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<table width="90%" border="0" cellspacing="3" cellpadding="0" align="center"> |
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<tr> |
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<td colspan="2"> |
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<div align="center"><img src="t/application_form.gif" width="269" height="16"></div> |
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</td> |
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</tr> |
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<tr> |
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<td colspan="2"> |
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<div align="center"> |
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<p align="left">To |
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apply for a position with PLIVA, please follow the instructions below:</p> |
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</div> |
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<ol> |
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<li>Complete |
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the contact information fields.</li> |
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<li>Select |
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a job position/location.</li> |
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<li>Enter |
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your cover letter with your recent salary history in the comments |
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section.</li> |
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<li>Attach |
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your résumé (preferably in MS Word or PDF format).</li> |
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<li>Click |
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Submit.</li> |
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<li>All |
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fields in <b>bold</b> are required</li> |
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</ol> |
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</td> |
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</tr> |
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<tr> |
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<td colspan="2"> </td> |
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</tr> |
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</table> |
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<form method="post" action=""> |
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<table width="90%" border="0" cellspacing="3" cellpadding="0" align="center"> |
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<tr> |
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<td width="26%"><b>First |
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Name</b>: </td> |
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<td> |
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<input type="text" name="textfield"> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%"> <b>Last |
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Name: </b></td> |
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<td> |
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<input type="text" name="textfield2"> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%"><b>Address |
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Line 1: </b></td> |
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<td> |
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<input type="text" name="textfield3"> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%"><b>Address |
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Line 2:</b></td> |
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<td> |
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<input type="text" name="textfield4"> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%"><b>City:</b></td> |
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<td> |
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<input type="text" name="textfield5"> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%"><b>State/Province:</b></td> |
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<td> |
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<input type="text" name="textfield6"> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%"><b>ZIP/Postal |
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Code: </b></td> |
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<td> |
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<input type="text" name="textfield7"> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%"><b>Country: |
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</b></td> |
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<td> |
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<select name="country" size="1"> |
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<option value="" selected>-- Select Your Country --</option> |
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{section name=c loop=$countries} |
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<option value="{$c/countries.iso}">{$c/countries.name}</option> |
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{/section} |
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</select> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%" height="22"><b>Email |
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Address: </b> </td> |
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<td height="22"> |
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<input type="text" name="textfield8"> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%"><b>Telephone:</b> |
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</td> |
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<td> |
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<input type="text" name="textfield9"> |
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</td> |
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</tr> |
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</table> |
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<table width="90%" border="0" cellspacing="3" cellpadding="0" align="center"> |
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<tr> |
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<td height="5" width="26%"> |
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<p> </p> |
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</td> |
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<td width="74%" height="2"> </td> |
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</tr> |
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<tr> |
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<td colspan="2" valign="top" height="117"> |
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<p align="left"><b>Purpose |
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of application: </b></p> |
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<p align="left"> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Interested in scholarship.</p> |
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<p align="left"> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Interested in current open position.</p> |
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<p align="left"> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Interested in joining PLIVA .</p> |
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</td> |
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</tr> |
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<tr> |
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<td width="26%" valign="top" height="7"> |
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<p> </p> |
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</td> |
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<td width="74%" valign="top" height="7"> </td> |
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</tr> |
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<tr> |
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<td colspan="2" valign="top" height="31"> |
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<p><b>Interest |
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in PLIVA via:</b></p> |
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<p> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Website</p> |
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<p> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Newspapers</p> |
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<p> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Television</p> |
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<p> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Company presentation</p> |
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<p> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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PLIVA product</p> |
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<p> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Friend</p> |
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<p> |
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<input type="radio" name="radiobutton" value="radiobutton"> |
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Other: |
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<input type="text" name="textfield10"> |
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</p> |
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</td> |
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</tr> |
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<tr> |
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<td colspan="2" valign="top" height="31"> </td> |
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</tr> |
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<tr> |
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<td width="26%" valign="top" height="31"> |
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<div align="left"><b>Comments:</b> |
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<textarea name="textfield11"></textarea> |
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</div> |
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</td> |
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<td width="74%" valign="top" height="31"> </td> |
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</tr> |
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<tr> |
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<td colspan="2" valign="top" height="31"> </td> |
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</tr> |
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<tr> |
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<td colspan="2" valign="top" height="31"><b>Attach |
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Résumé:</b> |
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<input type="file" name="file"> |
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<input type="submit" name="Submit" value="Submit File"> |
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</td> |
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</tr> |
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<tr> |
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<td colspan="2" valign="top" height="31"> |
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<div align="center"> |
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<input type="submit" name="Submit2" value="Submit"> |
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</div> |
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</td> |
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</tr> |
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</table> |
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<p> </p> |
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</form> |
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