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Old School Career Application form
Raw
application.php
<?php
/**
* @brief: job application for websites
* @created: 2010/07
*/
class JobApp
{
// config
public $email = 'something@example.com'; // recipient
public $pagetitle = 'Application for Employment';
public $company_name = false;
public $company_logo_url = "https://via.placeholder.com/300x90?text=Placeholder.com";
public $submit_message = 'Unsent';
public function __construct()
{
$this->site = isset( $_SERVER['SERVER_NAME'] ) ? $_SERVER['SERVER_NAME'] :'unknown';
$this->timestamp = time();
$this->date = date('Y-m-d');
$this->input = $_POST;
$this->process();
}
/**
* simple spam check
*/
private function isSpam($post)
{
if(!$this->timestamp - $_REQUEST['t'] < 1200) return false;
// check for spam
$_http = 0;
$_href = 0;
foreach ($post as $key => $value){
$key = $value;
// Annoying URL spams in comments any field
$_http += substr_count($value, "http");
$_href += substr_count($value, "href");
}
if ($_http > 1 OR $_href > 1){
return true;
} else {
return false;
}
}
private function isValidApplication($post)
{
if(empty($_POST['First_Name'])) return false;
if($this->isSpam($post)) return false;
}
private function process()
{
$form = '';
$subject = '';
$message = '';
$headers = '';
if($this->isValidApplication($_POST)) {
// process form results
foreach($_POST as $key => $value){
$form.= ucwords(str_replace("_", " ", $key));
$form.=": " . $value;
$form.="\r\n";
if(($key=="Middle_Name")
||($key=="position")
||($key=="special_qualifications")
||($key=="high_school_years_completed")
||($key=="college_years_completed")
||($key=="other_years_completed")
||($key=="rank_and_duties")
||($key=="employer_1_reason_for_leaving")
||($key=="employer_2_reason_for_leaving")
||($key=="business_reference_1_relationship1")
||($key=="business_reference_2_relationship2")) {
$form.="========\r\n";
}
}
// build email
$subject = "Application for ". $_POST["Last_Name"] . ", " . $_POST["First_Name"];
$headers .= 'From: Website Application <website@' . $site. '>' . "\r\n";
$message = $form;
$semail = $_REQUEST["Email"];
$submit_message="Thank you for your interest in a career at $this->company.";
// mail application
mail($email,$subject,$message, $headers);
// mail acknowledgement to sender - dangerous, could lead to relay spam
// mail($semail,$subject,$submit_message,$headers);
}
}
}
$JobApp = new JobApp();
$template['date'] = $JobApp->date;
$template['smessage'] = $JobApp->submit_message;
$template['timestamp'] = $JobApp->timestamp;
$template['title'] = $JobApp->pagetitle;
$template['input'] = $JobApp->input;
$template['company_name'] = $JobApp->company_name;
$template['company_logo_url'] = $JobApp->company_logo_url;
#====TEMPLATE=======*/
?><html lang='en-us'>
<head>
<meta charset='UTF-8'/>
<meta name='viewport' content='width=device-width, initial-scale=1'/>
<title><?php echo $template['title'] ?></title>
<style>
body { font-family:'Segoe UI',sans-serif}
main {width:800px;margin:auto}
.logo {max-height:80px}
img {max-width:100%}
.fineprint {font-size:12px}
.atc {text-align:center}
.db{display:block}
.cb{clear:both}
.nw{white-space:nowrap}
:required {border:2px red double}
.iwrap { float:left;padding:2px}
.iwrap label {display:block}
#Application label {font-weight:600}
#Application textarea {width:100%}
.noprint {text-decoration:none}
@media print {
.pagebreak { display: block; page-break-before: always; }
main {width:8in}
.noprint {display:none}
}
</style>
</head>
<body>
<main>
<section>
<p class='noprint' >Status: <?php echo $template["smessage"]; ?></p>
<p class='atc'><?php if(!empty($template['company_name'])) echo $template['company_name']; ?></p>
<p class='atc'><?php if(!empty($template['company_logo_url'])) echo "<img class='logo' src='" . $template['company_logo_url'] . "' alt=''/>"; ?></p>
<h1 class='atc'>Application For Employment</h1>
<p class='fineprint'>All applicants will be considered for employment without regard to race, religion, sex, national origin, age, marital or veteran status, medical condition, or handicap, or any other status protected by law.</p>
<p class='fineprint'>We are an Equal Opportunity Employer.</p>
</section>
<form name='application' method='post' id='Application'>
<input name='Date' type='hidden' value="<?php echo $template['date']; ?>" />
<fieldset>
<legend id='Personal'>Personal Information</legend>
<div class='iwrap'>
<label for='LastName' >* Last Name:</label>
<input name='Last_Name' id='LastName' required='required'/>
