VIPS Application
LCMS.FormBuilder.AddFormOnlyOnce('main_0_0_pnlViewForm', 'main_0_0_btnFormPost', 'main_0_0_hfCallBack', 'main_0_0_hfViewState', '{"data":{"paymentInfo":null,"properties":{"accountID":-1,"formID":157083,"title":"VIPS Application","description":null,"emailEntries":true,"emailEntriesTo":"","emailExcludeFormData":false,"isPasswordProtected":false,"formPassword":"","confirmationMessageType":"text","confirmationMessageText":"Thank you for filling out our form.","redirectURL":null,"emailConfirmation":false,"emailConfirmationIncludesFields":false,"emailConfirmationFieldSetID":null,"replyToFieldSetID":803272,"captchaFieldsetID":null,"emailConfirmationSubject":null,"emailConfirmationFrom":"","emailConfirmationBody":null,"formHeight":0,"basePrice":0.00,"enablePayments":true,"packageID":2,"requireSSL":false,"captchaCode":null,"showReportAbuseLink":false},"elements":[{"formElementID":803268,"fieldTitle":"Name","fieldType":"name","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Normal","order":0,"fields":[{"fieldID":1294110,"type":"text","name":"","defaultValue":null,"cssClass":["firstname"],"size":"16","fieldNote":"First","fieldRow":0,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294111,"type":"text","name":"","defaultValue":null,"cssClass":["lastname"],"size":"16","fieldNote":"Last","fieldRow":0,"isRequired":true,"isUnique":false,"options":[]}]},{"formElementID":803269,"fieldTitle":"Date of Birth","fieldType":"date","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"mm/dd/yyyy","order":1,"fields":[{"fieldID":1294112,"type":"text","name":"MM","defaultValue":null,"cssClass":["dateMonth"],"size":"2","fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294113,"type":"text","name":"DD","defaultValue":null,"cssClass":["dateDay"],"size":"2","fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294114,"type":"text","name":"YYYY","defaultValue":null,"cssClass":["dateYear"],"size":"4","fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[]}]},{"formElementID":803270,"fieldTitle":"Phone","fieldType":"phone","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"US","order":2,"fields":[{"fieldID":1294115,"type":"text","name":"(XXX)","defaultValue":null,"cssClass":["phone-areacode"],"size":"3","fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294116,"type":"text","name":"XXX-","defaultValue":null,"cssClass":["phone-prefix"],"size":"3","fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294117,"type":"text","name":"XXXX","defaultValue":null,"cssClass":["phone-suffix"],"size":"4","fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[]}]},{"formElementID":803271,"fieldTitle":"Address","fieldType":"address","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"US","order":3,"fields":[{"fieldID":1294118,"type":"text","name":"","defaultValue":null,"cssClass":["address1"],"size":"47","fieldNote":"Street Address","fieldRow":0,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294119,"type":"text","name":"","defaultValue":null,"cssClass":["address2"],"size":"47","fieldNote":"Address Line 2","fieldRow":1,"isRequired":false,"isUnique":false,"options":[]},{"fieldID":1294120,"type":"text","name":"","defaultValue":null,"cssClass":["city"],"size":"16","fieldNote":"City","fieldRow":2,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294121,"type":"state","name":"","defaultValue":null,"cssClass":["state"],"size":null,"fieldNote":"State","fieldRow":2,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294122,"type":"text","name":"","defaultValue":null,"cssClass":["zip"],"size":"5","fieldNote":"Zip Code","fieldRow":2,"isRequired":true,"isUnique":false,"options":[]}]},{"formElementID":803272,"fieldTitle":"Email","fieldType":"email","instructions":null,"cssClass":["medField"],"isRequired":false,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":true,"formatType":"Default","order":4,"fields":[{"fieldID":1294123,"type":"text","name":"","defaultValue":null,"cssClass":["email"],"size":"24","fieldNote":null,"fieldRow":0,"isRequired":false,"isUnique":false,"options":[]}]},{"formElementID":803273,"fieldTitle":"Preferred method of contact","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":5,"fields":[{"fieldID":1294124,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890691,"price":0.00,"text":"E-mai","isChecked":false,"isDefault":true,"order":0},{"optionID":890692,"price":0.00,"text":"Phone","isChecked":false,"isDefault":false,"order":1},{"optionID":890693,"price":0.00,"text":"Mail","isChecked":false,"isDefault":false,"order":2}]}]},{"formElementID":803274,"fieldTitle":"Do