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Submitted URL: https://coeurdetrucker.com/
Effective URL: https://form.jotform.com/240644516898064
Submission: On March 07 via api from US — Scanned from US
Effective URL: https://form.jotform.com/240644516898064
Submission: On March 07 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
Name: form_240644516898064 — POST https://submit.jotform.com/submit/240644516898064
<form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();" action="https://submit.jotform.com/submit/240644516898064" method="post" enctype="multipart/form-data" name="form_240644516898064"
id="240644516898064" accept-charset="utf-8" autocomplete="on" novalidate="true"><input type="hidden" name="formID" value="240644516898064"><input type="hidden" id="JWTContainer" value=""><input type="hidden" id="cardinalOrderNumber" value=""><input
type="hidden" id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1709684793812=>init-started:1709804853119=>validator-called:1709804853187=>validator-mounted-true:1709804853187=>init-complete:1709804853193"><input type="hidden"
id="submitSource" name="submitSource" value="mounted"><input type="hidden" id="buildDate" name="buildDate" value="1709684793812">
<div id="formCoverLogo" style="margin-bottom:32px" class="form-cover-wrapper form-has-cover form-page-cover-image-align-center">
<div class="form-page-cover-image-wrapper" style="max-width:752px"><img src="https://www.jotform.com/uploads/ymoglia/form_files/BANNER_CDT.65e7399f5576a5.08738659.png" class="form-page-cover-image" width="750" aria-label="Logo du formulaire"
style="aspect-ratio:750/187"></div>
</div>
<div role="main" class="form-all">
<ul class="form-section page-section">
<li id="cid_1" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-large">
<div class="header-text httal htvam">
<h1 id="header_1" class="form-header" data-component="header">Inscriptions à Cœur de trucker - Saison 3</h1>
<div id="subHeader_1" class="form-subHeader">L'émission Cœur de trucker est de retour pour une troisième saison! Camionneurs et camionneuses célibataires, vous désirez trouver l’amour? Il est temps de vous inscrire en remplissant le
formulaire ci-dessous. </div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_fullname" id="id_4"><label class="form-label form-label-top form-label-auto" id="label_4" for="first_4" aria-hidden="false"> Nom<span class="form-required">*</span> </label>
<div id="cid_4" class="form-input-wide jf-required" data-layout="full">
<div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_4" name="q4_nom[first]" class="form-textbox validate[required]" data-defaultvalue=""
autocomplete="section-input_4 given-name" size="10" data-component="first" aria-labelledby="label_4 sublabel_4_first" required="" value=""><label class="form-sub-label" for="first_4" id="sublabel_4_first"
style="min-height:13px">Prénom</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_4" name="q4_nom[last]" class="form-textbox validate[required]"
data-defaultvalue="" autocomplete="section-input_4 family-name" size="15" data-component="last" aria-labelledby="label_4 sublabel_4_last" required="" value=""><label class="form-sub-label" for="last_4" id="sublabel_4_last"
style="min-height:13px">Nom de famille</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_datetime" id="id_5"><label class="form-label form-label-top form-label-auto" id="label_5" for="lite_mode_5" aria-hidden="false"> Date de naissance </label>
<div id="cid_5" class="form-input-wide" data-layout="half">
<div data-wrapper-react="true">
<div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="day_5" name="q5_dateDe[day]" size="2" data-maxlength="2" data-age="" maxlength="2"
value="" autocomplete="off" aria-labelledby="label_5 sublabel_5_day" inputmode="numeric"><span class="date-separate" aria-hidden="true"> -</span><label class="form-sub-label" for="day_5" id="sublabel_5_day"
style="min-height:13px">Jour</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="month_5" name="q5_dateDe[month]" size="2" data-maxlength="2"
data-age="" maxlength="2" value="" autocomplete="off" aria-labelledby="label_5 sublabel_5_month" inputmode="numeric"><span class="date-separate" aria-hidden="true"> -</span><label class="form-sub-label" for="month_5"
id="sublabel_5_month" style="min-height:13px">Mois</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="year_5" name="q5_dateDe[year]"