</div>
<div class='iwrap'>
<label for='First_Name'>* First Name:</label>
<input name='First_Name' id='FirstName' required='required'/>
</div>
<div class='iwrap'>
<label for='Middle_Name'>Middle Name:</label>
<input name='Middle_Name' id='MiddleName'/>
</div>
<div class='iwrap'>
<label for='Address'>* Address:</label>
<input name='Address' id='Address' required='required'/>
</div>
<div class='iwrap'>
<label for='City'>City:</label>
<input name='City' id='City' required='required' />
</div>
<div class='iwrap'>
<label for='State'>St:</label>
<input type='text' name='State' id='State' size='2' maxlength='2' required='required'/>
</div>
<div class='iwrap'>
<label for='Zip'>* Zip:</label>
<input name='Zip' id='Zip' size='12' maxlength='12' required='required' />
</div>
<div class='iwrap'>
<label for='Phone'>* Phone:</label>
<input name='Phone' id='Phone' type='tel' size='16' maxlength='16' required='required' />
</div>
<div class='iwrap'>
<label for='Email'>* E-mail address:</label>
<input name='Email' id='Email' type='email' size='30' required='required'/>
</div>
</fieldset>
<fieldset>
<legend id='Position'>Position Information</legend>
<p>
<div><strong>Referred By:</strong></div>
<label class='nw'>Ad <input type='radio' name='referred_by' id='ourad' value='Ad'/></label>
<label class='nw'>Agency <input type='radio' name='referred_by' value='Agency'/></label>
<label class='nw'>Friend/Relative <input type='radio' name='referred_by' id='friendrel' value='Friend/Relative'/></label>
<label class='nw'>Other <input type='radio' id='other' name='referred_by' value='other'/></label>
<label class='nw'>Please List <input type='text' name='referrer' value=''/></label>
</p>
<p>
<label>Position(s) applied for: <input name='position' id='position' size='30' maxlength='30'/></label>
</p>
<p>
<span class='nw'>
<label><input type='radio' name='full_part_time' value='Full-time'/> Full-time </label>
<label><input type='radio' name='full_part_time' id='part-time' value='Part-time'/> Part-time</label>
</span>
<span class='nw'> <label>Part Time Availability:
<input name='part-time-hours' id='position' size='30' maxlength='30'/></label></span>
</p>
<p>
<label>Salary or Wages expected: <input size='10' maxlength='10' name='salary' id='Salary'/></label>
<span class='nw'>
<label><input name='period' type='radio' value='hourly'/> Per hour</label>
<label><input name='period' type='radio' value='yearly'/> Per year</label>
</span>
</p>
<p>
<label>Have you ever worked for us before? <input type='checkbox' name='prior_employee'/></label>
<label class='nw'>If yes, when: <input type='date' name='prior_start_date' size='30' maxlength='30'/></label>
</p>
<p>
<label>List anyone you know who works for us:
<textarea name='employees_known' rows='3' cols='40' ></textarea></label>
</p>
<p>
<label>List any skills, qualifications, or experiences that would especially qualify you for this position:
<textarea name='special_qualifications' rows='3' cols='40' ></textarea></label>
</p>
<p>
<label>Have you ever provided false information on any employment record, including applications, resumes, benefit
claim forms, leave requests, tax forms, etc? If so, explain:
<textarea name='false_information' rows='3' cols='40' ></textarea></label>
</p>
</fieldset>
<fieldset class='pagebreak'>
<legend id='Military'>Military Service</legend>
<p>
<label>Branch of Service: <input name='branch_of_service' size='35' maxlength='35'/></label>
</p>
<div class='iwrap'>
<label for='ServiceDateFrom'>From:</label>
<input name='service_date_from' id='ServiceDateFrom' type='date' size='10' maxlength='10'/>
</div>
<div class='iwrap'>
<label for='ServiceDateTo'>To: </label>
<input name='service_date_to' id='ServiceDateTo' type='date' size='10' maxlength='10'/>
</div>
<div class='iwrap'>
<label for='datedischarged'>Date Discharged:</label>
<input name='service_date_discharged' id='datedischarged' type='date' size='10' maxlength='10'/>
</div>
<div class="iwrap">
<label for="rankduties">Rank and Duties:</label>
<input name="rank_and_duties" id="rankduties" size="50" maxlength="50"/>
</div>
</fieldset>
<fieldset>
<legend>Eligibility</legend>
<p>
<label>Are you able to do the essential functions of the job(s) for which you are applying?? </label>
<input type='checkbox' name='can_do_job'/>
<label>If not, please identify the applicable functions that you can perform:
<textarea name='can_do_this' rows='3' cols='40' ></textarea></label>
</p>
<p>
<label>Are you over 18 years of age?