you have any previous work history?","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":6,"fields":[{"fieldID":1294125,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890694,"price":0.00,"text":"Yes","isChecked":false,"isDefault":true,"order":0},{"optionID":890695,"price":0.00,"text":"No","isChecked":false,"isDefault":false,"order":1}]}]},{"formElementID":803275,"fieldTitle":"Please briefly explain your work history.","fieldType":"paragraph","instructions":null,"cssClass":["medField"],"isRequired":false,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":7,"fields":[{"fieldID":1294126,"type":"textarea","name":"","defaultValue":null,"cssClass":null,"size":"46","fieldNote":null,"fieldRow":0,"isRequired":false,"isUnique":false,"options":[]}]},{"formElementID":803276,"fieldTitle":"Have you ever been convicted of a crime?","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":8,"fields":[{"fieldID":1294127,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890696,"price":0.00,"text":"Yes","isChecked":false,"isDefault":true,"order":0},{"optionID":890697,"price":0.00,"text":"No","isChecked":false,"isDefault":false,"order":1}]}]},{"formElementID":803277,"fieldTitle":"If yes, please explain your criminal history.","fieldType":"paragraph","instructions":null,"cssClass":["medField"],"isRequired":false,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":9,"fields":[{"fieldID":1294128,"type":"textarea","name":"","defaultValue":null,"cssClass":null,"size":"46","fieldNote":null,"fieldRow":0,"isRequired":false,"isUnique":false,"options":[]}]},{"formElementID":803278,"fieldTitle":"I give my permission to the Rochester Police Department, Rochester, Illinois, to conduct a background check to determine if I have a criminal record.","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":10,"fields":[{"fieldID":1294129,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890698,"price":0.00,"text":"I agree","isChecked":false,"isDefault":true,"order":0}]}]},{"formElementID":803280,"fieldTitle":"I authorize any and all persons, employers, partnerships, corporations, and all civilian and government entities, military agencies, law enforcement agencies, private, City, County, State, and Federal entities to release, furnish and exchange any and all available information relating to me for the purpose of determining my suitability to be appointed as a member of the ViPS Program. This includes, but is not limited to, all information related to my character, integrity, reputation, conduct and behavior. This authorizes release to the Rochester Police Department. This release is in addition to, and intended to curtail or diminish, the authorization and immunity provided by statute. I DO HEREBY RELEASE from any and all liability, all persons or entities disclosing information pursuant to this release.","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":11,"fields":[{"fieldID":1294132,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890699,"price":0.00,"text":"I agree","isChecked":false,"isDefault":true,"order":0}]}]},{"formElementID":803281,"fieldTitle":"Please check all of the duties that you would be willing to perform as a participant in the ViPS program.","fieldType":"checkbox","instructions":null,"cssClass":null,"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":12,"fields":[{"fieldID":1294133,"type":"checkbox","name":"","defaultValue":null,"cssClass":["checkboxes"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890700,"price":0.00,"text":"Parking cars during community events","isChecked":false,"isDefault":false,"order":0},{"optionID":890701,"price":0.00,"text":"Assist in traffic control","isChecked":false,"isDefault":false,"order":1},{"optionID":890702,"price":0.00,"text":"Assist in running Village information tent during 4th of July","isChecked":false,"isDefault":false,"order":2},{"optionID":890703,"price":0.00,"text":"Role playing during police trainings","isChecked":false,"isDefault":false,"order":3},{"optionID":890704,"price":0.00,"text":"Assist in putting up signs and marking parking lots for special events","isChecked":false,"isDefault":false,"order":4},{"optionID":890705,"price":0.00,"text":"Photography","isChecked":false,"isDefault":false,"order":5},{"optionID":890706,"price":0.00,"text":"Videography and video