size="4" data-maxlength="4" data-age="" maxlength="4" value="" autocomplete="off" aria-labelledby="label_5 sublabel_5_year"><label class="form-sub-label" for="year_5" id="sublabel_5_year" style="min-height:13px">Année</label></span>
</div><span class="form-sub-label-container" style="vertical-align:top"><input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_5" size="12" data-maxlength="12" data-age="" value=""
data-format="ddmmyyyy" data-seperator="-" placeholder="JJ-MM-AAAA" data-placeholder="DD-MM-YYYY" autocomplete="off" aria-labelledby="label_5 sublabel_5_litemode" inputmode="numeric"><img class=" newDefaultTheme-dateIcon icon-liteMode"
alt="Form not found" id="input_5_pick" src="https://cdn.jotfor.ms/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v2"><label class="form-sub-label" for="lite_mode_5"
id="sublabel_5_litemode" style="min-height:13px">Date</label></span>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_address" id="id_6" data-compound-hint=",,,,Veuillez sélectionner,,Veuillez sélectionner,"><label class="form-label form-label-top form-label-auto" id="label_6" for="input_6_addr_line1"
aria-hidden="false"> Adresse complète<span class="form-required">*</span> </label>
<div id="cid_6" class="form-input-wide jf-required" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_6_addr_line1" name="q6_adresseComplete[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="section-input_6 address-line1" data-component="address_line_1"
aria-labelledby="label_6 sublabel_6_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_6_addr_line1" id="sublabel_6_addr_line1" style="min-height:13px">Numéro et rue</label></span></span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_6_addr_line2" name="q6_adresseComplete[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_6 address-line2" data-component="address_line_2"
aria-labelledby="label_6 sublabel_6_addr_line2" required="" value="" maxlength="100"><label class="form-sub-label" for="input_6_addr_line2" id="sublabel_6_addr_line2" style="min-height:13px">Complément
d'adresse</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_6_city" name="q6_adresseComplete[city]" class="form-textbox validate[required] form-address-city" data-defaultvalue="" autocomplete="section-input_6 address-level2" data-component="city"
aria-labelledby="label_6 sublabel_6_city" required="" value="" maxlength="60"><label class="form-sub-label" for="input_6_city" id="sublabel_6_city" style="min-height:13px">Ville</label></span></span><span
class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_6_state" name="q6_adresseComplete[state]"
class="form-textbox validate[required] form-address-state" data-defaultvalue="" autocomplete="section-input_6 address-level1" data-component="state" aria-labelledby="label_6 sublabel_6_state" required="" value=""
maxlength="60"><label class="form-sub-label" for="input_6_state" id="sublabel_6_state" style="min-height:13px">État/Région</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_6_postal" name="q6_adresseComplete[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_6 off" data-component="zip"
aria-labelledby="label_6 sublabel_6_postal" value="" maxlength="20"><label class="form-sub-label" for="input_6_postal" id="sublabel_6_postal" style="min-height:13px">Code Postal</label></span></span><span
class="form-address-line form-address-country-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><select class="form-dropdown form-address-country is-active"
name="q6_adresseComplete[country]" id="input_6_country" data-component="country" required="" aria-labelledby="label_6 sublabel_6_country" autocomplete="section-input_6 country">
<option value="">Veuillez sélectionner</option>
<option value="Etats-Unis">Etats-Unis</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albanie">Albanie</option>
<option value="Algérie">Algérie</option>
<option value="Samoa américaines">Samoa américaines</option>
<option value="Andorre">Andorre</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antigua-et-Barbuda">Antigua-et-Barbuda</option>
<option value="Argentine">Argentine</option>
<option value="Arménie">Arménie</option>
<option value="Aruba">Aruba</option>
<option value="Australie">Australie</option>
<option value="Autriche">Autriche</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Les Bahamas">Les Bahamas</option>
<option value="Bahreïn">Bahreïn</option>
