April May June July Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Gender Sexo * -- Choose -- Male Female Valid Driver's License or State ID Number Numero de licencia * State Issued Estado * -- AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Cell Phone Numero de celular * Address Dirección * City Ciudad * State Estado * -- Choose -- AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Código postal * Time At Address Tiempo en residencia * yy 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 mm 0 1 2 3 4 5 6 7 8 9 10 11 Mailing Address Dirección de correspondencia Check if the same as above Mailing Address Dirección * Mailing City Ciudad * Mailing State Estado * -- Choose -- AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Mailing Zip Código postal * BANKING INFORMATION Información bancaria Active Activo ABA Number Numero de ABA * Bank Name Nombre de banco * Bank Address Direccion del banco Bank City Banco ciudad * Bank State Banco estado * -- Choose --AKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY Bank Zip Banco codigo postal Bank Phone Numero de Telefono Account Number Numero de cuenta bancaria * Account Type Typo de cuenta bancaria * Checking Account Savings Account Account Length Longitud de cuenta * yy 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 mm 0 1 2 3 4 5 6 7 8 9 10 11 Other bank account Other bank account Active Activo ABA Number Numero de ABA * Bank Name Nombre de banco * Bank Address Direccion del banco Bank City Banco ciudad * Bank State Banco estado * -- Choose --AKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY Bank Zip Banco codigo postal Bank Phone Numero de Telefono Account Number Numero de cuenta bancaria * Account Type Typo de cuenta bancaria * Checking Account Savings Account Account Length Longitud de cuenta * yy 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 mm 0 1 2 3 4 5 6 7 8 9 10 11 [Add More] [Liste más] DEBIT/CREDIT CARD INFORMATION Name On Card Billing Address Card Number [Edit] City Exp Date / State -- Choose -- AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Zip CVC * We may need to authenticate your debit/credit card to confirm it's valid. This will be done only once, provided there are no changes to your debit/credit card details. During this process, the card may be charged a nominal amount (typically $0.01) which will in turn be refunded. INCOME & EMPLOYMENT INFORMATION Ingresos y empleo información Income from alimony, child support or separate maintenance payments need not be disclosed if you don't wish us to consider this as a source of repayment. Ingresos por manutención de menores o pensión matrimonial u otros ingresos no es necesario declarar esta información si no va hacer utilizado como forma de pago. Monthly Income Ingresos Mensuales * Monthly Obligations Monthly Obligations Income Type Income Type * -- Select One -- Employment Social Security Disability Retirement Self-Employed Other Unemployment Benefits Payroll Type Tipo de saldo * -- Select One -- Cash Check Direct Deposit Pay Frequency Frecuencia de pago * -- Select One -- Weekly Bi-weekly Monthly Twice per Month Pay Day * -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday Pay Day * -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday Next Pay Date * Sample Date Sample Date (Select week day) Pay Day * 1st 15th Last ---- 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st of month 1st 15th Last ---- 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st and 1st 15th Last ---- 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st of month First Second Third Fourth Last -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday First Second Third Fourth Last -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday and First Second Third Fourth Last -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday If Payday On Bank Holiday If Payday On Bank Holiday Do Nothing Move To Previous Business Day Move To Next Business Day Employer Empleador * Occupation Posición / Título Date Of Hire Fecha de contratación Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Month Jan Feb March April May June July Aug Sep Oct Nov Dec Shift Horario Work Phone Numero del teléfono del empleo Ext.:Extensión: Work Fax Fax del trabajo: Cell Phone (Work) Numero de celular del empleo Employer Address Dirección de empleo Employer City Ciudad de empleo Employer State Estado -- Choose --AKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY Employer Zip Código postal Supervisor Supervisor Supervisor Phone Numero de teléfono Ext.:Extensión: Other Income Otro tipo de saldo Monthly Income Ingresos Mensuales * Monthly Obligations Monthly Obligations Income Type Income Type * -- Select One -- Employment Social Security Disability Retirement Self-Employed Other Unemployment Benefits Payroll Type Tipo de saldo * -- Select One -- Cash Check Direct Deposit Pay Frequency Frecuencia de pago * -- Select One -- Weekly Bi-weekly Monthly Twice per Month Pay Day * -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday Pay Day * -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday Next Pay Date * Sample Date Sample Date (Select week day) Pay Day * 1st 15th Last ---- 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st of month 1st 15th Last ---- 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st and 1st 15th Last ---- 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st of month First Second Third Fourth Last -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday First Second Third Fourth Last -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday and First Second Third Fourth Last -- Select -- Sunday Monday Tuesday Wednesday Thursday Friday Saturday If Payday On Bank Holiday If Payday On Bank Holiday Do Nothing Move To Previous Business Day Move To Next Business Day Employer Empleador Occupation Posición / Título Date Of Hire Fecha de contratación Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Month Jan Feb March April May June July Aug Sep Oct Nov Dec Shift Horario Work Phone Numero del teléfono del empleo Ext.:Extensión: Work Fax Fax del trabajo: Cell Phone (Work) Numero de celular del empleo Employer Address Dirección de empleo Employer City Ciudad de empleo Employer State Estado -- Choose --AKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY Employer Zip Código postal Supervisor Supervisor Supervisor Phone Numero de teléfono Ext.:Extensión: [Add More] [Liste más] MILITARY Militar Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to sign one of the following statements as applicable: La ley federal ofrece protections importantes a los miembros activos de las fuerzas armadas y sus dependientes. Para aseguramos de que estas protectiones sean dadas a aplicantes elegibles, requerimos que firme una de las siguientes lineas: * Yes I AM a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer. Soy un miembro de la reserva de las fuerzas armadas, fuerza naval, cuerpo marinos, fuerza aerea o guarda costera sirviendo actualmente segun sea requerido u orden que no especifica un periodo de 30 dias o mas. - or - I AM a dependent of a member of the Armed Forces on active duty as described above, because I am the member's spouse, the member's child under the age of eighteen years old, or I am an individual for whom the member provided more than one-half of my financial support for 180 days immediately preceding today's date. Soy un dependiente de un miembro de las Fuerzas Armadas sirviendo actualmente como lo explique arriba porque soy esposa (o) de un miembro, el hijo del miembro es menor de dieciocho años, o un sujeto para quien el miembro le mas de la mitad de apoyo financiero por 180 dias a partir de hoy. -------------------------------------------------------------------------------- OR -------------------------------------------------------------------------------- No I AM NOT a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer (or a dependent of such a member). No soy un miembro de la reserva de las fuerzas armadas, fuerza naval, cuerpo marinos, fuerza aerea o guarda costera sirviendo actualmente segun sea requerido u orden que no especifica un periodo de 30 dias o mas (o un dependiente de tal miembro). TEXT MESSAGE COMMUNICATION Comunicados mediante mensaje de texto Text Message Communication: Text Message Communication: * Yes I agree to receive notifications regarding my account via text message. Acepto recibir notificaciones sobre mi cuenta a través mensajes de texto. -------------------------------------------------------------------------------- OR -------------------------------------------------------------------------------- No I do not want to receive notifications regarding my account via text message. No quiero recibir notificaciones sobre mi cuenta a través de mensajes de texto. ADVERTISING PUBLICIDAD How did you hear about us? Como se entero de nosotros? -- Select One -- Other Drive by location Mazuma referral Pre-approval letter CraigsList Grocery Receipt Details LOGIN INFORMATION Información para entrada To monitor and manage your account, please create a user name and password. Para controlar y manejar su cuenta, favor de crear un nombre usuario y contraseña. (Username and Password require a minimum of 4 characters.) (Usuario y contraseña requiera un mínimo de 4 letras o símbolos) User Name Nombre de usuario * Password Contraseña * Repeat Password Repita contraseña * LOAN INFORMATION Información de solicitud Loan Amount Cantidad que solicita * -- Select Amount -- $200 $250 $300 $350 $400 $450 $500 $600 $700 $750 $800 $900 $1000 $1100 $1200 $1300 $1400 $1500 Find Your Routing Number 2020 CU Alternative Lending Solutions, LLC. All rights reserved