editing","isChecked":false,"isDefault":false,"order":6},{"optionID":890707,"price":0.00,"text":"Computer graphics","isChecked":false,"isDefault":false,"order":7}]}]},{"formElementID":803282,"fieldTitle":"Please indicate your shirt size","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":13,"fields":[{"fieldID":1294134,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890708,"price":0.00,"text":"Smal","isChecked":false,"isDefault":false,"order":0},{"optionID":890709,"price":0.00,"text":"Medium","isChecked":false,"isDefault":false,"order":1},{"optionID":890710,"price":0.00,"text":"Large","isChecked":false,"isDefault":false,"order":2},{"optionID":890711,"price":0.00,"text":"Extra Large","isChecked":false,"isDefault":false,"order":3},{"optionID":890712,"price":0.00,"text":"Other","isChecked":false,"isDefault":false,"order":4}]}]},{"formElementID":803283,"fieldTitle":"If other, please specify size.","fieldType":"text","instructions":null,"cssClass":["medField"],"isRequired":false,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":14,"fields":[{"fieldID":1294135,"type":"text","name":"","defaultValue":null,"cssClass":["textsingleline"],"size":"36","fieldNote":null,"fieldRow":0,"isRequired":false,"isUnique":false,"options":[]}]},{"formElementID":803284,"fieldTitle":"The information I have provided above is truthful and has been filled out to the best of my ability.","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":15,"fields":[{"fieldID":1294136,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890713,"price":0.00,"text":"I agree","isChecked":false,"isDefault":true,"order":0}]}]},{"formElementID":803285,"fieldTitle":"Applicant\\u0027s Electronic Signature","fieldType":"name","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Normal","order":16,"fields":[{"fieldID":1294137,"type":"text","name":"","defaultValue":null,"cssClass":["firstname"],"size":"16","fieldNote":"First","fieldRow":0,"isRequired":true,"isUnique":false,"options":[]},{"fieldID":1294138,"type":"text","name":"","defaultValue":null,"cssClass":["lastname"],"size":"16","fieldNote":"Last","fieldRow":0,"isRequired":true,"isUnique":false,"options":[]}]},{"formElementID":803286,"fieldTitle":"I am","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":true,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":17,"fields":[{"fieldID":1294139,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":true,"isUnique":false,"options":[{"optionID":890714,"price":0.00,"text":"18 years or older","isChecked":false,"isDefault":true,"order":0},{"optionID":890715,"price":0.00,"text":"Under the age of 18","isChecked":false,"isDefault":false,"order":1}]}]},{"formElementID":803287,"fieldTitle":"Parental Consent (to be completed by parent if applicant is under the age of 18)","fieldType":"sectionbreak","instructions":null,"cssClass":null,"isRequired":false,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":18,"fields":[{"fieldID":1294140,"type":"richtext","name":"","defaultValue":null,"cssClass":null,"size":"100","fieldNote":null,"fieldRow":0,"isRequired":false,"isUnique":false,"options":[]}]},{"formElementID":803288,"fieldTitle":"I give my child permission to participate in the Rochester Police Department\\u0027s Volunteers in Police Service (ViPS) Program.","fieldType":"dropdown","instructions":null,"cssClass":["medField"],"isRequired":false,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Default","order":19,"fields":[{"fieldID":1294141,"type":"select","name":"","defaultValue":null,"cssClass":["dropdown"],"size":null,"fieldNote":null,"fieldRow":0,"isRequired":false,"isUnique":false,"options":[{"optionID":890716,"price":0.00,"text":"I agree","isChecked":false,"isDefault":true,"order":0}]}]},{"formElementID":803289,"fieldTitle":"Applicant\\u0027s parent/guardian\\u0027s electronic signature (required if applicant is under the age of 18)","fieldType":"name","instructions":null,"cssClass":["medField"],"isRequired":false,"isUnique":false,"isEmailConfirmationField":false,"isHiddenEmailField":false,"isReplyToField":false,"formatType":"Normal","order":20,"fields":[{"fieldID":1294142,"type":"text","name":"","defaultValue":null,"cssClass":["firstname"],"size":"16","fieldNote":"First","fieldRow":0,"isRequired":false,"isUnique":false,"options":[]},{"fieldID":1294143,"type":"text","name":"","defaultValue":null,"cssClass":["lastname"],"size":"16","fieldNote":"Last","fieldRow":0,"isRequired":false,"isUnique":false,"options":[]}]}],"deleteInfo":null}}', 'main_0_0_hfIs508Compliant');