<input type='checkbox' name='over18' id='Eighteen'/></label>
<span class='nw'>(If not, a work permit will be required)</span>
</p>
<p>
<label> Are you legally eligibile for permanent employment in this country?
<input type='checkbox' name='legally eligibile' id='Legal' /></label>
<span class='nw'>(If hired, verification will be required by law.)</span>
</p>
<p>
<label>Are you currently employed? <input type='checkbox' name='currently_employed'/></label>
</p>
<p>
<label>If hired, will you work overtime if required?
<input type='checkbox' name='work_overtime'/></label>
</p>
<p>
<label for='startdate'>Date you are available to start work:
<input type='date' name='start_date' size='30' maxlength='30'/></label>
</p>
</fieldset>
<!--EDUCATION-->
<fieldset class='pagepreak'>
<legend id='Education'>Education</legend>
<fieldset>
<legend>High School</legend>
<div class='iwrap'>
<label for='highschool'>Name &amp; Location of High School Graduation</label>
<input name='high_school' id='highschool' size='60' maxlength='60' />
</div>
<div class='iwrap'>
<label for='highschoolcoursework'>Course of Study</label>
<input name='high_school_coursework' id='highschoolcoursework' size='30' maxlength='30'/>
</div>
<div class='iwrap'>
<label for='highschoolyearscompleted'>Years Completed</label>
<input name='high_school_years_completed' id='highschoolyearscompleted' size='10' maxlength='10'/>
</div>
<div class='cb'>
<label>Did you graduate? <input type='checkbox' name='high_school_graduate' /></label>
</div>
</fieldset>
<fieldset>
<legend>College</legend>
<div class='iwrap'>
<label for='college'>Name &amp; Location of College</label>
<input name='college' id='college' size='60' maxlength='60'/>
</div>
<div class="iwrap">
<label for="collegecoursework">Course of Study</label>
<input name="college_coursework" id="collegecoursework" size="30" maxlength="30"/>
</div>
<div class="iwrap">
<label for="collegeyearscompleted">Years Completed</label>
<input name="college_years_completed" id="collegeyearscompleted" size="10" maxlength="10" />
</div>
<br class="cb"/>
<div>
<label for="collegegraduate" class="di">Did you Graduate:</label>
<input type="checkbox" name="college_graduate" id="collegegraduate" />
</div>
</fieldset>
<fieldset>
<legend >Other Schooling</legend>
<div class="iwrap">
<label for="otherschool">School Name &amp; Location</label>
<input name="other_school" id="otherschool" size="50" maxlength="50" />
</div>
<div class="iwrap">
<label for="othercoursework">Course of Study:</label>
<input name="other_coursework" id="othercoursework" size="30" maxlength="30" />
</div>
<div class="iwrap">
<label for="otheryearscompleted">Years Completed:</label>
<input name="other_years_completed" id="otheryearscompleted" size="10" maxlength="10" />
</div>
<br class="cb"/>
<label for="othergraduate">Did you Graduate:
<input type="checkbox" name="other_graduate" id="othergraduate" /></label>
</fieldset>
</fieldset>
<fieldset class='pagebreak'>
<legend id='Employment'>Employment History</legend>
<p>List your most recent employers</p>
<fieldset>
<legend class="gray">Most Recent Employer</legend>
<div class="iwrap">
<label for="Employer1">Employer</label>
<input name="employer1" id="Employer1"
size="35" maxlength="35" />
</div>
<div class="iwrap">
<label for="Employer1JobTitle">Job Title</label>
<input name="employer_1_job_title" id="Employer1JobTitle" size="30" maxlength="30" />
</div>
<div class="iwrap">
<label for="Employer1DatesFrom">From</label>
<input name="employer_1_starting_date" id="Employer1DatesFrom" type="date" size="10" maxlength="10"/>
</div>
<div class="iwrap">
<label for="Employer1DatesTo">To</label>
<input name="employer_1_ending_date" id="Employer1DatesTo" type="date" size="10" maxlength="10"/>
</div>
<div class="iwrap">
<label for="Employer1Responsibilities">
Work performed and responsibilities</label>
<input name="employer_1_responsibilities" id="Employer1Responsibilities" size="50" maxlength="50"/>
</div>
<div class="iwrap">
<label for="Employer1StartingPay">Starting Pay</label>
<input name="employer_1_starting_pay" id="Employer1StartingPay" size="8" maxlength="8"/>
