Re: Error NEED HELP ASAP!!

That would make sense. I replaced leave with realea but i am getting this error.

I dont think i missed it anywhere but here is the code to see if you know what i am doign wrong

<cftry>
<cfoutput><cfset jobappid = '#appfirstname##form.applastname##DateFormat(Now(), "mmm-dd-yyyy")#'>
#jobappid#<br>

<cfset appdate= '#DateFormat(Now(), "yyyy-mmm-dd")#'>
</cfoutput>

<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobapp(jobappid, appdate, applastname, appfirstname, appmiddlename, appphone, appstreet, appcity, appstate, appzip, fulltime, eighteen, appposition, previous, previousdate, available, experiences, crime, hsaddres, hssubjects, hsyears, hsgrad, hsdiploma, collegeaddres, collegesubjects, collegeyears, collegegrad, collegediploma, techaddres, techsubjects, techyears, techgrad , techdiploma, q1, q2, q3)
VALUES(<cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#appdate#"/>,   
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appfirstname#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appmiddlename#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.applastname#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appphone#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appstreet#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appcity#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appstate#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appzip#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.fulltime#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.eighteen#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appposition#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.previous#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.previousdate#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.available#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.experiences#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.crime#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.hsaddres#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.hssubjects#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.hsyears#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.hsgrad#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.hsdiploma#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.collegeaddres#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.collegesubjects#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.collegeyears#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.collegegrad#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.collegediploma#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.techaddres#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.techsubjects#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.techyears#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.techgrad#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.techdiploma#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.q1#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.q2#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.q3#"/>)
   
   
</CFQUERY>

<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobappemp(jobappid, company, busphone, empfromdate, emptodate, startwage, endwage, realea, supervisor, description)
     VALUES(<cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.company#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.busphone#"/>,
     <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.empfromdate#"/>,
     <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.emptodate#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.startwage#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.endwage#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.realea#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.supervisor#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.description#"/>)

</CFQUERY>

<cfif not #form.company2# is "">
<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobappemp(jobappid, company, busphone, empfromdate, emptodate, startwage, endwage, realea, supervisor, description)
VALUES(<cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.company2#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.busphone2#"/>,
    <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.employfromdate2#"/>,
    <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.employtodate2#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.startwage2#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.endwage2#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.realea2#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.supervisor2#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.description2#"/>)
  
</CFQUERY>
</cfif>
<cfif not #form.company3# is "">
<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobappemp(jobappid, company, busphone, empfromdate, emptodate, startwage, endwage, realea, supervisor, description)
VALUES(<cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.company3#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.busphone3#"/>,
    <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.employfromdate3#"/>,
    <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.employtodate3#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.startwage3#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.endwage3#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.realea3#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.supervisor3#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.description3#"/>)
   
</CFQUERY>
</cfif>
<cfif not #form.company4# is "">
<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobappemp(jobappid, company, busphone, empfromdate, emptodate, startwage, endwage, realea, supervisor, description)
VALUES(<cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.company4#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.busphone4#"/>,
    <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.employfromdate4#"/>,
    <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.employtodate4#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.startwage4#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.endwage4#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.realea4#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.supervisor4#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.description4#"/>)

</CFQUERY>
</cfif>
<cfif not #form.company6# is "">
<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobappemp(jobappid, company, busphone, empfromdate, emptodate, startwage, endwage, realea, supervisor, description)
VALUES(<cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.company6#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.busphone6#"/>,
    <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.employfromdate6#"/>,
    <cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.employtodate6#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.startwage6#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.endwage6#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.realea6#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.supervisor6#"/>,
     <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.description6#"/>)

</CFQUERY>
</cfif>

<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobappref(jobappid, ref, refaddress, refphone)
VALUES(
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.ref1#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.refaddress1#"/>,
  <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.refphone1#"/>)

