Online Referral
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<ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">APPLICANT INFORMATION </div></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_selected" style="white-space: normal; width: 100%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Which branch of mentoring are you applying for? (Choose only one category)</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_113" value="Wide Range Trauma & Foster Care Mentoring (6 years old - 18+)">Wide Range Trauma & Foster Care Mentoring (6 years old - 18+)</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_113" value="Foster Care Specific Mentoring (8 years old - 18+)">Foster Care Specific Mentoring (8 years old - 18+)</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_113" value="Parental Mentorship for Parents & Underserved Families (18 years old- 50+)">Parental Mentorship for Parents & Underserved Families (18 years old- 50+)</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_113" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_113_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Name_First"><i class="fa fa-font"></i><label class="er_fld_label required">First Name:</label><input name="CST_15" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Name_Middle"><i class="fa fa-font"></i><label class="er_fld_label">Middle Name:</label><input name="CST_1" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Name_Last"><i class="fa fa-font"></i><label class="er_fld_label required">Last Name:</label><input name="CST_16" type="text" class="er_fld_required er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Address_Street_1"><i class="fa fa-font"></i><label class="er_fld_label required">Address:</label><input name="CST_14" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Address_City"><i class="fa fa-font"></i><label class="er_fld_label required">City:</label><input name="CST_2" type="text" class="er_fld_required er_fld_width100" value=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Address_State"><i class="fa fa-font"></i><label class="er_fld_label required">State:</label><input name="CST_12" type="text" class="er_fld_required er_fld_width50"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Address_Zip"><i class="fa fa-font"></i><label class="er_fld_label required">Zip Code:</label><input name="CST_13" type="text" class="er_fld_width25 er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Phone_Mobile"><i class="fa fa-font"></i><label class="er_fld_label required">Phone (Best contact number):</label><input name="CST_5" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_EMail"><i class="fa fa-font"></i><label class="er_fld_label required">Email Address:</label><input name="CST_4" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="CustomField_Value_8"> <i class="fa fa-font"></i><label class="er_fld_label required">Name of Home Church:</label><input name="CST_110" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col1 er_fld_type_radio_col2" style="white-space: normal; width: 25%;" draggable="false" map_to="CC_Gender"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Gender:</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_99" value="Male">Male</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_99" value="Female">Female</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_99" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_99_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Race"> <i class="fa fa-font"></i><label class="er_fld_label required">Race:</label><input name="CST_109" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="CC_DOB"><i class="fa fa-font"></i><label class="er_fld_label required">Date of Birth:</label><input name="CST_7" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_SSN"><i class="fa fa-font"></i><label class="er_fld_label required">SSN: (DCS Requirement)</label><input name="CST_8" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 16.6667%;" map_to="CC_Occupation"><i class="fa fa-font"></i><label class="er_fld_label">Occupation:</label><input name="CST_10" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="CC_Employer"><i class="fa fa-font"></i><label class="er_fld_label">Employer:</label><input name="CST_11" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Emergency Contact</label><input name="CST_9" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Relationship:</label><input name="CST_17" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Phone: </label><input name="CST_18" type="text" class="er_fld_required er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label required">Email Address:</label><input name="CST_19" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_large" draggable="false" style="width: 50%;"><i class="fa fa-paragraph"></i><label class="er_fld_label required">Please explain why you would like to serve in this role:</label><textarea name="CST_21" style="width:100%;" class="er_fld_required"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="CC_ReferringWorker_Ref"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Where did you hear about Christian Family Care (CFC)?</label><select name="CST_41" class="er_fld_required er_fld_width50"><option value="N/A" selected="">N/A</option><option value="CFC Website">CFC Website</option><option value="Church Partner">Church Partner</option><option value="Community Partner">Community Partner</option><option value="Google ">Google </option><option value="Facebook ">Facebook </option><option value="CFC Employee">CFC Employee</option><option value="Unknown">Unknown</option><option value="Other">Other</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="CC_ReferringWorker_Ref"><i class="fa fa-font"></i><label class="er_fld_label">If Other, please list below:</label><input name="CST_42" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;"><i class="fa fa-paragraph"></i><label class="er_fld_label required">Please list special skills, educational background, other languages, etc.</label><textarea name="CST_24" style="width:100%;" class="er_fld_required er_fld_width100"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col1" style="white-space: normal; width: 100%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Do you have a level one fingerprint identification card?</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_29" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_29" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_29" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_29_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col1" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Do you have any experience working with children or children in the foster care system?</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_25" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_25" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_25" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_25_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;"><i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, please explain:</label><textarea name="CST_27" style="width:100%;" class=""></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col1" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Do you have any physical limitations that may prevent you from performing the volunteer position for which you are applying you are applying? </label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_31" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_31" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_31" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_31_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;"><i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, please explain below:</label><textarea name="CST_30" style="width:100%;" class=""></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">APPLICANT AVAILABILITY </div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">Please check the days you are available to meet with a youth. Please list the window of time you are available below each day selected.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">MON.</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_47" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_47" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_47" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_47_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"><i class="fa fa-font"></i><label class="er_fld_label required">Times Available:</label><input name="CST_102" type="text" value="" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">TUES.</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_44" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_44_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"><i class="fa fa-font"></i><label class="er_fld_label required">Times Available:</label><input name="CST_103" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">WED.</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_46" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_46" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_46" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_46_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"><i class="fa fa-font"></i><label class="er_fld_label required">Times Available:</label><input name="CST_104" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">THURS.