{"id":200,"date":"2022-01-21T10:26:15","date_gmt":"2022-01-21T10:26:15","guid":{"rendered":"https:\/\/apply.mightyhealthc.co.uk\/?page_id=200"},"modified":"2022-01-26T12:48:44","modified_gmt":"2022-01-26T12:48:44","slug":"international","status":"publish","type":"page","link":"https:\/\/apply.mightyhealthc.co.uk\/index.php\/international\/","title":{"rendered":"International Application Form"},"content":{"rendered":"<script type=\"text\/javascript\">if(!gform){document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0});var gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),null==t&&(t=10),gform.hooks[o][n].push({tag:i,callable:r,priority:t})},doHook:function(o,n,r){if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[o][n]){var t,i=gform.hooks[o][n];i.sort(function(o,n){return o.priority-n.priority});for(var e=0;e<i.length;e++)\"function\"!=typeof(t=i[e].callable)&#038;&#038;(t=window[t]),\"action\"==o?t.apply(null,r):r[0]=t.apply(null,r)}if(\"filter\"==o)return r[0]},removeHook:function(o,n,r,t){if(null!=gform.hooks[o][n])for(var i=gform.hooks[o][n],e=i.length-1;0<=e;e--)null!=t&#038;&#038;t!=i[e].tag||null!=r&#038;&#038;r!=i[e].priority||i.splice(e,1)}}}<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">International Application Form<\/h2>\n                            <span class='gform_description'><\/span>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/index.php\/wp-json\/wp\/v2\/pages\/200#gf_1' novalidate>\n        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>10<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_10' style='width:10%;'><span>10%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform_body gform-body'><div id='gform_page_1_1' class='gform_page' >\n                                    <div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_1\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Personal Details<\/h3><div class='gsection_description' id='gfield_description_1_1'>Please ensure that you complete the application form in full. This form will be kept in confidence.\nPlease note that no applicant will be unfairly discriminated against. This includes discrimination on account of age, cultural\/religious\/political beliefs, disability, ethnicity, gender, race, relationship status, sexual orientation, and\/or Trade Union membership or stewardship.\n<\/div><\/div><div id=\"field_1_2\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_2' >Position applied for:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_1_2' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Senior Support Worker' >Senior Support Worker<\/option><option value='Care Worker' >Care Worker<\/option><\/select><\/div><\/div><fieldset id=\"field_1_3\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Preferred employment type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_3'>\n\t\t\t<div class='gchoice gchoice_1_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Part Time'  id='choice_1_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_3_0' id='label_1_3_0'>Part Time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Full time'  id='choice_1_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_3_1' id='label_1_3_1'>Full time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_5\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_5' >Surname<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='text' value='' class='large'    placeholder='Surname'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_6' >First name(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='text' value='' class='large'    placeholder='First name(s)' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_7\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_1_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_1_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_1_7_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_7_1' id='input_1_7_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_1_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_1_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_7_2' id='input_1_7_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_1_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_1_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_7_3' id='input_1_7_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_1_7_4_container' >\n                                        <input type='text' name='input_7.4' id='input_1_7_4' value=''      aria-required='true'    \/>\n                                        <label for='input_1_7_4' id='input_1_7_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_1_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_1_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_7_5' id='input_1_7_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country' id='input_1_7_6_container' >\n                                        <select name='input_7.6' id='input_1_7_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_1_7_6' id='input_1_7_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_8\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_8' >Telephone number (home):<\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_1_8' type='tel' value='' class='large'  placeholder='Mobile Number in international format'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_9' >Telephone number (mobile):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_1_9' type='tel' value='' class='large'  placeholder='Mobile Number in international format' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_10\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_10' >Email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_10' id='input_1_10' type='email' value='' class='large'   placeholder='Email address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_1_11\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have a Driving Licence?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_11'>\n\t\t\t<div class='gchoice gchoice_1_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Yes'  id='choice_1_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_11_0' id='label_1_11_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='No'  id='choice_1_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_12\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_12' >How long has your licence been held?<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='large'    placeholder='How long has your licence been held?'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_14\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_14' >Country where licence was issued:<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1_14' type='text' value='' class='large'    placeholder='Country where licence was issued:'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_4\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_1_15\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Are you a United Kingdom (UK), European Community (EC) or European Economic Area (EEA) National ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_15'>\n\t\t\t<div class='gchoice gchoice_1_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Yes'  id='choice_1_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_15_0' id='label_1_15_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='No'  id='choice_1_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_15_1' id='label_1_15_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_95\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Date of birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_1_95' class='ginput_container ginput_complex'>\n                                        <div class='gfield_date_day ginput_container ginput_container_date' id='input_1_95_2_container'>\n                                            <input type='number'  name='input_95[]' id='input_1_95_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_95_2' class='screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date' id='input_1_95_1_container'>\n                                        <input type='number'  name='input_95[]' id='input_1_95_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_95_1' class='screen-reader-text'>Month<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date' id='input_1_95_3_container'>\n                                        <input type='number'  