<option value="Bengladesh">Bengladesh</option>
<option value="Barbade">Barbade</option>
<option value="Biélorussie">Biélorussie</option>
<option value="Belgique">Belgique</option>
<option value="Belize">Belize</option>
<option value="Bénin">Bénin</option>
<option value="Bermudes">Bermudes</option>
<option value="Bhoutan">Bhoutan</option>
<option value="Bolivie">Bolivie</option>
<option value="Bosnie-Herzégovine">Bosnie-Herzégovine</option>
<option value="Botswana">Botswana</option>
<option value="Brésil">Brésil</option>
<option value="Brunéi">Brunéi</option>
<option value="Bulgarie">Bulgarie</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodge">Cambodge</option>
<option value="Cameroun">Cameroun</option>
<option selected="" value="Canada">Canada</option>
<option value="Cap-Vert">Cap-Vert</option>
<option value="Îles Caïmans">Îles Caïmans</option>
<option value="République Centre-Africaine">République Centre-Africaine</option>
<option value="Tchad">Tchad</option>
<option value="Chili">Chili</option>
<option value="Chine">Chine</option>
<option value="Ile de Noël">Ile de Noël</option>
<option value="Iles Coco (Quille)">Iles Coco (Quille)</option>
<option value="Colombie">Colombie</option>
<option value="Comores">Comores</option>
<option value="Congo">Congo</option>
<option value="Îles Cook">Îles Cook</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote d'Ivoire">Cote d'Ivoire</option>
<option value="Croatie">Croatie</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Chypre">Chypre</option>
<option value="République Tchèque">République Tchèque</option>
<option value="République Démocratique du Congo">République Démocratique du Congo</option>
<option value="Danemark">Danemark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominique">Dominique</option>
<option value="République dominicaine">République dominicaine</option>
<option value="Équateur">Équateur</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Guinée Equatoriale">Guinée Equatoriale</option>
<option value="Érythrée">Érythrée</option>
<option value="Estonie">Estonie</option>
<option value="Éthiopie">Éthiopie</option>
<option value="Îles Falkland">Îles Falkland</option>
<option value="Îles Féroé">Îles Féroé</option>
<option value="Fidji">Fidji</option>
<option value="Finlande">Finlande</option>
<option value="France">France</option>
<option value="Polynésie française">Polynésie française</option>
<option value="Gabon">Gabon</option>
<option value="La Gambie">La Gambie</option>
<option value="Géorgie">Géorgie</option>
<option value="Allemagne">Allemagne</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Grèce">Grèce</option>
<option value="Groenland">Groenland</option>
<option value="Grenade">Grenade</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernesey">Guernesey</option>
<option value="Guinée">Guinée</option>
<option value="Guinée Bissau">Guinée Bissau</option>
<option value="Guyane">Guyane</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hongrie">Hongrie</option>
<option value="Islande">Islande</option>
<option value="Inde">Inde</option>
<option value="Indonésie">Indonésie</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Irlande">Irlande</option>
<option value="Israël">Israël</option>
<option value="Italie">Italie</option>
<option value="Jamaïque">Jamaïque</option>
<option value="Japon">Japon</option>
<option value="Jersey">Jersey</option>
<option value="Jordanie">Jordanie</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Corée du Nord">Corée du Nord</option>
<option value="Corée du Sud">Corée du Sud</option>
<option value="Kosovo">Kosovo</option>
<option value="Koweït">Koweït</option>
<option value="Kirghizistan">Kirghizistan</option>
<option value="Laos">Laos</option>
<option value="Lettonie">Lettonie</option>
<option value="Liban">Liban</option>
<option value="Lesotho">Lesotho</option>
<option value="Libéria">Libéria</option>
<option value="Libye">Libye</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lituanie">Lituanie</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macédonie">Macédonie</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaisie">Malaisie</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malte">Malte</option>
<option value="Îles Marshall">Îles Marshall</option>
<option value="Martinique">Martinique</option>
<option value="Mauritanie">Mauritanie</option>
