Ready-to-use Employment Application form

This form is completely customizable!
JavaScript validates required fields; plus there is a verification on the server-side.
Captcha image protects the form against SPAM.
Captcha image can be reloaded.
There are many styles of Captcha image available.

How to use free BasicCaptcha code

1. Copy and paste the code below into your webpage.

2. Change the email address your@email.com to your own email address.

3. Change the return address http://www.YourWebsiteAddress.com/ThankYouPage.htm to your website address.

4. You can also change the email subject - Employment Application.

Warning: BasicCaptcha image has a link pointing to our site and promoting us; you must not remove the link, otherwise your site will be automatically banned in few days without warning. Do not add nofollow attribute!
If you don't like having a link then consider using our ProCaptcha form instead - click here.

<h2>Employment Application</h2>
<script type="text/javascript">
function ValidateForm(frm) {
if (frm.First_Name.value == "") {alert('First name is required.');frm.First_Name.focus();return false;}
if (frm.Last_Name.value == "") {alert('Last name is required.');frm.Last_Name.focus();return false;}
if (frm.Email_Address.value == "") {alert('Email address is required.');frm.Email_Address.focus();return false;}
if (frm.Email_Address.value.indexOf("@") < 1 || frm.Email_Address.value.indexOf(".") < 1) {alert('Please enter a valid email address.');frm.Email_Address.focus();return false;}
if (frm.Position.value == "") {alert('Position is required.');frm.Position.focus();return false;}
if (frm.Phone.value == "") {alert('Phone is required.');frm.Phone.focus();return false;}
if (frm.skip_CaptchaCode.value == "") {alert('Enter security code.');frm.skip_CaptchaCode.focus();return false;}
return true; }
function ReloadCaptchaImage(captchaImageId) {
var obj = document.getElementById(captchaImageId);
var src = '' + obj.src;
obj.src = '';
var date = new Date();
var pos = src.indexOf('&rad=');
if (pos >= 0) { src = src.substr(0, pos); }
obj.src = src + '&rad=' + date.getTime();
return false; }
</script>
<hr />
<form action="https://www.SnapHost.com/captcha/send.aspx" id="ContactUsCaptchaWebForm" method="post" onsubmit="return ValidateForm(this);" target="_top">
<input id="skip_WhereToSend" name="skip_WhereToSend" type="hidden" value="your@email.com" />
<input id="skip_SnapHostID" name="skip_SnapHostID" type="hidden" value="PA7GHZDNZSUY" />
<input id="skip_WhereToReturn" name="skip_WhereToReturn" type="hidden" value="http://www.YourWebsiteAddress.com/ThankYouPage.htm" />
<input id="skip_Subject" name="skip_Subject" type="hidden" value="Employment Application" />
<input id="skip_ShowUsersIp" name="skip_ShowUsersIp" type="hidden" value="1" />
<input id="skip_SendCopyToUser" name="skip_SendCopyToUser" type="hidden" value="1" />
<table border="0" cellpadding="5" cellspacing="0">
<tr>
<td style="width:50%">
<b>First name *</b><br />
<input name="First_Name" type="text" maxlength="50" style="width:260px" />
</td>
<td style="width:50%">
<b>Last name *</b><br />
<input name="Last_Name" type="text" maxlength="50" style="width:260px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Email *</b><br />
<input name="Email_Address" type="text" maxlength="100" style="width:535px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Portfolio website</b><br />
<input name="Portfolio" type="text" maxlength="255" value="http://" style="width:535px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Position you are applying for *</b><br />
<input name="Position" type="text" maxlength="100" style="width:535px" />
</td>
</tr>
<tr>
<td style="width:50%">
<b>Salary requirements</b><br />
<input name="Salary" type="text" maxlength="50" style="width:260px" />
</td>
<td style="width:50%">
<b>When can you start?</b><br />
<input name="StartDate" type="text" maxlength="50" style="width:260px" />
</td>
</tr>
<tr>
<td style="width:50%">
<b>Phone *</b><br />
<input name="Phone" type="text" maxlength="50" style="width:260px" />
</td>
<td style="width:50%">
<b>Fax</b><br />
<input name="Fax" type="text" maxlength="50" style="width:260px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Are you willing to relocate?</b><br />
<input name="Relocate" type="radio" value="Yes" checked="checked" /> Yes      
<input name="Relocate" type="radio" value="No" /> No      
<input name="Relocate" type="radio" value="NotSure" /> Not sure
</td>
</tr>
<tr>
<td colspan="2">
<b>Last company you worked for</b><br />
<input name="Organization" type="text" maxlength="100" style="width:535px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Reference / Comments / Questions</b><br />
<textarea name="Reference" rows="7" cols="40" style="width:535px"></textarea>
</td>
</tr>
</table>
<br />
<div style="text-align:center;">
<table border="0" cellpadding="0" cellspacing="0" style="text-align:center; width:300px; margin:auto;">
<tr><td colspan="2" style="padding-bottom:18px;">

<a href="http://www.snaphost.com/captcha/" alt="captcha email form" title="captcha email form">
captcha email form</a></td></tr>
<tr>
<td><i>Enter security code</i></td>
<td>SECURITY CODE</td>
</tr>
<tr>
<td>
<input name="skip_CaptchaCode" type="text" maxlength="6"
style="width:130px; height:28px; font-size:24px; text-align:center;" />
</td>
<td>
<a href="https://www.snaphost.com/captcha/ReadyForms/EmploymentApplicationForm.aspx"><img id="CaptchaImage" alt="Employment Application form" title="HTML code for Employment Application web form"
style="margin-left:20px; border:1px solid #999999;"
src="https://www.SnapHost.com/captcha/CaptchaImage.aspx?id=PA7GHZDNZSUY&ImgType=2" /></a>
<br /><a href="#" onclick="return ReloadCaptchaImage('CaptchaImage');"><span style="font-size:12px;">reload image</span></a>
</td>
</tr>
</table>
<br /><br />
<input name="skip_Submit" type="submit" value="Send Application" />
</div>
</form>

HTML code for "Employment Application" web form

How to use free BasicCaptcha code