</CFQUERY>
<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobappref(jobappid, ref, refaddress, refphone)
VALUES(<cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.ref2#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.refaddress2#"/>,
  <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.refphone2#"/>)
</CFQUERY>
<cfquery username='#username#' password='#password#'  datasource='#datasource#'>
INSERT INTO jobappref(jobappid, ref, refaddress, refphone)
VALUES(<cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#jobappid#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.ref3#"/>,
    <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.refaddress3#"/>,
  <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.refphone3#"/>)
</CFQUERY>

<cfmail to="doug@com"  from="jobApp@com" subject=".com Job Application" type="HTML">
    <font face="Verdana,Geneva,Arial,Helvetica,sans-serif" size="-1"><strong>
                <cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.appfirstname#"/><cfqueryparam cfsqltype="cf_sql_varchar" VALUE="#form.applastname#"/> </strong> has applied for a position:<br>
     <br>
     <b>Date Applied: </b><cfqueryparam cfsqltype="cf_sql_date" VALUE="#form.appdate#"/><br>
     Go to the admin section to review this application.
    
     </cfmail>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">

<html>
<head>
<link rel="stylesheet" href="style.css">
<title> Job Application Submitted</title>
</head>

<body>
<div align="center"><img src="images/_logo.gif" alt="" width="135" height="89" border="0"><p><br><br><br>
<h2>Your Application has been Processed Completely.</h2><br><br>
<form>
<input style="background-color: 069;
border-color: ccc;
font-family : verdana, Arial, Helvetica, sans-serif;
font-weight: bold;
font-size: 10px;
color: #fff;" type=button value="Close This Window" onClick="javascript:window.close();">
</form></div>

</html>
</body><cfcatch><cfdump var="#cfcatch#"></cfcatch>
</cftry>

THIS  BELOW IS THE FORM

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">

<html>
<head>
<link rel="stylesheet" href="style.css">
<title>rated Job Application</title>
</head>