<option value="Île Maurice">Île Maurice</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexique">Mexique</option>
<option value="Micronésie">Micronésie</option>
<option value="Moldavie">Moldavie</option>
<option value="Monaco">Monaco</option>
<option value="Mongolie">Mongolie</option>
<option value="Monténégro">Monténégro</option>
<option value="Montserrat">Montserrat</option>
<option value="Maroc">Maroc</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Nagorny-Karabakh">Nagorny-Karabakh</option>
<option value="Namibie">Namibie</option>
<option value="Nauru">Nauru</option>
<option value="Népal">Népal</option>
<option value="Pays-Bas">Pays-Bas</option>
<option value="Antilles néerlandaises">Antilles néerlandaises</option>
<option value="Nouvelle-Calédonie">Nouvelle-Calédonie</option>
<option value="Nouvelle-Zélande">Nouvelle-Zélande</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Nioué">Nioué</option>
<option value="Île Norfolk">Île Norfolk</option>
<option value="R&Atilde;&copy;publique turque de Chypre du Nord">R&Atilde;&copy;publique turque de Chypre du Nord</option>
<option value="Northern Mariana">Northern Mariana</option>
<option value="Norvège">Norvège</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palaos">Palaos</option>
<option value="Palestine">Palestine</option>
<option value="Panama">Panama</option>
<option value="Papouasie-Nouvelle-Guinée">Papouasie-Nouvelle-Guinée</option>
<option value="Paraguay">Paraguay</option>
<option value="Pérou">Pérou</option>
<option value="Philippines">Philippines</option>
<option value="Îles Pitcairn">Îles Pitcairn</option>
<option value="Pologne">Pologne</option>
<option value="Portugal">Portugal</option>
<option value="Porto Rico">Porto Rico</option>
<option value="Qatar">Qatar</option>
<option value="République du Congo">République du Congo</option>
<option value="Roumanie">Roumanie</option>
<option value="Russie">Russie</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint-Barthélémy">Saint-Barthélémy</option>
<option value="Sainte Hélène">Sainte Hélène</option>
<option value="Saint-Christophe-et-Niévès">Saint-Christophe-et-Niévès</option>
<option value="Sainte-Lucie">Sainte-Lucie</option>
<option value="Saint-Marin">Saint-Marin</option>
<option value="Saint-Pierre-et-Miquelon">Saint-Pierre-et-Miquelon</option>
<option value="Saint-Vincent-et-les-Grenadines">Saint-Vincent-et-les-Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="Saint Marin">Saint Marin</option>
<option value="Sao Tomé et Principe">Sao Tomé et Principe</option>
<option value="Arabie saoudite">Arabie saoudite</option>
<option value="Sénégal">Sénégal</option>
<option value="Serbie">Serbie</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapour">Singapour</option>
<option value="Slovaquie">Slovaquie</option>
<option value="Slovénie">Slovénie</option>
<option value="Îles Salomon">Îles Salomon</option>
<option value="Somalie">Somalie</option>
<option value="Somalie">Somalie</option>
<option value="Afrique du Sud">Afrique du Sud</option>
<option value="Sud Ossétie">Sud Ossétie</option>
<option value="South Sudan">South Sudan</option>
<option value="Espagne">Espagne</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Soudan">Soudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard">Svalbard</option>
<option value="eSwatini">eSwatini</option>
<option value="Suède">Suède</option>
<option value="Suisse">Suisse</option>
<option value="Syrie">Syrie</option>
<option value="Taïwan">Taïwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzanie">Tanzanie</option>
<option value="Thaïlande">Thaïlande</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Transnistrie Pridnestrovié">Transnistrie Pridnestrovié</option>
<option value="Trinité et Tobago">Trinité et Tobago</option>
<option value="Tristan da Cunha">Tristan da Cunha</option>
<option value="Tunisie">Tunisie</option>
<option value="Turquie">Turquie</option>
<option value="Turkménistan">Turkménistan</option>
<option value="Îles Turques-et-Caïques">Îles Turques-et-Caïques</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Ouganda">Ouganda</option>
<option value="Ukraine">Ukraine</option>
<option value="Émirats Arabes Unis">Émirats Arabes Unis</option>
<option value="Royaume-Uni">Royaume-Uni</option>
<option value="Uruguay">Uruguay</option>
