Can some show me how to build a form like this?

  • Profile Image
    Asked on August 15, 2013 at 03:26 PM

    Employment Opportunities


    Agape In Home & Health Care, LLC is currently seeking motivated individuals who have a desire to provide professional and loving in-home care to our clients.  If you are interested in applying for a position with our company, please fill out the pre-screening application online by using the form below or fax your resume to (816)548-3310.


    * = Required Information


    Full Name *

    Address *

    City *


    Ohio Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

    Zip *

    Primary Phone # *

    Secondary Phone #

    Email Address *



    Which position are you applying for?






    Are you 18 years or older?

     Yes  No

    Do you currently have a valid driver's license?

     Yes  No

    Do you currently have reliable transportation?

     Yes  No

    Do you currently have automobile liability insurance required by law?

     Yes  No


    Minimum number hours that you are available to work per week:

     30+  20+  10+


    Please indicate the number of years of experience related to the position which you are applying for.

     Less than 1 yr  1-2 yrs  3+ yrs

    Level of education:

     High School  Associate  Bachelor  Master 



    How did you hear about us?


    Attach Resume


  • Profile Image
    Answered on August 15, 2013 at 05:56 PM

    That is possible with Jotform, of course.

    You can search our Form Template Gallery. Here's a lit of example Job Application Forms:

    You can use a Template by clicking on the "Use Template" button:

    Just please make sure to login before using a template so you'll it later on your My Forms page. Let us know if you need any further assistance.