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File: eligible_youth_therealone.php
<script type="text/javascript" language="JavaScript"> <!-- // Code by ---------- Nikhil Nagpal -------------- //Disable right mouse click Script function isEmpty(str) { var t = /\S/ return !t.test(str) } // Function called when form submits function disabletext(e){ return false } function reEnable(){ return true } //if the browser is IE4+ document.onselectstart=new Function ("return false") //if the browser is NS6 if (window.sidebar){ document.onmousedown=disabletext document.onclick=reEnable } // Code finish // By ----------- Nikhil ------------- function checkform() { //alert(document.form1.next.value); { showalert=true if(document.form1.radio1) { if (document.form1.radio1.checked) showalert=false; } if(document.form1.radio2) { if (document.form1.radio2.checked) showalert=false; } if(document.form1.radio3) { if (document.form1.radio3.checked) showalert=false; } if(document.form1.radio4) { if (document.form1.radio4.checked) showalert=false; } if(document.form1.radio5) { if (document.form1.radio5.checked) showalert=false; 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return false; } } } --> </script> <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"> <head id="Head"> <SCRIPT language="JavaScript"> <!-- window.location="http://dfcs.dhr.georgia.gov/teenwork"; //--> </SCRIPT> <meta id="MetaDescription" name="DESCRIPTION" content="Georgia TeenWork " /> <meta id="MetaKeywords" name="KEYWORDS" content="" /> <meta id="MetaCopyright" name="COPYRIGHT" content="Copyright 2008 TeleVox" /> <meta id="MetaAuthor" name="AUTHOR" content="Georgia Teen Work " /> <meta name="RESOURCE-TYPE" content="DOCUMENT" /> <meta name="DISTRIBUTION" content="GLOBAL" /> <meta name="ROBOTS" content="INDEX, FOLLOW" /> <meta name="REVISIT-AFTER" content="1 DAYS" /> <meta name="RATING" content="GENERAL" /> <meta http-equiv="PAGE-ENTER" content="RevealTrans(Duration=0,Transition=1)" /> <style id="StylePlaceholder" type="text/css"> .arialsixtee { font-family: Arial; 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return true; } //]]> </script> <!--[if IE]> <link href="/Portals/_default/Skins/siteskin_new/site_ie_fix.css" rel="stylesheet" type="text/css" /> <![endif]--> <script src="http://tools.televoxsites.com/js/jquery/jquery-1.2.6.min.js" type="text/javascript"></script> <script type="text/javascript"> var DNN_skinPath = "/Portals/_default/Skins/siteskin_new/"; jQuery.noConflict();</script> <script src="http://tools.televoxsites.com/js/sifr3-436/sifr.js" type="text/javascript"></script> <script src="http://tools.televoxsites.com/js/swfobject.js" type="text/javascript"></script> <script src="js/jquery.cycle.all.min.js" type="text/javascript"></script> <script src="js/site.js" type="text/javascript"></script> <!--[if lt IE 7]> <script src="http://tools.televoxsites.com/js/pngfix.js" type="text/javascript"></script> <![endif]--> <div id="shell"> <div class="content"> <span class="headeraddress">Two Peachtree Street, NW Suite 18-213 Atlanta, Georgia 30303</span> <a href="http://www.georgiateenwork.org" id="logo">Georgia TeenWork</a> <div id="socialnetworking"> </div> <div id="iconnav"> <!--<a class="room" href="https:www.georgiateenwork.org" target="_blank">Georgia TeenWork</a> <a class="cert" href="http://www.georgiateenwork.org" >Georgia TeenWork</a>--> <!--<a class="signup" href="/signup/tabid/113/Default.aspx">Georgia TeenWork</a>--> </div> <div id="pinknav" class="topnav"> <iframe src="menu_header.html" frameborder="0" width="670px" height="43px" allowtransparency="yes"></iframe> </div> <h1 class='price'> </h1> <p><img src="images/Titles_application_for_eligible_youth.jpg" width="421" height="21" /><br /> <strong>The Department of Human Services TeenWork Program </strong></p><br /> <div id="dnn_ContentPane" class="maincontent"> <div id="dnn_ctr438_ContentPane" class="DNNAlignleft"><!