<option value="Ouzbekistan">Ouzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Ville du Vatican">Ville du Vatican</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Iles Vierges Britanniques">Iles Vierges Britanniques</option>
<option value="Île de Man">Île de Man</option>
<option value="Iles Vierges Américaines">Iles Vierges Américaines</option>
<option value="Wallis et Futuna">Wallis et Futuna</option>
<option value="Sahara Occidental">Sahara Occidental</option>
<option value="Yémen">Yémen</option>
<option value="Zambie">Zambie</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="other">Autre</option>
</select><label class="form-sub-label" for="input_6_country" id="sublabel_6_country" style="min-height:13px">Pays</label></span></span></div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_phone" id="id_7"><label class="form-label form-label-top form-label-auto" id="label_7" for="input_7_full"> Numéro de téléphone<span class="form-required">*</span> </label>
<div id="cid_7" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="tel" id="input_7_full" name="q7_numeroDe[full]" data-type="mask-number"
class="mask-phone-number form-textbox validate[required, Fill Mask]" data-defaultvalue="" autocomplete="section-input_7 tel-national" style="width:310px" data-masked="true" placeholder="(000) 000-0000" data-component="phone"
aria-labelledby="label_7 sublabel_7_masked" required="" value="" inputmode="text" maskvalue="(###) ###-####"><label class="form-sub-label" for="input_7_full" id="sublabel_7_masked" style="min-height:13px">Merci de saisir un numéro de
téléphone valide.</label></span> </div>
</li>
<li class="form-line jf-required" data-type="control_email" id="id_8"><label class="form-label form-label-top form-label-auto" id="label_8" for="input_8" aria-hidden="false"> Courriel<span class="form-required">*</span> </label>
<div id="cid_8" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_8" name="q8_courriel" class="form-textbox validate[required, Email]"
data-defaultvalue="" autocomplete="section-input_8 email" style="width:310px" size="310" data-component="email" aria-labelledby="label_8 sublabel_input_8" required="" value=""><label class="form-sub-label" for="input_8"
id="sublabel_input_8" style="min-height:13px">exemple@exemple.com</label></span> </div>
</li>
<li class="form-line" data-type="control_divider" id="id_9">
<div id="cid_9" class="form-input-wide" data-layout="full">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_10"><label class="form-label form-label-top form-label-auto" id="label_10" for="input_10" aria-hidden="false"> Lien vers votre compte Facebook </label>
<div id="cid_10" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_10" name="q10_lienVers" data-type="input-textbox" class="form-textbox validate[Url]"
data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_10 sublabel_input_10" value=""><label class="form-sub-label" for="input_10" id="sublabel_input_10" style="min-height:13px">Merci
d'inscrire le lien vers votre compte Facebook. Ex : http://facebook.com/coeurdetrucker</label></span> </div>
</li>
<li class="form-line" data-type="control_textarea" id="id_11"><label class="form-label form-label-top form-label-auto" id="label_11" for="input_11" aria-hidden="false"> Si vous avez d'autres réseaux sociaux, merci de les inscrire ici :
</label>
<div id="cid_11" class="form-input-wide" data-layout="full"> <textarea id="input_11" class="form-textarea" name="q11_siVous" style="width:648px;height:163px" data-component="textarea" aria-labelledby="label_11"></textarea> </div>
</li>
<li class="form-line" data-type="control_divider" id="id_12">
<div id="cid_12" class="form-input-wide" data-layout="full">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_13"><label class="form-label form-label-top form-label-auto" id="label_13" aria-hidden="false"> Êtes-vous camionneur?<span class="form-required">*</span> </label>
<div id="cid_13" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_13" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_13"
class="form-radio validate[required]" id="input_13_0" name="q13_etesvousCamionneur" value="Oui" required=""><label id="label_input_13_0" for="input_13_0">Oui</label></span><span class="form-radio-item" style="clear:left"><span
class="dragger-item"></span><input type="radio" aria-describedby="label_13" class="form-radio validate[required]" id="input_13_1" name="q13_etesvousCamionneur" value="Non, mais j’aimerais trouver l’amour avec Cœur de trucker!"
