{"id":4995,"date":"2022-09-16T10:48:54","date_gmt":"2022-09-16T10:48:54","guid":{"rendered":"https:\/\/carepromise.ca\/?page_id=4995"},"modified":"2022-09-16T11:03:43","modified_gmt":"2022-09-16T11:03:43","slug":"application-form","status":"publish","type":"page","link":"https:\/\/carepromise.ca\/index.php\/application-form\/","title":{"rendered":"Application Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4995\" class=\"elementor elementor-4995\">\n\t\t\t\t\t\t\t        <section class=\"elementor-section elementor-top-section elementor-element elementor-element-aca5b8c elementor-section-boxed elementor-section-height-default elementor-section-height-default ct-header-fixed-none ct-row-max-none\" data-id=\"aca5b8c\" data-element_type=\"section\">\n            \n                        <div class=\"elementor-container elementor-column-gap-default \">\n                    <div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-515b04e\" data-id=\"515b04e\" data-element_type=\"column\">\n            <div class=\"elementor-widget-wrap elementor-element-populated\">\n                        \t\t<div class=\"elementor-element elementor-element-36d55cd elementor-widget elementor-widget-spacer\" data-id=\"36d55cd\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.7.5 - 14-09-2022 *\/\n.elementor-column .elementor-spacer-inner{height:var(--spacer-size)}.e-container{--container-widget-width:100%}.e-container>.elementor-widget-spacer{width:var(--container-widget-width,var(--spacer-size));-ms-flex-item-align:stretch;align-self:stretch;-ms-flex-negative:0;flex-shrink:0}.e-container>.elementor-widget-spacer>.elementor-widget-container,.e-container>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer{height:100%}.e-container>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner{height:var(--container-widget-height,var(--spacer-size))}<\/style>\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/div>\n        <\/div>\n                            <\/div>\n        <\/section>\n                <section class=\"elementor-section elementor-top-section elementor-element elementor-element-954f77c elementor-section-boxed elementor-section-height-default elementor-section-height-default ct-header-fixed-none ct-row-max-none\" data-id=\"954f77c\" data-element_type=\"section\">\n            \n                        <div class=\"elementor-container elementor-column-gap-default \">\n                    <div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-df9822a\" data-id=\"df9822a\" data-element_type=\"column\">\n            <div class=\"elementor-widget-wrap\">\n                                    <\/div>\n        <\/div>\n                <div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-55c97b4\" data-id=\"55c97b4\" data-element_type=\"column\">\n            <div class=\"elementor-widget-wrap elementor-element-populated\">\n                        \t\t<div class=\"elementor-element elementor-element-08ab4c8 fluentform-widget-submit-button-center fluent-form-widget-step-header-yes fluent-form-widget-step-progressbar-yes fluentform-widget-submit-button-custom elementor-widget elementor-widget-fluent-form-widget\" data-id=\"08ab4c8\" data-element_type=\"widget\" data-widget_type=\"fluent-form-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\n            <div class=\"fluentform-widget-wrapper fluentform-widget-align-default\">\n\n                \n                <div class='fluentform fluentform_wrapper_4'><form data-form_id=\"4\" id=\"fluentform_4\" class=\"frm-fluent-form fluent_form_4 ff-el-form-top ff_form_instance_4_1 ff-form-loading\" data-form_instance=\"ff_form_instance_4_1\" method=\"POST\" ><p style=\"display: none !important;\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"215\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><input type='hidden' name='__fluent_form_embded_post_id' value='4995' \/><input type=\"hidden\" id=\"_fluentform_4_fluentformnonce\" name=\"_fluentform_4_fluentformnonce\" value=\"e68350c661\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/4995\" \/><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class='ff-el-input--label asterisk-right'><label for='ff_4_names_first_name_'>First Name<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_4_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"First Name\" ><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class='ff-el-input--label asterisk-right'><label for='ff_4_names_last_name_'>Last Name<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_4_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Last Name\" ><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_4_datetime'>Date Of Birth<\/label> <\/div><div class='ff-el-input--content'><input