-- Start_Module_438 --><div id="dnn_ctr438_ModuleContent"> <span id="dnn_ctr438_ViewHTMLArchive_ViewHTMLArchive_lblContent" class="Normal"> <script type="text/javascript"> <!-- var theForm = document.forms['frmApplication']; 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?></STRONG></font></P> <P><STRONG>This application will not be ready to complete until Wednesday 1/13/10</STRONG></P> <P><STRONG>*Indicates required fields</STRONG></P> <div id="ValidationSummary1" style="color:Red;display:none;"></div> <TABLE cellSpacing="0" cellPadding="5" width="100%" border="0"> <TR align="left"> <TD width="20%"><table cellspacing="0" cellpadding="5" width="100%" border="0"> <tr align="left"> <td width="333"><p><strong>First Name</strong>:</p></td> <td colspan="5"><input name="txtCompanyName" type="text" maxlength="255" size="40" id="txtCompanyName" /> <br /> <span id="RequiredFieldValidator1" style="color:Red;display:none;">Please enter a Company Name</span></td> </tr> <tr align="left"> <td><p><strong>Last Name </strong>:</p></td> <td colspan="5"><p> <input name="txtAddress1" type="text" maxlength="255" size="40" id="txtAddress1" /> <br /> <span id="RequiredFieldValidator3" style="color:Red;display:none;">Please enter your company address</span> </p></td> </tr> <tr align="left"> <td><strong>Address: </strong></td> <td colspan="5"><textarea name="txtCompanyDescription2" rows="2" cols="40" id="txtCompanyDescription2"></textarea> <br /> <span id="RequiredFieldValidator2" style="color:Red;display:none;">Please enter a company description</span></td> </tr> <tr align="left"> <td height="9"><strong>City</strong>:</td> <td width="350" height="9"><input name="txtCity" type="text" maxlength="50" size="15" id="txtCity" /> <span id="RequiredFieldValidator4" style="color:Red;display:none;">*</span> <strong><span style="COLOR: #ff0000">*</span>Zip:</strong> <input name="txtZip" type="text" maxlength="5" size="8" id="txtZip" /> <span id="RegularExpressionValidator1" style="color:Red;display:none;">*</span> <span id="RequiredFieldValidator6" style="display:inline-block;color:Red;width:8px;display:none;">*</span></td> <td width="58" height="9" align="left"><strong><font color="#ff0000"><strong><strong><font color="#000000"></font></strong></strong></font></strong></td> <td width="69" height="9" align="left"></td> </tr> <div id="pnlOneSub"> <tr align="left"> <td height="14"><strong><strong><strong><font color="#ff0000"><strong><strong><font color="#000000"><strong>County</strong>:<br /> </font></strong></strong></font></strong></strong></strong></td> <td colspan="5" height="14"><p> <select name="ddCounty" id="ddCounty" style="width:133px;"> <option value="">Select a county</option> <?php while ($rows = mysql_fetch_array($resQry)) { ?> <option value="<?php echo $rows[0]?>"><?php echo $rows[1]; ?></option> <?php } ?> </select> <span id="Requiredfieldvalidator13" style="display:inline-block;color:Red;height:14px;width:32px;display:none;">*</span> </p></td> </tr> </div> <tr align="left"> <td><strong>Birth Date :</strong></td> <td colspan="5"><input name="txtContactName" type="text" maxlength="100" size="40" id="txtContactName" /> <br /> <span id="RequiredFieldValidator7" style="color:Red;display:none;">Please enter a contact name</span></td> </tr> <TR vAlign="top" align="left"> <TD ><STRONG>Ages</STRONG>: <BR> (check all that apply) </TD> <TD> <table width="460" border="0" cellpadding="5" id="chkInternAges" style="height:60px;width:450px;"> <tr> <td> <input id="chkInternAges_0" type="checkbox" name="chkInternAges[]" checked="checked" value="14" /><label for="chkInternAges_0">14</label> </td> <td> <input id="chkInternAges_1" type="checkbox" name="chkInternAges[]" value="15" /><label for="chkInternAges_0">15</label> </td> <td> <input id="chkInternAges_2" type="checkbox" name="chkInternAges[]" value="16" /><label for="chkInternAges_1">16</label> </td> <td> <input