{"id":291,"date":"2026-04-16T20:47:56","date_gmt":"2026-04-16T20:47:56","guid":{"rendered":"https:\/\/fleetgenius-teamforms.com\/?page_id=291"},"modified":"2026-04-16T20:47:56","modified_gmt":"2026-04-16T20:47:56","slug":"personnel-action-form","status":"publish","type":"page","link":"https:\/\/fleetgenius-teamforms.com\/index.php\/personnel-action-form\/","title":{"rendered":"Personnel Action Form"},"content":{"rendered":"<style id=\"wpforms-css-vars-219-block-35b6ed45-c1a7-4d93-b184-743c84944cdd\">\n\t\t\t\t#wpforms-219.wpforms-block-35b6ed45-c1a7-4d93-b184-743c84944cdd {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-35b6ed45-c1a7-4d93-b184-743c84944cdd wpforms-render-modern\" id=\"wpforms-219\"><form id=\"wpforms-form-219\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"219\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/291\" data-token=\"f7fdad7cd510854f5751ff1a1f226a03\" data-token-time=\"1787526839\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-219-field_1-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"1\"><div id=\"wpforms-219-field_1\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-219-field_1-error\"><div>\n<div class=\"sc-ilsqYI btmdxU\">\n<div class=\"sc-bTFmqi iHsZsg\">\n<div class=\"sc-fuNSHy gHScgJ\">\n<div class=\"sc-fKFIqR bPvHGa\">\n<div class=\"sc-cazNlz fYHZhH\">\n<div class=\"sc-hfNCTQ drlqOF\">\n<div class=\"FieldDropZoneContainer\">\n<h3 class=\"FieldDropTarget paired vertical\"><strong>**TO BE COMPLETED BY MANAGER**\u00a0<\/strong><\/h3>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"ReactModalPortal\">\n<div class=\"ReactModal__Overlay ReactModal__Overlay--after-open phx-Modal-overlay phx-Modal-overlay-fullScreen\">\n<div class=\"ReactModal__Content ReactModal__Content--after-open sc-eQaGpr hATZeP phx-Modal phx-Modal--fullScreen\">\n<div class=\"sc-goiVcJ lcfwtj phx-ModalContent\">\n<div class=\"sc-hufbNW DKwDE\">\n<div class=\"fr-box fr-basic fr-top\">\n<div class=\"fr-wrapper\">\n<div class=\"fr-element fr-view\">\n<p><strong>Use this form for all New Team Member\/ Current Team Member Changes<\/strong><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-219-field_2-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_2\">Region <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-219-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Four Corners\"  class=\"choice-1 depth-1\"  >Four Corners<\/option><option value=\"Midwest\"  class=\"choice-2 depth-1\"  >Midwest<\/option><option value=\"Mid-Atlantic\"  class=\"choice-3 depth-1\"  >Mid-Atlantic<\/option><option value=\"Northeast\"  class=\"choice-4 depth-1\"  >Northeast<\/option><option value=\"PNW\"  class=\"choice-9 depth-1\"  >PNW<\/option><option value=\"Southeast\"  class=\"choice-5 depth-1\"  >Southeast<\/option><option value=\"SCA\"  class=\"choice-6 depth-1\"  >SCA<\/option><option value=\"Texas\"  class=\"choice-7 depth-1\"  >Texas<\/option><option value=\"Test\"  class=\"choice-8 depth-1\"  >Test<\/option><\/select><\/div><div id=\"wpforms-219-field_54-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_54\">Location <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-219-field_54\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][54]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Admin\"  class=\"choice-5 depth-1\"  >Admin<\/option><option value=\"Atlanta South\"  class=\"choice-6 depth-1\"  >Atlanta South<\/option><option value=\"Augusta\"  class=\"choice-7 depth-1\"  >Augusta<\/option><option value=\"CAC\"  class=\"choice-8 depth-1\"  >CAC<\/option><option value=\"Colorado Springs\"  class=\"choice-9 depth-1\"  >Colorado Springs<\/option><option value=\"Corona\"  class=\"choice-10 depth-1\"  >Corona<\/option><option value=\"Denver\"  class=\"choice-11 depth-1\"  >Denver<\/option><option value=\"El Cajon\"  class=\"choice-12 depth-1\"  >El Cajon<\/option><option value=\"Elma Metal\"  class=\"choice-13 depth-1\"  >Elma Metal<\/option><option value=\"Greeley\"  class=\"choice-14 depth-1\"  >Greeley<\/option><option value=\"Jackson\"  class=\"choice-15 depth-1\"  >Jackson<\/option><option value=\"Kent\"  class=\"choice-16 depth-1\"  >Kent<\/option><option value=\"Lake City\"  class=\"choice-17 depth-1\"  >Lake City<\/option><option value=\"Lancaster\"  class=\"choice-18 depth-1\"  >Lancaster<\/option><option value=\"Largo\"  class=\"choice-19 depth-1\"  >Largo<\/option><option value=\"Lacey\"  class=\"choice-20 depth-1\"  >Lacey<\/option><option value=\"Moreno Valley\"  class=\"choice-21 depth-1\"  >Moreno Valley<\/option><option value=\"Norcross\"  class=\"choice-22 depth-1\"  >Norcross<\/option><option value=\"Oceanside\"  class=\"choice-23 depth-1\"  >Oceanside<\/option><option value=\"Orange County\"  class=\"choice-24 depth-1\"  >Orange County<\/option><option value=\"Phoenix\"  class=\"choice-25 depth-1\"  >Phoenix<\/option><option value=\"Rochester\"  class=\"choice-26 depth-1\"  >Rochester<\/option><option value=\"Seattle\"  class=\"choice-27 depth-1\"  >Seattle<\/option><option value=\"Tampa - Special Projects Southeast\"  class=\"choice-28 depth-1\"  >Tampa &#8211; Special Projects Southeast<\/option><option value=\"Tucson\"  class=\"choice-29 depth-1\"  >Tucson<\/option><option value=\"West Palm\"  class=\"choice-30 depth-1\"  >West Palm<\/option><option value=\"Winston-Salem\"  class=\"choice-31 depth-1\"  >Winston-Salem<\/option><\/select><\/div><div id=\"wpforms-219-field_4-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_4\">Effective Date of Action <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-219-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][4][date]\" aria-errormessage=\"wpforms-219-field_4-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-219-field_5-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"5\"><div id=\"wpforms-219-field_5\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-219-field_5-error\"><p><strong>Please Note:<\/strong><\/p>\n<p>&#8211; The payroll cycle runs from Monday &#8211; Sunday.<br \/>\n&#8211; The effective date of this PAF will be the upcoming Monday.<br \/>\n&#8211; Pending management&#8217;s approval, the PAF change\/update\/increase will be paid out the following week.<br \/>\n&#8211; Approval line chain: Site Manager submits, Regional Manager approves, VP is final approval.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-219-field_6-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Action Type <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_6_1\" name=\"wpforms[fields][6]\" value=\"New Hire\" aria-errormessage=\"wpforms-219-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_6_1\">New Hire<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_6_2\" name=\"wpforms[fields][6]\" value=\"Re-Hire\" aria-errormessage=\"wpforms-219-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_6_2\">Re-Hire<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_6_3\" name=\"wpforms[fields][6]\" value=\"Termination\" aria-errormessage=\"wpforms-219-field_6_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_6_3\">Termination<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_6_4\" name=\"wpforms[fields][6]\" value=\"Pay Change\" aria-errormessage=\"wpforms-219-field_6_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_6_4\">Pay Change<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_6_5\" name=\"wpforms[fields][6]\" value=\"Position Change\" aria-errormessage=\"wpforms-219-field_6_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_6_5\">Position Change<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_6_6\" name=\"wpforms[fields][6]\" value=\"Leave of Absence\" aria-errormessage=\"wpforms-219-field_6_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_6_6\">Leave of Absence<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_6_7\" name=\"wpforms[fields][6]\" value=\"Return from Leave\" aria-errormessage=\"wpforms-219-field_6_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_6_7\">Return from Leave<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_56-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"56\" style=\"display:none;\"><div id=\"wpforms-219-field_56\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-219-field_56-error\"><p>PAF submissions for <strong>Terminations<\/strong> is disabled. Managers\/supervisors can now process a termination <strong>directly in Paycor<\/strong>. Below are the steps for submitting the termination via Paycor. Should you need assistance with a termination, please contact <strong>Human Resources<\/strong>.<\/p>\n<p>HR will be notified when a termination is submitted. HR will review and approve accordingly. Managers\/supervisors will receive an email notification confirming when termination workflow is approved.<\/p>\n<p>1. On the team member\u2019s Summary screen in Paycor, in the left menu, select\u202f<b>Status Changes<\/b>.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-535\" src=\"https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture1.png\" alt=\"\" width=\"792\" height=\"358\" srcset=\"https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture1.png 396w, https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture1-300x136.png 300w\" sizes=\"auto, (max-width: 792px) 100vw, 792px\" \/><\/p>\n<p>2. Select\u202f<b>Actions,<\/b>\u202fthen select\u202f<b>Terminate<\/b><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-536\" src=\"https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture2.png\" alt=\"\" width=\"792\" height=\"319\" srcset=\"https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture2.png 405w, https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture2-300x121.png 300w\" sizes=\"auto, (max-width: 792px) 100vw, 792px\" \/><\/p>\n<p><b>Termination Details\u00a0<\/b><\/p>\n<ul>\n<li>Only do the\u00a0highlighted.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-537\" src=\"https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture3.png\" alt=\"\" width=\"792\" height=\"484\" srcset=\"https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture3.png 380w, https:\/\/fleetgenius-teamforms.com\/wp-content\/uploads\/2026\/08\/Picture3-300x183.png 300w\" sizes=\"auto, (max-width: 792px) 100vw, 792px\" \/><\/p>\n<ol>\n<li><b>Enter\u202fteam member\u2019s last day\u202f(termination date).