name='input_95[]' id='input_1_95_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_95_3' class='screen-reader-text'>Year<\/label>\n                                   <\/div>\n                                <\/div><\/fieldset><div id=\"field_1_16\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_16' >National ID number:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_1_16' type='text' value='' class='large'    placeholder='National ID number' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_17\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_17' >Passport number:<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_1_17' type='text' value='' class='large'    placeholder='Passport number:'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_93\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='gform_browse_button_1_93' >Upload National ID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_93' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_93&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_93&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_93&quot;,&quot;filelist&quot;:&quot;gform_preview_1_93&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/?gf_page=69f21c6ace0f380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:93},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;3&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_93&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_93' class='gform_drop_area'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button id='gform_browse_button_1_93' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_1_93\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gform_fileupload_rules' id='gfield_upload_rules_1_93'>Max. file size: 10 MB, Max. files: 3.<\/span><ul class='validation_message validation_message--hidden-on-empty gfield_validation_message gform-ul-reset' id='gform_multifile_messages_1_93'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_93'><\/div><\/div><div id=\"field_1_94\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='gform_browse_button_1_94' >Upload Passport<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_94' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_94&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_94&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_94&quot;,&quot;filelist&quot;:&quot;gform_preview_1_94&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/?gf_page=69f21c6ace0f380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:94},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;3&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_94&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_94' class='gform_drop_area'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button id='gform_browse_button_1_94' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_1_94\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gform_fileupload_rules' id='gfield_upload_rules_1_94'>Max. file size: 10 MB, Max. files: 3.<\/span><ul class='validation_message validation_message--hidden-on-empty gfield_validation_message gform-ul-reset' id='gform_multifile_messages_1_94'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_94'><\/div><\/div><fieldset id=\"field_1_28\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Are you are related to a member of staff or Service User at Mighty Health Care Limited?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_28'>\n\t\t\t<div class='gchoice gchoice_1_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Yes'  id='choice_1_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_28_0' id='label_1_28_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='No'  id='choice_1_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_28_1' id='label_1_28_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_29\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_29' >Name of Person<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_1_29' type='text' value='' class='large'    placeholder='Name of Person'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_30\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_30' >Relation<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_1_30' type='text' value='' class='large'    placeholder='Relationship with person'  aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_53' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_22\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Next of Kin<\/h3><\/div><div id=\"field_1_23\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_23' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='text' value='' class='large'    placeholder='Next of Kin Name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_24' >Relation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_1_24' type='text' value='' class='large'    placeholder='Relationship with Next of Kin e.g spouse' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_25\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_25' >Mobile Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_25' id='input_1_25' type='tel' value='' class='large'  placeholder='Next of Kin&#039;s Mobile Number' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_26\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_26' >Email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_26' id='input_1_26' type='email' value='' class='large'   placeholder='Next of Kin&#039;s Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_1_27\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_1_27' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_1_27_1_container' >\n                                        <input type='text' name='input_27.1' id='input_1_27_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_27_1' id='input_1_27_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_1_27_2_container' >\n                                        <input type='text' name='input_27.2' id='input_1_27_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_27_2' id='input_1_27_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_1_27_3_container' >\n                                    <input type='text' name='input_27.3' id='input_1_27_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_27_3' id='input_1_27_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_1_27_4_container' >\n                                        <input type='text' name='input_27.4' id='input_1_27_4' value=''      aria-required='true'    \/>\n                                        <label for='input_1_27_4' id='input_1_27_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_1_27_5_container' >\n                                    <input type='text' name='input_27.5' id='input_1_27_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_27_5' id='input_1_27_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country' id='input_1_27_6_container' >\n                                        <select name='input_27.6' id='input_1_27_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_1_27_6' id='input_1_27_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_55' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_55' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_31\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Equality Act 2010<\/h3><div class='gsection_description' id='gfield_description_1_31'>Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a \u201csubstantial\u201d and \u201clong term adverse effect\u201d on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at: www.gov.uk\/definition-of-disability-under-equality-act-2010.\n<\/div><\/div><fieldset id=\"field_1_32\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >For the purposes of this application and the interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_32'>\n\t\t\t<div class='gchoice gchoice_1_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Yes'  id='choice_1_32_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_32\"   \/>\n\t\t\t\t\t<label for='choice_1_32_0' id='label_1_32_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='No'  id='choice_1_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_1' id='label_1_32_1'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Prefer Not Discuss'  id='choice_1_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_2' id='label_1_32_2'>Prefer Not Discuss<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_32'>If you have any special requirements to support you to complete this form (e.g. the need for large print or additional time) please contact us on +44 (0) 2921 780 020\n<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_56' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_56' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_33\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Education<\/h3><\/div><fieldset id=\"field_1_20\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Have you completed and passed the Nurse Aide Training or related course?