id="chkInternAges_3" type="checkbox" name="chkInternAges[]" value="17" /><label for="chkInternAges_2">17</label> </td> <td> <input id="chkInternAges_4" type="checkbox" name="chkInternAges[]" value="18" /><label for="chkInternAges_3">18</label> </td> <td> <input id="chkInternAges_5" type="checkbox" name="chkInternAges[]" value="19" /><label for="chkInternAges_4">19</label> </td> <td> <input id="chkInternAges_6" type="checkbox" name="chkInternAges[]" value="20" /><label for="chkInternAges_5">20</label> </td> <td> <input id="chkInternAges_7" type="checkbox" name="chkInternAges[]" value="21" /><label for="chkInternAges_6">21</label> </td> <td> <input id="chkInternAges_8" type="checkbox" name="chkInternAges[]" value="no preference" /><label for="chkInternAges_7">No Preference</label> </td> </tr> </table> </TD> </TR> <tr align="left"> <td><strong>what georgia high school do you attend? </strong></td> <td colspan="5"><select name="ddJobSiteCounty" id="ddJobSiteCounty"> <option value="">Select </option> <?php while ($rows1 = mysql_fetch_array($resQry1)) { ?> <option value="<?php echo $rows1[0]?>"><?php echo $rows1[1]; ?></option> <?php } ?> </select></td> </tr> <tr align="left"> <td valign="top" height="27"><strong>Other High School ? </strong></td> <td valign="top" colspan="5" height="27"><p> <input name="txtContactEmail" type="text" maxlength="50" size="40" id="txtContactEmail" /> <span id="RegularExpressionValidator4" style="display:inline-block;color:Red;width:16px;display:none;">*</span> <span id="RequiredFieldValidator20" style="color:Red;display:none;">*</span><br /> </p></td> </tr> <tr align="left"> <td valign="top" height="2"><p><strong>What college do you attend? </strong> </p></td> <td valign="top" colspan="5" height="2"><input name="txtContactEmail" type="text" maxlength="50" size="40" id="txtContactEmail" /></td> </tr> <tr align="left"> <td valign="top" height="2"><p><strong>What grade or level? </strong> </p></td> <td><table id="chkKindsOfJob" cellpadding="5" border="0" style="height:176px;"> <tr> <td> <input id="chkKindsOfJobs_0" type="checkbox" name="chkKindsOfJobs[]" value="Business" /> <label for="chkKindsOfJobs_0">9</label> </td> <td> <input id="chkKindsOfJobs_4" type="checkbox" name="chkKindsOfJobs[]" value="Maintenance" /> <label for="chkKindsOfJobs_4"> freshman</label></td> </tr> <tr> <td> <input id="chkKindsOfJobs_1" type="checkbox" name="chkKindsOfJobs[]" value="Environment" /> <label for="chkKindsOfJobs_1">10</label> </td> <td> <input id="chkKindsOfJobs_5" type="checkbox" name="chkKindsOfJobs[]" value="Media" /><label for="chkKindsOfJobs_5">sophomore</label> </td> </tr> <tr> <td> <input id="chkKindsOfJobs_2" type="checkbox" name="chkKindsOfJobs[]" value="Health" /> <label for="chkKindsOfJobs_2">11</label> </td> <td> <input id="chkKindsOfJobs_6" type="checkbox" name="chkKindsOfJobs[]" value="Retail Sales" /> junior</td> </tr> <tr> <td> <input id="chkKindsOfJobs_3" type="checkbox" name="chkKindsOfJobs[]" value="Hotels" /> <label for="chkKindsOfJobs_3">12</label> </td> <td> <input id="checkbox1" type="checkbox" name="checkbox1" value="Sports" /> <label for="chkKindsOfJobs_7">senior</label> </td> </tr> <tr> <td colspan="2"> <input id="chkKindsOfJobs_3" type="checkbox" name="chkKindsOfJobs[]" value="Hotels" /> <label for="chkKindsOfJobs_3">GED program & GED completion </label> </td> </tr> </table></td> </tr> </table> </TD> </TR> </TABLE></TD> </TR> <TR> <TD align="right" width="50%"><input type=submit class="inputButtonSmall" style="width:80px" name=previous value=Previous onClick="document.location.href='<a href = "javascript:history.go(-1)"> </TD> <TD align="left" width="50%" colSpan="-3"> <input type="hidden" name="process" value="1"> <input class="inputButtonSmall" type=submit name=next value="Next" style="width:80px" onClick=" javascript:return checkform();" > </TD> </TR> <TR> <TD align="left" width="50%"></TD> <TD align="left" width="50%"></TD> </TR> </TABLE> </div> </form> </span> <!