</div>
<div class="iwrap">
<label for="Employer1FinalPay">Final Pay</label>
<input name="employer_1_ending_Pay" id="Employer1FinalPay" size="8" maxlength="8"/>
</div>
<div class="iwrap">
<label for="Employer1Address">Address</label>
<input name="employer_1_address" id="Employer1Address" size="50" maxlength="50"/>
</div>
<div class="iwrap">
<label for="Employer1Telephone">Telephone</label>
<input type="tel" name="employer_1_phone" id="Employer1Telephone"/>
</div>
<br class="cb"/>
<div class="iwrap">
<label for="Employer1Supervisor">Immediate Supervisor and Title</label>
<input name="employer_1_supervisor" id="Employer1Supervisor"
size="35" maxlength="35"/>
</div>
<div class="iwrap">
<label for="Employer1Contact">May we contact this person?</label>
<input name="employer_1_contact" id="Employer1Contact" type="checkbox"/>
</div>
<br class="cb"/>
<div class="iwrap">
<label for="Employer1ReasonForLeaving">Reason for Leaving</label>
<input name="employer_1_reason_for_leaving" id="Employer1ReasonForLeaving" size="50" maxlength="50"/>
</div>
</fieldset>
<fieldset>
<legend class="gray">Next Most Recent Employer</legend>
<div class="iwrap">
<label for="Employer2">Employer</label>
<input name="employer_2" id="Employer2" size="35" maxlength="35" />
</div>
<div class="iwrap">
<label for="Employer2Title">Job Title</label>
<input name="employer_2_jobtitle" id="Employer2Title" size="35" maxlength="35" />
</div>
<div class="iwrap">
<label for="Employer2From">From</label>
<input name="employer_2_starting_date" id="Employer2From" type="date" size="10" maxlength="10" />
</div>
<div class="iwrap">
<label for="Employer2To">To</label>
<input name="employer_2_ending_date" id="Employer2To" type="date" size="10" maxlength="10" />
</div>
<div class="iwrap">
<label for="Employer2Responsibilities">
Work performed and responsibilities</label>
<input name="employer_2_responsibilities" id="Employer2Responsibilities" size="50"/>
</div>
<div class="iwrap">
<label class="di" for="Employer2StartingPay">Starting Pay</label>
<input name="employer_2_starting_pay" id="Employer2StartingPay" size="10" maxlength="10"/>
</div>
<div class="iwrap">
<label class="di" for="Employer2FinalPay">Final Pay</label>
<input name="employer_2_ending_pay" id="Employer2FinalPay" size="10" maxlength="10" />
</div>
<div class="iwrap">
<label for="Employer2Address">Address</label>
<input name="employer_2_address" id="Employer2Address" size="50" maxlength="50" />
</div>
<div class="iwrap">
<label for="Employer2Telephone">Telephone: </label>
<input name="employer_2_phone" id="Employer2Telephone" type="tel" size="16" maxlength="16" />
</div>
<br class="cb"/>
<div class="iwrap">
<label for="Employer2Supervisor">Immediate Supervisor and Title</label>
<input name="employer_2_supervisor" id="Employer2Supervisor" size="35" maxlength="35"/>
</div>
<div class="iwrap">
<label for="Employer2Contact" class="di">May we contact this person? </label>
<input name="employer_2_contact" id="Employer1Contact" type="checkbox"/>
</div>
<br class="cb"/>
<div class="iwrap">
<label for="Employer2ReasonForLeaving">Reason for Leaving: </label>
<input name="employer_2_reason_for_leaving" id="Employer2ReasonForLeaving" size="50" maxlength="50" />
</div>
</fieldset>
</fieldset>
<fieldset>
<legend id="Business">Business References</legend>
<fieldset>
<legend class="gray">Reference</legend>
<div class="iwrap">
<label>Name:</label>
<input name="business_reference_1_name" size="25" maxlength="35" />
</div>
<div class="iwrap">
<label>Address:</label>
<input name="business_reference_1_address" size="25" maxlength="35"/>
</div>
<div class="iwrap">
<label for="BusinessReference1Phone">Telephone:</label>
<input name="business_reference_1_phone" id="BusinessReference1Phone" size="16" maxlength="16" type="tel" />
</div>
<div class="iwrap">
<label for="BusinessReference1Relationship">Relationship:</label>
<input name="business_reference_1_relationship" id="BusinessReference1Relationship" size="20" maxlength="35" />
</div>
</fieldset>
<fieldset>
<legend class="gray">Reference 2</legend>
<div class="iwrap">
<label>Name:</label>