<\/b>\u00a0The termination day will primarily be the last day worked, or the date\u00a0you were notified the\u00a0member was not returning\/the company ended employment.\u00a0The system shows when the inactive period starts based on what\u00a0date you enter.<\/li>\n<li><b>Choose a\u202fTermination\u00a0Reason\u202ffrom the list.<br \/>\n<\/b> <span style=\"color:#ff0000\">Do not use any termination reasons that begin with \u201czDNU.\u201d\u00a0<\/span><\/li>\n<li><b>Select\u00a0kind\u00a0of termination:<br \/>\n<\/b> Voluntary:\u202fthe\u00a0team\u00a0member\u00a0chose\u00a0to end employment.<br \/>\nInvoluntary:\u202fthe\u00a0company\u00a0ended employment.<\/li>\n<li><b>Indicate \u201cEligibility for Rehire\u201d.<br \/>\n<\/b> If\u00a0eligibility is <strong>\u201cN<\/strong><b>o\u201d<\/b>\u00a0or\u00a0<strong>\u201c<\/strong><b>Conditional\u201d\u00a0<\/b>please indicate why within your comments added to the \u201cNotes\u201d section.<\/li>\n<li>Notes should be added which support the submitted termination. HR will review to validate the termination reason used.<\/li>\n<li>Submit Termination\n<ol>\n<li>The next screen\u00a0is to\u00a0indicate\u00a0if you will be filling the vacant position. If\u00a0you plan to hire for the position, select \u201cYes\u201d\u00a0to\u00a0add the now vacant job as a\u202f<b>Draft Job<\/b>\u202fin the Paycor Applicant Tracking System\u00a0(ATS), also referred to as\u00a0Paycor Recruiting.\u00a0Otherwise select \u201cNo.\u201d<\/li>\n<li>If yes,\u00a0indicate\u00a0the date you wish to fill the position by\u00a0(\u201cTarget Fill Date\u201d), and add any comments you\u00a0may have for the recruiter.<\/li>\n<li>Select <strong>Submit Termination<\/strong>.<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<p><b>Email all supporting documentation for the termination to hr@fleetgenius.com.<\/b><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-219-field_7-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"7\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_7\">Transfer From <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-219-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-219-field_7-error\" required><\/div><div id=\"wpforms-219-field_8-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"8\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_8\">Transfer To <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-219-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-219-field_8-error\" required><\/div><div id=\"wpforms-219-field_9-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"9\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Is this a &quot;Safety Sensitive&quot; position?<\/legend><ul id=\"wpforms-219-field_9\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_9_1\" name=\"wpforms[fields][9]\" value=\"Yes\" aria-errormessage=\"wpforms-219-field_9_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_9_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_9_2\" name=\"wpforms[fields][9]\" value=\"No\" aria-errormessage=\"wpforms-219-field_9_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_9_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_10-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"10\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Is the position &quot;Safety Incentive Program&quot; eligible? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_10\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_10_1\" name=\"wpforms[fields][10]\" value=\"Yes\" aria-errormessage=\"wpforms-219-field_10_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_10_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_10_2\" name=\"wpforms[fields][10]\" value=\"No\" aria-errormessage=\"wpforms-219-field_10_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_10_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_51-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"51\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Addition to staff or replacement? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_51\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_51_1\" name=\"wpforms[fields][51]\" value=\"Addition to staff\" aria-errormessage=\"wpforms-219-field_51_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_51_1\">Addition to staff<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_51_2\" name=\"wpforms[fields][51]\" value=\"Replacement\" aria-errormessage=\"wpforms-219-field_51_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_51_2\">Replacement<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-219-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-219-field_3\" >FLSA Job Location<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-219-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-219-field_52-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"52\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">If replacement, provide name of team member being replaced <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-219-field_52\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][52][first]\" aria-errormessage=\"wpforms-219-field_52-error\" required><label for=\"wpforms-219-field_52\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-219-field_52-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][52][last]\" aria-errormessage=\"wpforms-219-field_52-last-error\" required><label for=\"wpforms-219-field_52-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-219-field_11-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"divider\" data-field-id=\"11\"><h3 id=\"wpforms-219-field_11\" aria-errormessage=\"wpforms-219-field_11-error\">Team Member Information<\/h3><\/div><div id=\"wpforms-219-field_12-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"name\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Team Member Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-219-field_12\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][12][first]\" aria-errormessage=\"wpforms-219-field_12-error\" required><label for=\"wpforms-219-field_12\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-219-field_12-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][12][middle]\" aria-errormessage=\"wpforms-219-field_12-middle-error\" ><label for=\"wpforms-219-field_12-middle\" class=\"wpforms-field-sublabel after\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-219-field_12-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][12][last]\" aria-errormessage=\"wpforms-219-field_12-last-error\" required><label for=\"wpforms-219-field_12-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-219-field_13-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"number\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_13\">Team Member Number<\/label><input type=\"number\" id=\"wpforms-219-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" step=\"any\" aria-errormessage=\"wpforms-219-field_13-error\" ><\/div><div id=\"wpforms-219-field_14-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"phone\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_14\">Home Phone<\/label><input type=\"tel\" id=\"wpforms-219-field_14\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][14]\" aria-label=\"Home Phone\" aria-errormessage=\"wpforms-219-field_14-error\" ><\/div><div id=\"wpforms-219-field_15-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"phone\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_15\">Cell Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-219-field_15\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][15]\" aria-label=\"Cell Phone\" aria-errormessage=\"wpforms-219-field_15-error\" required><\/div><div id=\"wpforms-219-field_16-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"radio\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">Gender<\/legend><ul id=\"wpforms-219-field_16\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_16_1\" name=\"wpforms[fields][16]\" value=\"Male\" aria-errormessage=\"wpforms-219-field_16_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_16_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_16_2\" name=\"wpforms[fields][16]\" value=\"Female\" aria-errormessage=\"wpforms-219-field_16_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_16_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_17-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"17\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_17\">Referred By (if applicable)<\/label><input type=\"text\" id=\"wpforms-219-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-219-field_17-error\" ><\/div><div id=\"wpforms-219-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"18\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Will the team member be using a company or personal phone? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_18_1\" name=\"wpforms[fields][18]\" value=\"Company\" aria-errormessage=\"wpforms-219-field_18_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_18_1\">Company<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_18_2\" name=\"wpforms[fields][18]\" value=\"Personal\" aria-errormessage=\"wpforms-219-field_18_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_18_2\">Personal<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_19-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"email\" data-field-id=\"19\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_19\">Team Member\/Candidate&#039;s Personal Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-219-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" spellcheck=\"false\" aria-errormessage=\"wpforms-219-field_19-error\" required><\/div><div id=\"wpforms-219-field_20-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"20\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Is a company phone available to them? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_20_1\" name=\"wpforms[fields][20]\" value=\"Yes\" aria-errormessage=\"wpforms-219-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_20_2\" name=\"wpforms[fields][20]\" value=\"No\" aria-errormessage=\"wpforms-219-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_20_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_21-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Was team member using a company or personal phone? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_21_1\" name=\"wpforms[fields][21]\" value=\"Company\" aria-errormessage=\"wpforms-219-field_21_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_21_1\">Company<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_21_2\" name=\"wpforms[fields][21]\" value=\"Personal\" aria-errormessage=\"wpforms-219-field_21_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_21_2\">Personal<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_22-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"22\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_22\">Company Phone Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-219-field_22\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][22]\" aria-label=\"Company Phone Number\" aria-errormessage=\"wpforms-219-field_22-error\" required><\/div><div id=\"wpforms-219-field_23-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"divider\" data-field-id=\"23\"><h3 id=\"wpforms-219-field_23\" aria-errormessage=\"wpforms-219-field_23-error\">Position Information<\/h3><\/div><div id=\"wpforms-219-field_24-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_24\">Job Title <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-219-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Driver\"  class=\"choice-1 depth-1\"  >Driver<\/option><option value=\"CDL Driver\"  class=\"choice-2 depth-1\"  >CDL Driver<\/option><option value=\"Delivery Truck Driver\"  class=\"choice-19 depth-1\"  >Delivery Truck Driver<\/option><option value=\"Hybrid Driver\"  class=\"choice-3 depth-1\"  >Hybrid Driver<\/option><option value=\"Lead Driver\"  class=\"choice-4 depth-1\"  >Lead Driver<\/option><option value=\"CSR Routing\"  class=\"choice-6 depth-1\"  >CSR Routing<\/option><option value=\"Dispatch\"  class=\"choice-7 depth-1\"  >Dispatch<\/option><option value=\"IT Specialist\"  class=\"choice-9 depth-1\"  >IT Specialist<\/option><option value=\"Site Manager\"  class=\"choice-13 depth-1\"  >Site Manager<\/option><option value=\"Assistant Site Manager\"  class=\"choice-18 depth-1\"  >Assistant Site Manager<\/option><option value=\"Site Lead\"  class=\"choice-21 depth-1\"  >Site Lead<\/option><option value=\"Welder\"  class=\"choice-14 depth-1\"  >Welder<\/option><option value=\"Yard Labor\"  class=\"choice-15 depth-1\"  >Yard Labor<\/option><option value=\"Yard Lead\"  class=\"choice-20 depth-1\"  >Yard Lead<\/option><option value=\"Yard Maint Tech\"  class=\"choice-16 depth-1\"  >Yard Maint Tech<\/option><option value=\"Other\"  class=\"choice-17 depth-1\"  >Other<\/option><\/select><\/div><div id=\"wpforms-219-field_53-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"53\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_53\">If Other, please specify Job Title <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-219-field_53\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][53]\" aria-errormessage=\"wpforms-219-field_53-error\" required><\/div><div id=\"wpforms-219-field_35-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"35\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_35\">New Pay Rate <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-219-field_35\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][35]\" step=\"any\" aria-errormessage=\"wpforms-219-field_35-error\" required><\/div><div id=\"wpforms-219-field_36-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"36\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_36\">Previous Pay Rate <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-219-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" step=\"any\" aria-errormessage=\"wpforms-219-field_36-error\" required><\/div><div id=\"wpforms-219-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"radio\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Company Driving Privileges <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_28_1\" name=\"wpforms[fields][28]\" value=\"Yes\" aria-errormessage=\"wpforms-219-field_28_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_28_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_28_2\" name=\"wpforms[fields][28]\" value=\"No\" aria-errormessage=\"wpforms-219-field_28_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_28_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_29-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-hide wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_29\">License Type<\/label><select id=\"wpforms-219-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Regular License\"  class=\"choice-1 depth-1\"  >Regular License<\/option><option value=\"Commercial License (A)\"  class=\"choice-2 depth-1\"  >Commercial License (A)<\/option><option value=\"Commercial License (B)\"  class=\"choice-3 depth-1\"  >Commercial License (B)<\/option><\/select><\/div><div