What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.

At JotForm, we want to make sure that you’re getting the online form builder help that you need. Our friendly customer support team is available 24/7.

We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you’d like help immediately, feel free to search for a similar question, or submit your question or concern.

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

    Asked by Thurston 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


    Page URL:

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    JotForm Support

    Answered by Welvin on August 15, 2013 at 05:56 PM


    Please check your first thread: http://www.jotform.com/answers/256801.