<body>
<TABLE BORDER=0 CELLSPACING=0 CELLPADDING=0 width="785">

<TR><TD> </TD>
   <TD>
   <table border="0" cellspacing="0" cellpadding="0">
   <tr><TD colspan="3"><table><tr valign="bottom"><td><img src="images/_logo.gif" alt="" width="135" height="89" border="0"></td><td><strong><font style="font-size : 10pt;"> <br>  Industries<br>    Incorporated<br><br></font></strong></td><td> <!--- office use ---></td></tr></table></td></tr>
<tr><TD colspan="3" align="center"><font style="font-size : 16pt;color: #036;font-weight : bold;">Application for Employment</font><br><br></td></tr>
   <tr><td colspan="3">
   <P>TO APPLICANT: We sincerely appreciate your interest in ries, Inc. as a prospective employer. Thank
you for taking the time to complete this application.<br><br>
The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national
origin. Federal law also prohibits other types of discrimination such as age, citizenship, disability, veterans status, and participation in union activities, ancestry, marital status, parental status, or sexual orientation. The Fair Credit
Reporting Act imposes restrictions with respect to credit data. This list, however, is not exhaustive of the grounds on
which discrimination is prohibited.<br><br>
(Please Type Carefully)<br><hr size="4" color="003366"><img src="images/spacer_transp.gif" width="4" height="4" border="0" alt=""></td></tr>
<cfform action="http://wwro" method="post" enablecab="No" scriptsrc="/cfform.js">
    <tr><td colspan="2" height="40"><h2>Personal</h2><br><strong>Date: </strong><cfoutput>#DateFormat( Now(), "MMMM DD, YYYY")#</cfoutput></td>
    </tr>
    <tr><td  valign="bottom" colspan="2" height="40"><b>First Name:</b><input type="Text" name="appfirstname" message="Please supply your name." required size="17"> <b>Middle Name:</b><input type="text" name="appmiddlename" size="22"> <b>Last Name:</b><input type="text" name="applastname" size="42"></td>
    </tr>
    <tr><td height="40"><strong>Social Security No.:</strong>  <font style="text-decoration: underline;">   must be provided upon request  </font><br><img src="images/spacer_transp.gif" alt="" width="2" height="4" border="0"></td>
      <td height="40"><strong>Telephone Number:
        <input type="text" name="appphone">
      </strong></td>
    </tr>
    <tr><td colspan="2"><strong>Address:</strong><input type="Text" name="appstreet" required size="45"><input type="Text" name="appcity" message="Please supply your city." required size="30"><select name="appstate">
<option value="WI">WI</option>
<option value=" "></option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="DC">DC</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NC">NC</option>
<option value="ND">ND</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="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="VT">VT</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
</select><input type="Text" name="appzip" message="Please supply a correctly formatted zip code." size="10" required maxlength="10"></td>
    </tr>
    <tr><td colspan="2"><img src="images/spacer_transp.gif" alt="" width="85" height="4" border="0"><strong>No.   Street <img src="images/spacer_transp.gif" alt="" width="200" height="4" border="0">City <img src="images/spacer_transp.gif" alt="" width="173" height="4" border="0">State <img src="images/spacer_transp.gif" alt="" width="25" height="4" border="0">Zip</strong></td>
     </tr>
<!---  <tr><td colspan="2"><hr size="2" color="003366"></td></tr> --->
     <tr><td height="41">Are you eligible for full time employment? (i.e. 40 hrs/wk)
If hired, you are required to submit proof of your eligibility to work</td><td><input type="radio" name="fulltime" value="Yes">Yes <input type="radio" name="fulltime" value="No">No</td>
        </tr>
  <tr><td height="41">Are you over the age of 18 years old?<br>
If no, hire is subject to verification that you are of minimum legal age.</td><td><input type="radio" name="eighteen" value="Yes">Yes <input type="radio" name="eighteen" value="No">No</td>
        </tr>
    <tr><td colspan="3"><img src="images/spacer_transp.gif" width="2" height="4" border="0"><br><b>Position(s) applied for:</b>  <input type="Text" name="appposition" size="80"></td>
      </tr>
    <tr>
      <td colspan="3"> </td>
    </tr>
     <tr><td height="41">Were you previously employed by us? <input type="radio" name="previous" value="Yes">Yes <input type="radio" name="previous" value="No">No</td><td>   If yes, when? <input type="Text" name="previousdate" size="30" required></td>
        </tr>
<tr><td colspan="3"><img src="images/spacer_transp.gif" width="2" height="4" border="0"><br>If your application is favorable, when will you be available to work?  <input type="Text" name="available" size="60"></td>
      </tr>
<tr>
  <td colspan="2"><br>Are there any other job related experiences, skills, or qualifications which will be of special benefit in the job for which you are applying for?<br>
<textarea name="experiences" rows="4" cols="93"></textarea></td>
</tr>
<tr valign="bottom"><td height="25">Have you ever been convicted of a major crime?</td><td><cfinput type="radio" name="crime" value="Yes" required="yes" message="Must answer if you have ever been convicted of a major crime">Yes <cfinput type="radio" name="crime" value="No" required="yes" message="Must answer if you have ever been convicted of a major crime">No</td>
        </tr>
<tr><td colspan="2">(Excluding minor traffic violations, sealed or expunged records, or cases where you were found not guilty)<br><br></td></tr>

<tr><td colspan="2"><hr size="4" color="003366"></td></tr>
<tr><td colspan="2" align="center"><h2>Employment History</h2></td></tr>
<tr><td colspan="2" align="center"><h4>List below present and past employment,beginning with the most recent.</h4><br></td></tr>