id=\"wpforms-219-field_30-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"name\" data-field-id=\"30\"><fieldset><legend class=\"wpforms-field-label\">Manager Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-219-field_30\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][30][first]\" aria-errormessage=\"wpforms-219-field_30-error\" required><label for=\"wpforms-219-field_30\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-219-field_30-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][30][last]\" aria-errormessage=\"wpforms-219-field_30-last-error\" required><label for=\"wpforms-219-field_30-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-219-field_31-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"email\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_31\">Manager Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-219-field_31\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][31]\" spellcheck=\"false\" aria-errormessage=\"wpforms-219-field_31-error\" required><\/div><div id=\"wpforms-219-field_32-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"radio\" data-field-id=\"32\"><fieldset><legend class=\"wpforms-field-label\">FLSA Status <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_32\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_32_1\" name=\"wpforms[fields][32]\" value=\"Hourly\" aria-errormessage=\"wpforms-219-field_32_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_32_1\">Hourly<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_32_2\" name=\"wpforms[fields][32]\" value=\"Salary\" aria-errormessage=\"wpforms-219-field_32_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_32_2\">Salary<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_33-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"33\"><fieldset><legend class=\"wpforms-field-label\">Team Member Type <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-219-field_33\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_33_1\" name=\"wpforms[fields][33]\" value=\"Full Time\" aria-errormessage=\"wpforms-219-field_33_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_33_1\">Full Time<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_33_2\" name=\"wpforms[fields][33]\" value=\"Part Time\" aria-errormessage=\"wpforms-219-field_33_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_33_2\">Part Time<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_33_3\" name=\"wpforms[fields][33]\" value=\"Temp\" aria-errormessage=\"wpforms-219-field_33_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_33_3\">Temp<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_34-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"34\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_34\">Part Time Hours per Week<\/label><input type=\"number\" id=\"wpforms-219-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" step=\"any\" aria-errormessage=\"wpforms-219-field_34-error\" ><\/div><div id=\"wpforms-219-field_37-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_37\">Temp Date From<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-219-field_37\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][37][date]\" aria-errormessage=\"wpforms-219-field_37-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-219-field_38-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"38\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_38\">Temp Date To<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-219-field_38\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][38][date]\" aria-errormessage=\"wpforms-219-field_38-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-219-field_39-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"39\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Stop Pay Reason<\/legend><ul id=\"wpforms-219-field_39\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_39_2\" name=\"wpforms[fields][39]\" value=\"Leave of Absence\" aria-errormessage=\"wpforms-219-field_39_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_39_2\">Leave of Absence<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_39_3\" name=\"wpforms[fields][39]\" value=\"Military Service\" aria-errormessage=\"wpforms-219-field_39_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_39_3\">Military Service<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_39_4\" name=\"wpforms[fields][39]\" value=\"Other\" aria-errormessage=\"wpforms-219-field_39_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_39_4\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_40-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"40\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_40\">Other Stop Pay Reason <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-219-field_40\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-219-field_40-error\" required><\/div><div id=\"wpforms-219-field_41-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"41\"><fieldset><legend class=\"wpforms-field-label\">Separation Reason<\/legend><ul