required=""><label id="label_input_13_1" for="input_13_1">Non, mais j’aimerais trouver l’amour avec Cœur de trucker!</label></span></div>
</div>
</li>
<li class="form-line form-field-hidden" style="display: none !important;" data-type="control_textbox" id="id_20"><label class="form-label form-label-top form-label-auto" id="label_20" for="input_20" aria-hidden="false"> Quel est votre
employeur actuel? </label>
<div id="cid_20" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_20" name="q20_quelEst" data-type="input-textbox" class="form-textbox"
data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_20 sublabel_input_20" value=""><label class="form-sub-label" for="input_20" id="sublabel_input_20" style="min-height:13px">Nom de
l'entreprise pour laquelle vous travailler</label></span> </div>
</li>
<li class="form-line form-field-hidden" style="display: none !important;" data-type="control_textbox" id="id_21"><label class="form-label form-label-top form-label-auto" id="label_21" for="input_21" aria-hidden="false"> Transport routier
</label>
<div id="cid_21" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_21" name="q21_transportRoutier" data-type="input-textbox" class="form-textbox"
data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_21 sublabel_input_21" value=""><label class="form-sub-label" for="input_21" id="sublabel_input_21" style="min-height:13px">Longue ou
courte distance?</label></span> </div>
</li>
<li class="form-line form-field-hidden" style="display: none !important;" data-type="control_dropdown" id="id_37"><label class="form-label form-label-top form-label-auto" id="label_37" for="input_37" aria-hidden="false"> Type de camion </label>
<div id="cid_37" class="form-input-wide" data-layout="half"> <select class="form-dropdown" id="input_37" name="q37_typeDe37" style="width:310px" data-component="dropdown" aria-label="Type de camion">
<option value="">Veuillez sélectionner</option>
<option value="Remorque fermée">Remorque fermée</option>
<option value="Benne">Benne</option>
<option value="Citerne">Citerne</option>
<option value="Plateau">Plateau</option>
<option value="Autre">Autre</option>
</select> </div>
</li>
<li class="form-line form-field-hidden" style="display: none !important;" data-type="control_textbox" id="id_22"><label class="form-label form-label-top form-label-auto" id="label_22" for="input_22" aria-hidden="false"> Merci de préciser votre
type de camion </label>
<div id="cid_22" class="form-input-wide" data-layout="half"> <input type="text" id="input_22" name="q22_merciDe22" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox"
aria-labelledby="label_22" value=""> </div>
</li>
<li class="form-line" data-type="control_divider" id="id_24">
<div id="cid_24" class="form-input-wide" data-layout="full">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
</div>
</li>
<li id="cid_23" class="form-input-wide form-field-hidden" style="display: none !important;" data-type="control_head">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_23" class="form-header" data-component="header">Cœur de trucker est présentement à la recherche des camionneurs et camionneuses de sa 3e saison.</h2>
<div id="subHeader_23" class="form-subHeader">Toutefois, merci de remplir les prochaines questions pour que nous puissions vous contacter lorsque les camionneurs célibataires seront sélectionnés.</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_26"><label class="form-label form-label-top form-label-auto" id="label_26" for="input_26" aria-hidden="false"> Depuis quand êtes-vous célibataire? </label>
<div id="cid_26" class="form-input-wide" data-layout="half"> <input type="text" id="input_26" name="q26_depuisQuand" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox"
aria-labelledby="label_26" value=""> </div>
</li>
<li class="form-line" data-type="control_radio" id="id_27"><label class="form-label form-label-top form-label-auto" id="label_27" aria-hidden="false"> Avez-vous des enfants? </label>