</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_45" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_45" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_45" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_45_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"><i class="fa fa-font"></i><label class="er_fld_label required">Times Available:</label><input name="CST_105" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">FRI.</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_35" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_35" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_35" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_35_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Times Available:</label><input name="CST_106" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">SAT.</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_49" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_49" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_49" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_49_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Times Available:</label><input name="CST_107" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">SUN.</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_50" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_50" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_50" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_50_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Times Available:</label><input name="CST_108" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_medium" draggable="false" style="width: 50%;"><i class="fa fa-paragraph"></i><label class="er_fld_label required">Is there any area of volunteer work that you would not wish to be asked to serve? If yes, please describe below:</label><textarea name="CST_53" style="width:100%;" class="er_fld_required"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"><i class="fa fa-font"></i><label class="er_fld_label required">Name of Home Church (if you have one):</label><input name="CST_54" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label required">Pastors Name:</label><input name="CST_55" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">APPLICANT HOUSEHOLD INFORMATION</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 100%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">Please provide information for each member of your household.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 20%;"><i class="fa fa-font"></i><label class="er_fld_label">Name:</label><input name="CST_56" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col1 er_fld_type_radio_col2" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Gender:</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="Male">Male</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="Female ">Female </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_60" value="Other:">Other:<input class="cst_Other" name="CST_60_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label">Date of Birth:</label><input name="CST_58" type="text" class="er_fld_width50"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label">Relationship:</label><input name="CST_59" type="text" class="er_fld_width75"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 20%;"><i class="fa fa-font"></i><label class="er_fld_label">Name:</label><input name="CST_61" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col2" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Gender:</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_62" value="Male ">Male </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_62" value="Female">Female</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_62" value="Other:">Other:<input class="cst_Other" name="CST_62_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label">Date of Birth:</label><input name="CST_63" type="text" class="er_fld_width50"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label">Relationship:</label><input name="CST_65" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 20%;"><i class="fa fa-font"></i><label class="er_fld_label">Name:</label><input name="CST_66" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col2" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Gender:</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_69" value="Male">Male</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_69" value="Female">Female</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_69" value="Other:">Other:<input class="cst_Other" name="CST_69_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label">Date of Birth:</label><input name="CST_67" type="text" class="er_fld_width50"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label">Relationship:</label><input name="CST_68" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 20%;"><i class="fa fa-font"></i><label class="er_fld_label">Name:</label><input name="CST_70" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col2" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Gender:</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_73" value="Male">Male</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_73" value="Female">Female</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_73" value="Other:">Other:<input class="cst_Other" name="CST_73_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label">Date of Birth:</label><input name="CST_71" type="text" class="er_fld_width50"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label">Relationship:</label><input name="CST_72" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 20%;"><i class="fa fa-font"></i><label class="er_fld_label">Name:</label><input name="CST_74" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col2" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Gender:</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_81" value="Male">Male</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_81" value="Female">Female</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_81" value="Other:">Other:<input class="cst_Other" name="CST_81_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label">Date of Birth:</label><input name="CST_75" type="text" class="er_fld_width50"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label">Relationship:</label><input name="CST_76" type="text" class="er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 100%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">REFERENCES</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">Please list the names, addresses, phone numbers, and email addresses of three people you would like to use as character references (only people you have known for at least 1-year). Include one relative. Any information Christian Family Care gathers from these references will be held as confidential and not released to the applicant.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info">Reference # 1</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"><i class="fa fa-font"></i><label class="er_fld_label required">Name:</label><input name="CST_83" type="text" class="er_fld_required er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label required">Relationship to applicant:</label><input name="CST_84" type="text" class="er_fld_required er_fld_width100"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Email Address:</label><input name="CST_87" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label required">Phone Number:</label><input name="CST_85" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Address:</label><input name="CST_86" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info">Reference # 2</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"><i class="fa fa-font"></i><label class="er_fld_label required">Name:</label><input name="CST_88" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Relationship to applicant:</label><input name="CST_91" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label required">Email Address:</label><input name="CST_92" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Phone Number:</label><input name="CST_90" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Address:</label><input name="CST_89" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info">Reference # 3</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Name:</label><input name="CST_93" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Relationship to applicant:</label><input name="CST_94" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label required">Email Address:</label><input name="CST_96" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label required">Phone Number:</label><input name="CST_95" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Address:</label><input name="CST_97" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Signature:</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_100" value="By checking this box, I consent to sign this form electronically:">By checking this box, I consent to sign this form electronically:</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_100" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_100_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Printed Name:</label><input name="CST_101" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 100%;"><i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">**Please submit a current resume to MENTOR-CFC@erinbox.com**</div></li></ul>
Submit