<input name="business_reference_2_name" size="25" maxlength="30" />
</div>
<div class="iwrap">
<label>Address:</label>
<input name="business_reference_2_address" size="25" maxlength="30" />
</div>
<div class="iwrap">
<label>Telephone:</label>
<input name="business_reference_2_phone" type="tel" size="16" maxlength="16" />
</div>
<div class="iwrap">
<label for='businessferencerelationship2'>Relationship:</label>
<input name='business_reference_2_relationship' id='businessferencerelationship2' size='20' maxlength='30'/>
</div>
</fieldset>
</fieldset>
<fieldset class='pagebreak'>
<legend id="Final">Finalize</legend>
<p> The above information is true and complete to the best of my knowledge.
Should I be employed by the Company, any misrepresentations or false statement contained herein may be considered cause for possible dismissal.
The company has my permission to obtain all necessary information about the references
I have listed, or any other sources, concerning my prior employment, personal history,
or credit standing and I release all parties from any possible damages resulting
from disclosing such information with or without prior written notice to me.
I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the company.</p>
<p>All applicants for employment may be required to submit to urinalysis,
blood tests or other screening, as part of the Company's pre-employment drug screening
process, and prior to the employment physical for the purpose of detecting the presence of alcohol or illegal drugs. Applicants tested will be required to sign a Consent/Release form prior to testing; and, any applicant refusing to sign any required form will be disqualified from further consideration. This alcohol and illegal drug screening will be perfromed by a licensed, certified testing service, and all applicants tested may be required to give a sample of the bodily fluid in the presence of another person, usually an employee of the testing service. A positive test may result in denial of employment.</p>
<p>I understand this application does not constitute an employment contract of any kind.
Should I be employed by the Company, I may resign such employment at any time at my
discretion with or without prior notice and the Company may terminate my employment
at any time at their discretion, with or without cause and with or without notice.</p>
<input type='button' onclick='return checkForm();' value="Check Form" onsubmit='this.disabled=true'/>
<input type="button" onclick="window.print()" value="Print this Page" />
<input type="submit" id="Go" value="Submit Application"/>
<input type="reset" value=" Clear Form "/>
</fieldset>
<input name="t" value="${timestamp}" type="hidden"/>
</form>
<script type="text/javascript">
//<![CDATA[
var JobApp = {};
JobApp.initialize = function () {
//require review first
document.getElementById('Go').disabled=true;
}
/* check required form elements */
JobApp.checkForm = function() {
if(document.getElementById('LastName').value == '') {
alert('You have not entered a Last Name');
document.getElementById('LastName').focus();
return false;
}
if(document.getElementById('FirstName').value == '') {
alert('You have not entered a First Name');
document.getElementById('FirstName').focus();
return false;
}
if(document.getElementById('Phone').value == '') {
alert('You have not entered a Phone number');
document.getElementById('Phone').focus();
return false;
}
if(document.getElementById('Date').value == '') {
alert('You have not entered a Date to Confirm your agreement');
document.getElementById('Date').focus();
return false;
}
alert("Looks Good! Press Print or Submit Application");
document.getElementById('Go').disabled = false;
return true;
}
/* disable submit until checked*/
window.onload=JobApp.initialize();
//]]>
</script>
<br class="cb"/>
</main>
</div>
</html>
@miwebguy

miwebguy commented Sep 2, 2021

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Some refactoring, mobile view set.

@miwebguy

miwebguy commented Sep 2, 2021

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Placeholder Logo

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