<div id="cid_27" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_27" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_27"
class="form-radio" id="input_27_0" name="q27_avezvousDes" value="Oui"><label id="label_input_27_0" for="input_27_0">Oui</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input
type="radio" aria-describedby="label_27" class="form-radio" id="input_27_1" name="q27_avezvousDes" value="Non"><label id="label_input_27_1" for="input_27_1">Non</label></span></div>
</div>
</li>
<li class="form-line form-field-hidden" style="display: none !important;" data-type="control_textbox" id="id_28"><label class="form-label form-label-top form-label-auto" id="label_28" for="input_28" aria-hidden="false"> Quel est l'âge de votre
enfant / vos enfants? </label>
<div id="cid_28" class="form-input-wide" data-layout="half"> <input type="text" id="input_28" name="q28_quelEst28" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox"
aria-labelledby="label_28" value=""> </div>
</li>
<li class="form-line" data-type="control_textarea" id="id_29"><label class="form-label form-label-top form-label-auto" id="label_29" for="input_29" aria-hidden="false"> Qu’aimez-vous faire en dehors du travail? </label>
<div id="cid_29" class="form-input-wide" data-layout="full"> <span class="form-sub-label-container" style="vertical-align:top"><textarea id="input_29" class="form-textarea" name="q29_quaimezvousFaire" style="width:648px;height:163px"
data-component="textarea" aria-labelledby="label_29 sublabel_input_29"></textarea><label class="form-sub-label" for="input_29" id="sublabel_input_29" style="min-height:13px">Passe-temps, loisirs, etc...</label></span> </div>
</li>
<li class="form-line jf-required" data-type="control_fileupload" id="id_30"><label class="form-label form-label-top form-label-auto" id="label_30" for="input_30" aria-hidden="false"> Merci de joindre 2 photos de vous à ce formulaire.<span
class="form-required">*</span> </label>
<div id="cid_30" class="form-input-wide jf-required" data-layout="full">
<div class="jfQuestion-fields" data-wrapper-react="true">
<div class="jfField isFilled">
<div class="jfUpload-wrapper">
<div class="jfUpload-container">
<div class="jfUpload-button-container">
<div class="jfUpload-button" aria-hidden="true" tabindex="0" style="display:none" data-version="v2">Parcourir les fichiers<div class="jfUpload-heading forDesktop">Glissez-déposez des fichiers ici</div>
<div class="jfUpload-heading forMobile">Choisissez un fichier</div>
</div>
</div>
</div>
<div class="jfUpload-files-container">
<div class="validate[multipleUpload] validate[required]">
<div class="qq-uploader">
<div class="qq-upload-drop-area" style="display: none;"><span>Drop files here to upload</span></div>
<div class="qq-upload-button " aria-hidden="true" style="position: relative; overflow: hidden; direction: ltr;">Parcourir les fichiers<div class="jfUpload-heading forDesktop">Glissez-déposez des fichiers ici</div>
<div class="jfUpload-heading forMobile">Choisissez un fichier</div>
</div>
<div class="inputContainer" role="button" aria-label="Parcourir les fichiers
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</div>
</div>
</div>
<div data-wrapper-react="true"></div>
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</div>
</div>
</li>
<li class="form-line" data-type="control_divider" id="id_32">
<div id="cid_32" class="form-input-wide" data-layout="full">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
