tests.pmi.edu Open in urlscan Pro
209.104.6.225  Public Scan

Form analysis
2 forms found in the DOM

POST

<form action="" method="post">
  <input name="SurveyAdProgramID" type="hidden" value="80">
  <input name="SurveyadProgramDescrip" type="hidden" value="Health Care Administration Online">
  <div class="form-group row">
    <div class="col-sm-6">
      <div><label class="control-label">Employer<span class="message">*</span></label></div>
      <input class="form-control full-on-mobiles" maxlength="255" name="SurveyEmployer" required="required" type="text" value="" autofocus="">
    </div>
    <div class="col-sm-6">
      <div><label class="control-label">Department<span class="message">*</span></label></div>
      <input class="form-control full-on-mobiles" maxlength="255" name="SurveyDepartment" required="required" type="text" value="">
    </div>
  </div><!-- /.form-group -->
  <div class="form-group row">
    <div class="col-sm-6">
      <div><label class="control-label">Your Name<span class="message">*</span></label></div>
      <input class="form-control full-on-mobiles" maxlength="255" name="SurveyYourName" required="required" type="text" value="">
    </div>
    <div class="col-sm-6">
      <div><label class="control-label">Your Title<span class="message">*</span></label></div>
      <input class="form-control full-on-mobiles" maxlength="255" name="SurveyYourTitle" required="required" type="text" value="">
    </div>
  </div><!-- /.form-group -->
  <div class="form-group row">
    <div class="col-sm-6">
      <div><label class="control-label">Email<span class="message">*</span></label></div>
      <input class="form-control full-on-mobiles" maxlength="255" name="SurveyEmail" required="required" type="email" value="">
    </div>
    <div class="col-sm-6">
      <div><label class="control-label">Phone<span class="message">*</span></label></div>
      <input class="form-control full-on-mobiles" id="SurveyPhone" maxlength="255" name="SurveyPhone" required="required" type="tel" value="">
    </div>
  </div><!-- /.form-group -->
  <div style="clear:both;height:20px;"></div>
  <h3>Employee Information (PMI Graduate)</h3>
  <div class="form-group row">
    <div class="col-sm-6">
      <div><label class="control-label">Employee Name</label></div>
      <input class="form-control full-on-mobiles" disabled="disabled" id="SurveyEmployeeName" maxlength="255" name="SurveyEmployeeName" type="text" value="Kristina Jeffries">
    </div>
    <div class="col-sm-6">
      <div><label class="control-label">Employee Title</label></div>
      <input class="form-control full-on-mobiles" id="SurveyEmployeeTitle" maxlength="255" name="SurveyEmployeeTitle" type="text" value="">
    </div>
  </div><!-- /.form-group -->
  <div class="form-group row">
    <div class="col-sm-6">
      <div><label class="control-label">Hire Date</label></div>
      <span id="span_date2"><input autocomplete="off" class="form-control full-on-mobiles date" name="SurveyEmployeeHireDate" type="text" value=""></span>
    </div>
    <div class="col-sm-6">
      <div><label class="control-label">Current Salary - $/Hour Amount</label></div>
      <input class="form-control full-on-mobiles" id="SurveyEmployeeWage" maxlength="255" name="SurveyEmployeeWage" type="text" value="">
    </div>
  </div><!-- /.form-group -->
  <input alt="Submit" name="form_submit" type="submit" value="Continue">
  <script src="https://cdnjs.cloudflare.com/ajax/libs/jquery.inputmask/3.1.62/jquery.inputmask.bundle.js"></script>
  <script>
    jQuery(window).load(function() {
      var phones = [{
        "mask": "(###) ###-####"
      }, {
        "mask": "(###) ###-##############"
      }];
      jQuery('#SurveyPhone').inputmask({
        mask: phones,
        greedy: false,
        definitions: {
          '#': {
            validator: "[0-9]",
            cardinality: 1
          }
        }
      });
    });
    $('#span_date .date').datepicker({
      'format': 'm/d/yyyy',
      'todayHighlight': true,
      'autoclose': true
    });
    $('#span_date2 .date').datepicker({
      'format': 'm/d/yyyy',
      'todayHighlight': true,
      'autoclose': true
    });
    $('#span_date3 .date').datepicker({
      'format': 'm/d/yyyy',
      'todayHighlight': true,
      'autoclose': true
    });
  </script>
</form>

POST /login

<form action="/login" method="post" id="logout_form">
  <input name="logout" type="hidden" value="1">
</form>

Text Content

EMPLOYER SURVEY

We appreciate you taking a few minutes to provide your input so we can evaluate
employer satisfaction of one of our Health Care Administration Online graduates
here at Pima Medical Institute (PMI). Your feedback is very valuable and we will
use the information provided to help improve our program and continue to become
the best that we can be!
PMI respects your privacy and your name will not be used in any statistical
information.



EMPLOYER INFORMATION

Employer*
Department*
Your Name*
Your Title*
Email*
Phone*



EMPLOYEE INFORMATION (PMI GRADUATE)

Employee Name
Employee Title
Hire Date
Current Salary - $/Hour Amount
© Pima Medical Institute 2024