id=\"wpforms-219-field_41\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_41_1\" name=\"wpforms[fields][41]\" value=\"Voluntary\" aria-errormessage=\"wpforms-219-field_41_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_41_1\">Voluntary<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_41_2\" name=\"wpforms[fields][41]\" value=\"Laid Off\" aria-errormessage=\"wpforms-219-field_41_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_41_2\">Laid Off<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_41_3\" name=\"wpforms[fields][41]\" value=\"Discharged for Cause\" aria-errormessage=\"wpforms-219-field_41_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_41_3\">Discharged for Cause<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_42-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"42\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_42\">Discharged Reason<\/label><input type=\"text\" id=\"wpforms-219-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" aria-errormessage=\"wpforms-219-field_42-error\" ><\/div><div id=\"wpforms-219-field_43-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"43\"><fieldset><legend class=\"wpforms-field-label\">Eligible for Rehire?<\/legend><ul id=\"wpforms-219-field_43\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_43_1\" name=\"wpforms[fields][43]\" value=\"Yes\" aria-errormessage=\"wpforms-219-field_43_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_43_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_43_2\" name=\"wpforms[fields][43]\" value=\"No\" aria-errormessage=\"wpforms-219-field_43_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_43_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-219-field_43_3\" name=\"wpforms[fields][43]\" value=\"Conditional\" aria-errormessage=\"wpforms-219-field_43_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-219-field_43_3\">Conditional<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-219-field_44-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"44\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_44\">Conditional Reason<\/label><input type=\"text\" id=\"wpforms-219-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-219-field_44-error\" ><\/div><div id=\"wpforms-219-field_45-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"textarea\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_45\">Additional Notes<\/label><textarea id=\"wpforms-219-field_45\" class=\"wpforms-field-medium\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-219-field_45-error\" ><\/textarea><\/div><div id=\"wpforms-219-field_46-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-hide wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-219-field_46\">Submitting Manager <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-219-field_46\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][46]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Angie De Winter\"  class=\"choice-1 depth-1\"  >Angie De Winter<\/option><option value=\"Carlos Ruiz\"  class=\"choice-9 depth-1\"  >Carlos Ruiz<\/option><option value=\"Chelsie White\"  class=\"choice-59 depth-1\"  >Chelsie White<\/option><option value=\"David Gross\"  class=\"choice-12 depth-1\"  >David Gross<\/option><option value=\"David Van Evera\"  class=\"choice-13 depth-1\"  >David Van Evera<\/option><option value=\"Donna Anderson\"  class=\"choice-54 depth-1\"  >Donna Anderson<\/option><option value=\"Eric Nims\"  class=\"choice-15 depth-1\"  >Eric Nims<\/option><option value=\"Henry Pettis\"  class=\"choice-19 depth-1\"  >Henry Pettis<\/option><option value=\"Ignacio Martinez\"  class=\"choice-21 depth-1\"  >Ignacio Martinez<\/option><option value=\"Jerramie Argo\"  class=\"choice-26 depth-1\"  >Jerramie Argo<\/option><option value=\"Joe Galindo\"  class=\"choice-27 depth-1\"  >Joe Galindo<\/option><option value=\"Joe Gosnell\"  class=\"choice-28 depth-1\"  >Joe Gosnell<\/option><option value=\"Jorge Zavala\"  class=\"choice-32 depth-1\"  >Jorge Zavala<\/option><option value=\"Joseph Rock\"  class=\"choice-60 depth-1\"  >Joseph Rock<\/option><option value=\"Justin Cyphers\"  class=\"choice-33 depth-1\"  >Justin Cyphers<\/option><option value=\"Matthew McCleary\"  class=\"choice-36 depth-1\"  >Matthew McCleary<\/option><option value=\"Matthew Michaelis\"  class=\"choice-37 depth-1\"  >Matthew Michaelis<\/option><option value=\"Mike Hinkley\"  class=\"choice-55 depth-1\"  >Mike Hinkley<\/option><option value=\"Mike Hokett\"  class=\"choice-40 depth-1\"  >Mike Hokett<\/option><option value=\"Robert Miller\"  class=\"choice-44 depth-1\"  >Robert Miller<\/option><option value=\"Rowell Zara\"  class=\"choice-58 depth-1\"  >Rowell Zara<\/option><option value=\"Saddi Palma\"  class=\"choice-56 depth-1\"  >Saddi Palma<\/option><option value=\"Sheldon Monsegue\"  class=\"choice-48 depth-1\"  >Sheldon Monsegue<\/option><option value=\"Sky Tallabas\"  class=\"choice-49 depth-1\"  >Sky Tallabas<\/option><option value=\"Ward Orzech\"  class=\"choice-52 depth-1\"  >Ward Orzech<\/option><\/select><\/div><div id=\"wpforms-219-field_47-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-hide\" 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