data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_4_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\" ><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_4_phone'>Phone Number<\/label> <\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Phone Number\" data-name=\"phone\" id=\"ff_4_phone\" inputmode=\"tel\" ><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_4_email'>Email<\/label> <\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_4_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\" ><\/div><\/div><div class='ff-el-group ff-el-form-right'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_4_file-upload_1'>Upload Resume<\/label> <\/div><div class='ff-el-input--content'><label for='ff_4_file-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn'>Choose File<\/span> <input type=\"file\" name=\"file-upload\" id=\"ff_4_file-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" data-name=\"file-upload\" multiple=\"1\" ><\/label><\/div><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\" >Submit Form<\/button><\/div><\/form><div id='fluentform_4_errors' class='ff-errors-in-stack ff_form_instance_4_1 ff-form-loading_errors ff_form_instance_4_1_errors'><\/div><\/div>        <script type=\"text\/javascript\">\n            window.fluent_form_ff_form_instance_4_1 = {\"id\":\"4\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\",\"asteriskPlacement\":\"asterisk-right\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_4_1\",\"form_id_selector\":\"fluentform_4\",\"rules\":{\"names[first_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"names[middle_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"names[last_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"datetime\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"phone\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"valid_phone_number\":{\"value\":false,\"message\":\"Phone number is not valid\"}},\"email\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"email\":{\"value\":true,\"message\":\"This field must contain a valid email\"}},\"file-upload\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"max_file_size\":{\"value\":20971520,\"_valueFrom\":\"MB\",\"message\":\"Maximum file size limit is 20MB\"},\"max_file_count\":{\"value\":1,\"message\":\"You can upload maximum 1 file\"},\"allowed_file_types\":{\"value\":[],\"message\":\"Invalid file type\"}}}};\n                    <\/script>\n                    <\/div>\n\n            \t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/div>\n        <\/div>\n                <div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-e0af41e\" data-id=\"e0af41e\" data-element_type=\"column\">\n            <div class=\"elementor-widget-wrap\">\n                                    <\/div>\n        <\/div>\n                            <\/div>\n        <\/section>\n                <section class=\"elementor-section elementor-top-section elementor-element elementor-element-bddc445 elementor-section-boxed elementor-section-height-default elementor-section-height-default ct-header-fixed-none ct-row-max-none\" data-id=\"bddc445\" data-element_type=\"section\">\n            \n                        <div class=\"elementor-container elementor-column-gap-default \">\n                    <div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8d00e07\" data-id=\"8d00e07\" data-element_type=\"column\">\n            <div class=\"elementor-widget-wrap elementor-element-populated\">\n                        \t\t<div class=\"elementor-element elementor-element-e1c6ff0 elementor-widget elementor-widget-spacer\" data-id=\"e1c6ff0\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/div>\n        <\/div>\n                            <\/div>\n        <\/section>\n        \t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>&#916; First Name Last Name Date Of Birth Phone Number Email Upload Resume Choose File Submit Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_mi_skip_tracking":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/carepromise.ca\/index.php\/wp-json\/wp\/v2\/pages\/4995"}],"collection":[{"href":"https:\/\/carepromise.ca\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/carepromise.ca\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/carepromise.ca\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/carepromise.ca\/index.php\/wp-json\/wp\/v2\/comments?post=4995"}],"version-history":[{"count":19,"href":"https:\/\/carepromise.ca\/index.php\/wp-json\/wp\/v2\/pages\/4995\/revisions"}],"predecessor-version":[{"id":5020,"href":"https:\/\/carepromise.ca\/index.php\/wp-json\/wp\/v2\/pages\/4995\/revisions\/5020"}],"wp:attachment":[{"href":"https:\/\/carepromise.ca\/index.php\/wp-json\/wp\/v2\/media?parent=4995"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}