29 |
> |
> |
30 |
<table width="90%" border="0" cellspacing="3" cellpadding="0" align="center"> |
<table width="90%" border="0" cellspacing="3" cellpadding="0" align="center"> |
31 |
<tr> |
<tr> |
32 |
<td><b>First Name</b>: </td> |
<td>{rinput name=first_name desc="First Name:"}</td> |
33 |
<td> |
<td> |
34 |
<input type="text" name="first_name" size="30"> |
{input type="text" name="first_name" size="30"} |
35 |
</td> |
</td> |
36 |
</tr> |
</tr> |
37 |
<tr> |
<tr> |
38 |
<td> <b>Last Name: </b></td> |
<td>{rinput name=last_name desc="Last Name:"}</b></td> |
39 |
<td> |
<td> |
40 |
<input type="text" name="last_name" size="30"> |
{input type="text" name="last_name" size="30"} |
41 |
</td> |
</td> |
42 |
</tr> |
</tr> |
43 |
<tr> |
<tr> |
44 |
<td><b>Address Line 1: </b></td> |
<td>{rinput name=address1 desc="Address Line 1:"}</td> |
45 |
<td> |
<td> |
46 |
<input type="text" name="address1" size="30"> |
{input type="text" name="address1" size="30"} |
47 |
</td> |
</td> |
48 |
</tr> |
</tr> |
49 |
<tr> |
<tr> |
50 |
<td><b>Address Line 2:</b></td> |
<td>Address Line 2:</td> |
51 |
<td> |
<td> |
52 |
<input type="text" name="address2" size="30"> |
<input type="text" name="address2" size="30"> |
53 |
</td> |
</td> |
54 |
</tr> |
</tr> |
55 |
<tr> |
<tr> |
56 |
<td><b>City:</b></td> |
<td>{rinput name=city desc="City:"}</td> |
57 |
<td> |
<td> |
58 |
<input type="text" name="city" size="30"> |
{input type="text" name="city" size="30"} |
59 |
</td> |
</td> |
60 |
</tr> |
</tr> |
61 |
<tr> |
<tr> |
62 |
<td><b>State/Province:</b></td> |
<td>State/Province:</td> |
63 |
<td> |
<td> |
64 |
<input type="text" name="state" size="30"> |
<input type="text" name="state" size="30"> |
65 |
</td> |
</td> |
66 |
</tr> |
</tr> |
67 |
<tr> |
<tr> |
68 |
<td><b>ZIP/Postal Code: </b></td> |
<td>{rinput name=zip desc="ZIP/Postal Code:"}</td> |
69 |
<td> |
<td> |
70 |
<input type="text" name="zip" size="30"> |
{input type="text" name="zip" size="30"} |
71 |
</td> |
</td> |
72 |
</tr> |
</tr> |
73 |
<tr> |
<tr> |
82 |
</td> |
</td> |
83 |
</tr> |
</tr> |
84 |
<tr> |
<tr> |
85 |
<td><b>Email Address: </b> </td> |
<td>{rinput name=email desc="Email Address:"}</td> |
86 |
<td> |
<td> |
87 |
<input type="text" name="email" size="30"> |
{input type="email" name="email" size="30"} |
88 |
</td> |
</td> |
89 |
</tr> |
</tr> |
90 |
<tr> |
<tr> |
91 |
<td><b>Telephone:</b> |
<td>{rinput name=tel desc="Telephone:"}</td> |
|
</td> |
|
92 |
<td> |
<td> |
93 |
<input type="text" name="tel" size="30"> |
{input type="text" name="tel" size="30"} |
94 |
</td> |
</td> |
95 |
</tr> |
</tr> |
96 |
<tr> |
<tr> |
100 |
<input type="radio" name="purpose" value="scholarship"> |
<input type="radio" name="purpose" value="scholarship"> |
101 |
Interested in scholarship. |
Interested in scholarship. |
102 |
<br> |
<br> |
103 |
<input type="radio" name="purpose" value="open position"> |
<input type="radio" name="purpose" value="open position" {if $position}checked{/if}> |
104 |
Interested in current open position. |
Interested in |
105 |
|
{if $position} |
106 |
|
open position {$position.title} at {$position.location} |
107 |
|
{else} |
108 |
|
current open position. |
109 |
|
{/if} |
110 |
<br> |
<br> |
111 |
<input type="radio" name="purpose" value="joining PLIVA"> |
<input type="radio" name="purpose" value="joining PLIVA"> |
112 |
Interested in joining PLIVA. |
Interested in joining PLIVA. |
113 |
</p> |
</p> |
114 |
|
{if $position} |
115 |
|
<input type="hidden" name="open_position" value="{$position.title}/{$position.job_code}/{$position.department}/{$position.location}"> |
116 |
|
{/if} |
117 |
</td> |
</td> |
118 |
</tr> |
</tr> |
119 |
<tr> |
<tr> |
138 |
</tr> |
</tr> |
139 |
<tr> |
<tr> |
140 |
<td colspan="2" valign="top"> |
<td colspan="2" valign="top"> |
141 |
<div align="left"><b>Comments:</b> |
<div align="left">Comments: |
142 |
<br> |
<br> |
143 |
<textarea name="comments" rows=5 cols=55></textarea> |
<textarea name="comments" rows=5 cols=40></textarea> |
144 |
</div> |
</div> |
145 |
</td> |
</td> |
146 |
</tr> |
</tr> |
147 |
<tr> |
<tr> |
148 |
<td colspan="2" valign="top" align="center"><b>Attach Résumé:</b> |
<td colspan="2" valign="top"><b>Attach Résumé:</b> |
149 |
<INPUT TYPE="hidden" name="MAX_FILE_SIZE" value="4000000"> |
<INPUT TYPE="hidden" name="MAX_FILE_SIZE" value="4000000"> |
150 |
<input type="file" name="resume" size=30> |
<input type="file" name="resume" size=30> |
151 |
<br><div class="silver">Maximum size of résumé is 4000000 bytes!</div> |
<br><div class="silver">Maximum size of résumé is 4000000 bytes!</div> |