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* INSCRIPTIONS À CŒUR DE TRUCKER - SAISON 3 L'émission Cœur de trucker est de retour pour une troisième saison! Camionneurs et camionneuses célibataires, vous désirez trouver l’amour? Il est temps de vous inscrire en remplissant le formulaire ci-dessous. * Nom* PrénomNom de famille * Date de naissance -Jour -MoisAnnée Date * Adresse complète* Numéro et rue Complément d'adresse VilleÉtat/Région Code Postal Veuillez sélectionner Etats-Unis Afghanistan Albanie Algérie Samoa américaines Andorre Angola Anguilla Antigua-et-Barbuda Argentine Arménie Aruba Australie Autriche Azerbaijan Les Bahamas Bahreïn Bengladesh Barbade Biélorussie Belgique Belize Bénin Bermudes Bhoutan Bolivie Bosnie-Herzégovine Botswana Brésil Brunéi Bulgarie Burkina Faso Burundi Cambodge Cameroun Canada Cap-Vert Îles Caïmans République Centre-Africaine Tchad Chili Chine Ile de Noël Iles Coco (Quille) Colombie Comores Congo Îles Cook Costa Rica Cote d'Ivoire Croatie Cuba Curaçao Chypre République Tchèque République Démocratique du Congo Danemark Djibouti Dominique République dominicaine Équateur Egypt El Salvador Guinée Equatoriale Érythrée Estonie Éthiopie Îles Falkland Îles Féroé Fidji Finlande France Polynésie française Gabon La Gambie Géorgie Allemagne Ghana Gibraltar Grèce Groenland Grenade Guadeloupe Guam Guatemala Guernesey Guinée Guinée Bissau Guyane Haiti Honduras Hong Kong Hongrie Islande Inde Indonésie Iran Iraq Irlande Israël Italie Jamaïque Japon Jersey Jordanie Kazakhstan Kenya Kiribati Corée du Nord Corée du Sud Kosovo Koweït Kirghizistan Laos Lettonie Liban Lesotho Libéria Libye Liechtenstein Lituanie Luxembourg Macao Macédonie Madagascar Malawi Malaisie Maldives Mali Malte Îles Marshall Martinique Mauritanie Île Maurice Mayotte Mexique Micronésie Moldavie Monaco Mongolie Monténégro Montserrat Maroc Mozambique Myanmar Nagorny-Karabakh Namibie Nauru Népal Pays-Bas Antilles néerlandaises Nouvelle-Calédonie Nouvelle-Zélande Nicaragua Niger Nigeria Nioué Île Norfolk République turque de Chypre du Nord Northern Mariana Norvège Oman Pakistan Palaos Palestine Panama Papouasie-Nouvelle-Guinée Paraguay Pérou Philippines Îles Pitcairn Pologne Portugal Porto Rico Qatar République du Congo Roumanie Russie Rwanda Saint-Barthélémy Sainte Hélène Saint-Christophe-et-Niévès Sainte-Lucie Saint-Marin Saint-Pierre-et-Miquelon Saint-Vincent-et-les-Grenadines Samoa Saint Marin Sao Tomé et Principe Arabie saoudite Sénégal Serbie Seychelles Sierra Leone Singapour Slovaquie Slovénie Îles Salomon Somalie Somalie Afrique du Sud Sud Ossétie South Sudan Espagne Sri Lanka Soudan Suriname Svalbard eSwatini Suède Suisse Syrie Taïwan Tajikistan Tanzanie Thaïlande Timor-Leste Togo Tokelau Tonga Transnistrie Pridnestrovié Trinité et Tobago Tristan da Cunha Tunisie Turquie Turkménistan Îles Turques-et-Caïques Tuvalu Ouganda Ukraine Émirats Arabes Unis Royaume-Uni Uruguay Ouzbekistan Vanuatu Ville du Vatican Venezuela Vietnam Iles Vierges Britanniques Île de Man Iles Vierges Américaines Wallis et Futuna Sahara Occidental Yémen Zambie Zimbabwe Autre Pays * Numéro de téléphone* Merci de saisir un numéro de téléphone valide. * Courriel* exemple@exemple.com * * Lien vers votre compte Facebook Merci d'inscrire le lien vers votre compte Facebook. Ex : http://facebook.com/coeurdetrucker * Si vous avez d'autres réseaux sociaux, merci de les inscrire ici : * * Êtes-vous camionneur?* OuiNon, mais j’aimerais trouver l’amour avec Cœur de trucker! * Quel est votre employeur actuel? Nom de l'entreprise pour laquelle vous travailler * Transport routier Longue ou courte distance? * Type de camion Veuillez sélectionner Remorque fermée Benne Citerne Plateau Autre * Merci de préciser votre type de camion * * CŒUR DE TRUCKER EST PRÉSENTEMENT À LA RECHERCHE DES CAMIONNEURS ET CAMIONNEUSES DE SA 3E SAISON. Toutefois, merci de remplir les prochaines questions pour que nous puissions vous contacter lorsque les camionneurs célibataires seront sélectionnés. * Depuis quand êtes-vous célibataire? * Avez-vous des enfants? OuiNon * Quel est l'âge de votre enfant / vos enfants? * Qu’aimez-vous faire en dehors du travail? Passe-temps, loisirs, etc... * Merci de joindre 2 photos de vous à ce formulaire.* Parcourir les fichiers Glissez-déposez des fichiers ici Choisissez un fichier Drop files here to upload Parcourir les fichiers Glissez-déposez des fichiers ici Choisissez un fichier Cancelof Cancelof * * * * Soumettre le formulaire * Should be Empty: March‹› 2024«» Mars 2024Aujourd'huiDLMMJVS25262728291234567891011121314151617181920212223242526272829303112345678910111213