This file contains hidden or bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
.sqs-block-map {pointer-events: none;} |
This file contains hidden or bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
<fieldset> | |
<legend>State</legend> | |
<select name="state" size="1"> | |
<option value="AK">AK</option> | |
<option value="AL">AL</option> | |
<option value="AR">AR</option> | |
<option value="AZ">AZ</option> | |
<option value="CA">CA</option> | |
<option value="CO">CO</option> | |
<option value="CT">CT</option> |
This file contains hidden or bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
<fieldset> | |
<legend>Nationality</legend> | |
<select class="form-control dropdown" id="nationality" name="nationality"> | |
<option value="" selected="selected" disabled="disabled">-- select one --</option> | |
<option value="afghan">Afghan</option> | |
<option value="albanian">Albanian</option> | |
<option value="algerian">Algerian</option> | |
<option value="american">American</option> | |
<option value="andorran">Andorran</option> | |
<option value="angolan">Angolan</option> |
This file contains hidden or bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
<fieldset> | |
<legend>Religion</legend> | |
<select class="form-control dropdown" id="religion" name="religion"> | |
<option value="" selected="selected" disabled="disabled">-- select one --</option> | |
<option value="African Traditional & Diasporic">African Traditional & Diasporic</option> | |
<option value="Agnostic">Agnostic</option> | |
<option value="Atheist">Atheist</option> | |
<option value="Baha'i">Baha'i</option> | |
<option value="Buddhism">Buddhism</option> | |
<option value="Cao Dai">Cao Dai</option> |
This file contains hidden or bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
<fieldset> | |
<legend>Education</legend> | |
<select class="form-control dropdown" id="education" name="education"> | |
<option value="" selected="selected" disabled="disabled">-- select one --</option> | |
<option value="No formal education">No formal education</option> | |
<option value="Primary education">Primary education</option> | |
<option value="Secondary education">Secondary education or high school</option> | |
<option value="GED">GED</option> | |
<option value="Vocational qualification">Vocational qualification</option> | |
<option value="Bachelor's degree">Bachelor's degree</option> |
This file contains hidden or bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
<fieldset> | |
<legend>Ethnicity</legend> | |
<select class="form-control dropdown" id="ethnicity" name="ethnicity"> | |
<option value="" selected="selected" disabled="disabled">-- select one --</option> | |
<optgroup label="White"> | |
<option value="White English">English</option> | |
<option value="White Welsh">Welsh</option> | |
<option value="White Scottish">Scottish</option> | |
<option value="White Northern Irish">Northern Irish</option> | |
<option value="White Irish">Irish</option> |
This file contains hidden or bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
<fieldset> | |
<legend>Employment status</legend> | |
<select class="form-control dropdown" id="employment" name="employment"> | |
<option value="" selected="selected" disabled="disabled">-- select one --</option> | |
<option value="Employed">Employed</option> | |
<option value="Self-employed">Self-employed</option> | |
<option value="Out of work">Out of work</option> | |
<option value="Homemaker">Homemaker</option> | |
<option value="Student">Student</option> | |
<option value="Retired">Retired</option> |
This file contains hidden or bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
<fieldset> | |
<legend>Occupation</legend> | |
<select class="form-control dropdown" id="occupation" name="occupation"> | |
<option value="" selected="selected" disabled="disabled">-- select one --</option> | |
<optgroup label="Healthcare Practitioners and Technical Occupations:"> | |
<option value="1">- Chiropractor</option> | |
<option value="2">- Dentist</option> | |
<option value="3">- Dietitian or Nutritionist</option> | |
<option value="4">- Optometrist</option> | |
<option value="5">- Pharmacist</option> |