<tr>
<td colspan="2">

<table cellspacing="0" cellpadding="1" border="1" bordercolor="000000">
<tr>
<td align="center" rowspan="2">Name and Address of Company<br>and Type of Business</td>
<td align="center" height="3">From</td>
<td align="center" height="3">To</td>
<td rowspan="2" align="center">Weekly<br>Starting<br>Salary or Wage</td>
<td rowspan="2" align="center">Weekly<br>Ending<br>Salary or Wage</td>
<td rowspan="2" align="center">Reason for<br>Leaving</td>
<td rowspan="2" align="center">Name of<br>Supervisor</td>
<td height="3" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td align="center" height="10">Month/Year</td>
<td align="center" height="10">Month/Year</td>
<td height="2" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" height="15"><textarea name="company" rows="5" cols="20"></textarea></td>
<td height="5"><input type="Text" name="empfromdate" size="12" height="5"></td>
<td height="5"><input type="Text" name="emptodate" size="12"></td>
<td height="5"><input type="Text" name="startwage" size="10"></td>
<td height="5"><input type="Text" name="endwage" size="10"></td>
<td height="5"><input type="Text" name="realea" size="15"></td>
<td height="5"><input type="Text" name="supervisor" size="15"></td>
<td height="10" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" colspan="6" height="25"><textarea name="description" rows="5" cols="80">Description of Duties:</textarea></td>
<td height="40" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td height="5">Telephone:<input type="Text" name="busphone" size="15"></td>
<td height="5" bordercolor="ffffff" width="1"></td>
</tr>
</table>