-- End_Module_438 --> </div></div> </div> <div id="leftpane"><p><strong><span class="sidebarbig">TeenWork Hotline</span></strong><br /> <span class="sidebar">888-884-4712 </span><span class="sidebarsmall">GeorgiaTeenWork@dhr.state.ga.us</span><span class="sidebar"> <strong><br /> <br /> </strong></span><span class="sidebarbig"><strong>Application Deadline</strong></span><span class="sidebar"><br /> 4/30/10</span> </p> <div id="dnn_LeftPane"><img src="images/3_diverse_at_office_arms_folded_program_small.jpg" width="144" height="176" ><br > <br > <img src="images/group_of_youth_at_computer_small.jpg" width="144" height="176" > </div> </div> </div><!-- end content div --> </div><!-- End shell div --> <div id="footer"><iframe src="footer.html" frameborder="0" width="100%"></iframe> <p> <!--<span class="admin"><a id="dnn_dnnLOGIN_cmdLogin" class="SkinObject" href="javascript:__doPostBack('dnn$dnnLOGIN$cmdLogin','')">administration</a></span>--> </p> </div><!--end footer--> <script type="text/javascript"> var sshowa = new SWFObject("/Portals/_default/Skins/siteskin_new/socialnet.swf", "slideshow", "163", "46", "6", "#000000"); 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dnn_ctr497_FormMaster_rfv__20090626T074321.controltovalidate = "dnn_ctr497_FormMaster_ctl__20090626T074321"; dnn_ctr497_FormMaster_rfv__20090626T074321.errormessage = "A value is required"; dnn_ctr497_FormMaster_rfv__20090626T074321.display = "Dynamic"; dnn_ctr497_FormMaster_rfv__20090626T074321.validationGroup = "773575a1-7871-4f3f-9d19-5014fb8b31b1"; dnn_ctr497_FormMaster_rfv__20090626T074321.evaluationfunction = "RequiredFieldValidatorEvaluateIsValid"; dnn_ctr497_FormMaster_rfv__20090626T074321.initialvalue = ""; var dnn_ctr497_FormMaster_rev__20090626T074351 = document.all ? document.all["dnn_ctr497_FormMaster_rev__20090626T074351"] : document.getElementById("dnn_ctr497_FormMaster_rev__20090626T074351"); dnn_ctr497_FormMaster_rev__20090626T074351.controltovalidate = "dnn_ctr497_FormMaster_ctl__20090626T074321"; dnn_ctr497_FormMaster_rev__20090626T074351.errormessage = "A valid email is required"; dnn_ctr497_FormMaster_rev__20090626T074351.display = "Dynamic"; dnn_ctr497_FormMaster_rev__20090626T074351.validationGroup = "773575a1-7871-4f3f-9d19-5014fb8b31b1"; dnn_ctr497_FormMaster_rev__20090626T074351.evaluationfunction = "RegularExpressionValidatorEvaluateIsValid"; dnn_ctr497_FormMaster_rev__20090626T074351.validationexpression = "\\w+([-+.]\\w+)*@\\w+([-.]\\w+)*\\.\\w+([-.]\\w+)*"; //]]> </script> <script type="text/javascript"> //<![CDATA[ var Page_ValidationActive = false; if (typeof(ValidatorOnLoad) == "function") { ValidatorOnLoad(); } function ValidatorOnSubmit() { if (Page_ValidationActive) { return ValidatorCommonOnSubmit(); } else { return true; } } document.getElementById('dnn_ctr497_FormMaster_rfv__20090626T102018').dispose = function() { Array.remove(Page_Validators, document.getElementById('dnn_ctr497_FormMaster_rfv__20090626T102018')); } document.getElementById('dnn_ctr497_FormMaster_rfv__20090626T074129').dispose = function() { Array.remove(Page_Validators, document.getElementById('dnn_ctr497_FormMaster_rfv__20090626T074129')); } document.getElementById('dnn_ctr497_FormMaster_rev__20090626T074151').dispose = function() { Array.remove(Page_Validators, document.getElementById('dnn_ctr497_FormMaster_rev__20090626T074151')); } document.getElementById('dnn_ctr497_FormMaster_rfv__20090626T074321').dispose = function() { Array.remove(Page_Validators, document.getElementById('dnn_ctr497_FormMaster_rfv__20090626T074321')); } document.getElementById('dnn_ctr497_FormMaster_rev__20090626T074351').dispose = function() { Array.remove(Page_Validators, document.getElementById('dnn_ctr497_FormMaster_rev__20090626T074351')); } //]]> </script> <!--</form>--> </body> </html>
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