</td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="2"><table cellspacing="0" cellpadding="1" border="1" bordercolor="000000">
<tr>
<td align="center" rowspan="2">Name and Address of Company<br>and Type of Business</td>
<td align="center" height="3">From</td>
<td align="center" height="3">To</td>
<td rowspan="2" align="center">Weekly<br>Starting<br>Salary or Wage</td>
<td rowspan="2" align="center">Weekly<br>Ending<br>Salary or Wage</td>
<td rowspan="2" align="center">Reason for<br>Leaving</td>
<td rowspan="2" align="center">Name of<br>Supervisor</td>
<td height="3" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td align="center" height="10">Month/Year</td>
<td align="center" height="10">Month/Year</td>
<td height="2" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" height="15"><textarea name="company2" rows="5" cols="20"></textarea></td>
<td height="5"><input type="Text" name="empfromdate2" size="12" height="5"></td>
<td height="5"><input type="Text" name="emptodate2" size="12"></td>
<td height="5"><input type="Text" name="startwage2" size="10"></td>
<td height="5"><input type="Text" name="endwage2" size="10"></td>
<td height="5"><input type="Text" name="realea2" size="15"></td>
<td height="5"><input type="Text" name="supervisor2" size="15"></td>
<td height="10" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" colspan="6" height="25"><textarea name="description2" rows="5" cols="80">Description of Duties:</textarea></td>
<td height="40" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td height="5">Telephone:<input type="Text" name="busphone2" size="15"></td>
<td height="5" bordercolor="ffffff" width="1"></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="2"><table cellspacing="0" cellpadding="1" border="1" bordercolor="000000">
<tr>
<td align="center" rowspan="2">Name and Address of Company<br>and Type of Business</td>
<td align="center" height="3">From</td>
<td align="center" height="3">To</td>
<td rowspan="2" align="center">Weekly<br>Starting<br>Salary or Wage</td>
<td rowspan="2" align="center">Weekly<br>Ending<br>Salary or Wage</td>
<td rowspan="2" align="center">Reason for<br>Leaving</td>
<td rowspan="2" align="center">Name of<br>Supervisor</td>
<td height="3" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td align="center" height="10">Month/Year</td>
<td align="center" height="10">Month/Year</td>
<td height="2" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" height="15"><textarea name="company3" rows="5" cols="20"></textarea></td>
<td height="5"><input type="Text" name="empfromdate3" size="12" height="5"></td>
<td height="5"><input type="Text" name="emptodate3" size="12"></td>
<td height="5"><input type="Text" name="startwage3" size="10"></td>
<td height="5"><input type="Text" name="endwage3" size="10"></td>
<td height="5"><input type="Text" name="realea3" size="15"></td>
<td height="5"><input type="Text" name="supervisor3" size="15"></td>
<td height="10" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" colspan="6" height="25"><textarea name="description3" rows="5" cols="80">Description of Duties:</textarea></td>
<td height="40" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td height="5">Telephone:<input type="Text" name="busphone3" size="15"></td>
<td height="5" bordercolor="ffffff" width="1"></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="2"><table cellspacing="0" cellpadding="1" border="1" bordercolor="000000">
<tr>
<td align="center" rowspan="2">Name and Address of Company<br>and Type of Business</td>
<td align="center" height="3">From</td>
<td align="center" height="3">To</td>
<td rowspan="2" align="center">Weekly<br>Starting<br>Salary or Wage</td>
<td rowspan="2" align="center">Weekly<br>Ending<br>Salary or Wage</td>
<td rowspan="2" align="center">Reason for<br>Leaving</td>
<td rowspan="2" align="center">Name of<br>Supervisor</td>
<td height="3" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td align="center" height="10">Month/Year</td>
<td align="center" height="10">Month/Year</td>
<td height="2" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" height="15"><textarea name="company4" rows="5" cols="20"></textarea></td>
<td height="5"><input type="Text" name="empfromdate4" size="12" height="5"></td>
<td height="5"><input type="Text" name="emptodate4" size="12"></td>
<td height="5"><input type="Text" name="startwage4" size="10"></td>
<td height="5"><input type="Text" name="endwage4" size="10"></td>
<td height="5"><input type="Text" name="realea4" size="15"></td>
<td height="5"><input type="Text" name="supervisor4" size="15"></td>
<td height="10" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" colspan="6" height="25"><textarea name="description4" rows="5" cols="80">Description of Duties:</textarea></td>
<td height="40" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td height="5">Telephone:<input type="Text" name="busphone4" size="15"></td>
<td height="5" bordercolor="ffffff" width="1"></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="2"><table cellspacing="0" cellpadding="1" border="1" bordercolor="000000">
<tr>
<td align="center" rowspan="2">Name and Address of Company<br>and Type of Business</td>
<td align="center" height="3">From</td>
<td align="center" height="3">To</td>
<td rowspan="2" align="center">Weekly<br>Starting<br>Salary or Wage</td>
<td rowspan="2" align="center">Weekly<br>Ending<br>Salary or Wage</td>
<td rowspan="2" align="center">Reason for<br>Leaving</td>
<td rowspan="2" align="center">Name of<br>Supervisor</td>
<td height="3" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td align="center" height="10">Month/Year</td>
<td align="center" height="10">Month/Year</td>
<td height="2" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" height="15"><textarea name="company5" rows="5" cols="20"></textarea></td>
<td height="5"><input type="Text" name="empfromdate5" size="12" height="5"></td>
<td height="5"><input type="Text" name="emptodate5" size="12"></td>
<td height="5"><input type="Text" name="startwage5" size="10"></td>
<td height="5"><input type="Text" name="endwage5" size="10"></td>
<td height="5"><input type="Text" name="realea5" size="15"></td>
<td height="5"><input type="Text" name="supervisor5" size="15"></td>
<td height="10" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td rowspan="2" colspan="6" height="25"><textarea name="description5" rows="5" cols="80">Description of Duties:</textarea></td>
<td height="40" bordercolor="ffffff" width="1"></td>
</tr>
<tr>
<td height="5">Telephone:<input type="Text" name="busphone5" size="15"></td>
<td height="5" bordercolor="ffffff" width="1"></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr><td colspan="2"><hr size="4" color="003366"></td></tr>
<tr><td colspan="2"><h2>Educational Record</h2></td></tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="2"><table cellspacing="0" cellpadding="1" border="1" bordercolor="000000">
<tr>
<td align="center">School</td>
<td align="center">Name and Address</td>
<td align="center">Subjects Studied</td>
<td align="center">Number of<br>Years<br>Completed</td>
<td align="center">Did you<br>Graduate?</td>
<td>Diploma,<br>Degree or<br>Certificate</td>
</tr>
<tr>
<td>High School</td>
<td><textarea name="hsaddres" rows="3" cols="20"></textarea></td>
<td><textarea name="hssubjects" rows="3" cols="15"></textarea></td>
<td><input type="Text" name="hsyears" size="9"></td>
<td><input type="radio" name="hsgrad" value="Yes">Yes<br><input type="radio" name="hsgrad" value="No" checked>No</td>
<td><input type="Text" name="hsdiploma" size="11"></td>
</tr>
<tr>
<td>College or University</td>
<td><textarea name="collegeaddres" rows="3" cols="20"></textarea></td>
<td><textarea name="collegesubjects" rows="3" cols="15"></textarea></td>
<td><input type="Text" name="collegeyears" size="9"></td>
<td><input type="radio" name="collegegrad" value="Yes">Yes<br><input type="radio" name="collegegrad" value="No" checked>No</td>
<td><input type="Text" name="collegediploma" size="11"></td>
</tr>
<tr>
<td>Vocational or Technical</td>
<td><textarea name="techaddres" rows="3" cols="20"></textarea></td>
<td><textarea name="techsubjects" rows="3" cols="15"></textarea></td>
<td><input type="Text" name="techyears" size="9"></td>
<td><input type="radio" name="techgrad" value="Yes">Yes<br><input type="radio" name="techgrad" value="No" checked>No</td>
<td><input type="Text" name="techdiploma" size="11"></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr><td colspan="2"><h2>Personal References</h2></td></tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="2"><table cellspacing="0" cellpadding="2" border="1" bordercolor="000000">
<tr>
<td align="center">Name and Relationship</td>
<td align="center">Address</td>
<td align="center">Phone Number</td>
</tr>
<tr>
<td><textarea name="ref1" rows="2" cols="30"></textarea></td>
<td><textarea name="refaddress1" rows="2" cols="40"></textarea></td>
<td><input type="Text" name="refphone1" size="14"></td>
</tr>
<tr>
<td><textarea name="ref2" rows="2" cols="30"></textarea></td>
<td><textarea name="refaddress2" rows="2" cols="40"></textarea></td>
<td><input type="Text" name="refphone2" size="14"></td>
</tr>
<tr>
<td><textarea name="ref3" rows="2" cols="30"></textarea></td>
<td><textarea name="refaddress3" rows="2" cols="40"></textarea></td>
<td><input type="Text" name="refphone3" size="14"></td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr><td colspan="2" align="center"> <h2>PLEASE READ EACH STATEMENT CAREFULLY BEFORE SUBMITING</h2></td></tr>
<tr><td colspan="2" height="41"><table><tr valign="top"><td><cfinput type="checkbox" name="q1" value="Yes" required="yes" checked="No"  message="You must read and check the first box agreeing to the terms in order for your application to be processed"> </td><td> I certify that all information provided in this employment application is true and complete. I understand that any false information or
omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.</td></tr></table></td></tr>
<tr><td colspan="2" height="41"><table><tr valign="top"><td><cfinput type="checkbox" name="q2" value="Yes" required="yes" message="You must read and check the second box agreeing to the terms in order for your application to be processed"> </td><td>  I further understand that this application is not intended to be a contract of employment, nor does this application obligate
Industries, Inc. in any way if they decide to employ me. I understand and agree that my employment is at-will and can be
terminated by either party with or without notice, at any time, for any reason or no reason at all.</td></tr></table></td></tr>
<tr><td colspan="2" height="41"><table><tr valign="top"><td><cfinput type="checkbox" name="q3" value="Yes" required="yes" message="You must read and check the third box agreeing to the terms in order for your application to be processed"> </td><td>  I authorize , Inc. to do a background investigation on me. This includes a request from previous/present
employers as to my employment history, personal references and school records and I hereby release all persons and corporations
requesting or supplying information from all liability or responsibility to me in doing so.</td></tr></table></td></tr>
<tr>
   <td colspan="2"><br><br>
This application will be kept on file for one year from the date of application.
     </td></tr>
<tr>
   <td colspan="2">
<br><br><input type="Submit" value="Next Step">
     </td></tr></cfform>
  </TABLE>
    </TD>
   <TD WIDTH=5> </TD>
  </TR>
</TABLE>
</html>

</body>