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_20'>\n\t\t\t<div class='gchoice gchoice_1_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Yes'  id='choice_1_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_20_0' id='label_1_20_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='No'  id='choice_1_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_21\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_21' >Upload Nurse Aide Training Certificates<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='67108864' \/><input name='input_21' id='input_1_21' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_21\" onchange='javascript:gformValidateFileSize( this, 67108864 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_21'>Max. file size: 64 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_21'><\/div><\/div><\/div><fieldset id=\"field_1_34\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Educational qualifications<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header\"><div class=\"gfield_header_item\">School\/College\/University<\/div><div class=\"gfield_header_item\">Examination(s) Passed<\/div><div class=\"gfield_header_item\">Qualification(s) Gained<\/div><div class=\"gfield_header_item\">Year Obtained<\/div><div class=\"gfield_header_item gfield_header_item--icons\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group'><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell1' data-label='School\/College\/University'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_34\" aria-label='School\/College\/University, Row 1' data-aria-label-template='School\/College\/University, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell2' data-label='Examination(s) Passed'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_34\" aria-label='Examination(s) Passed, Row 1' data-aria-label-template='Examination(s) Passed, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell3' data-label='Qualification(s) Gained'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_34\" aria-label='Qualification(s) Gained, Row 1' data-aria-label-template='Qualification(s) Gained, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell4' data-label='Year Obtained'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_34\" aria-label='Year Obtained, Row 1' data-aria-label-template='Year Obtained, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_icons'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_34'>All qualifications will be subject to a satisfactory check<\/div><\/fieldset><div id=\"field_1_36\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='gform_browse_button_1_36' >Upload all certificates<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_36' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_36&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_36&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_36&quot;,&quot;filelist&quot;:&quot;gform_preview_1_36&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/?gf_page=69f21c6ace0f380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;36700160b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:36},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_1_36&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_36' class='gform_drop_area'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button id='gform_browse_button_1_36' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_1_36\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gform_fileupload_rules' id='gfield_upload_rules_1_36'>Max. file size: 35 MB.<\/span><ul class='validation_message validation_message--hidden-on-empty gfield_validation_message gform-ul-reset' id='gform_multifile_messages_1_36'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_36'><\/div><\/div><fieldset id=\"field_1_35\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Training Courses Attended or Completing<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header\"><div class=\"gfield_header_item\">Subject<\/div><div class=\"gfield_header_item\">Location\/Details<\/div><div class=\"gfield_header_item\">Date<\/div><div class=\"gfield_header_item gfield_header_item--icons\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group'><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell1' data-label='Subject'><input aria-invalid='false'   aria-label='Subject, Row 1' data-aria-label-template='Subject, Row {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell2' data-label='Location\/Details'><input aria-invalid='false'   aria-label='Location\/Details, Row 1' data-aria-label-template='Location\/Details, Row {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_35_cell3' data-label='Date'><input aria-invalid='false'   aria-label='Date, Row 1' data-aria-label-template='Date, Row {0}' type='text' name='input_35[]' value=''   \/><\/div><div class='gfield_list_icons'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 20)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 20)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_1_37\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='gform_browse_button_1_37' >Upload Certificates for training courses<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_37' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_37&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_37&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_37&quot;,&quot;filelist&quot;:&quot;gform_preview_1_37&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/?gf_page=69f21c6ace0f380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;67108864b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:37},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;20&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_37&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_37' class='gform_drop_area'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button id='gform_browse_button_1_37' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_1_37\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gform_fileupload_rules' id='gfield_upload_rules_1_37'>Max. file size: 64 MB, Max. files: 20.<\/span><ul class='validation_message validation_message--hidden-on-empty gfield_validation_message gform-ul-reset' id='gform_multifile_messages_1_37'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_37'><\/div><\/div><div id=\"field_1_92\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='gform_browse_button_1_92' >Upload Your CV<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_92' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_92&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_92&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_92&quot;,&quot;filelist&quot;:&quot;gform_preview_1_92&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/?gf_page=69f21c6ace0f380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:92},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;1&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_92&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_92' class='gform_drop_area'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button id='gform_browse_button_1_92' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_1_92\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gform_fileupload_rules' id='gfield_upload_rules_1_92'>Max. file size: 10 MB, Max. files: 1.<\/span><ul class='validation_message validation_message--hidden-on-empty gfield_validation_message gform-ul-reset' id='gform_multifile_messages_1_92'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_92'><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_57' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_57' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_38\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Employment History<\/h3><\/div><fieldset id=\"field_1_40\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have employment history?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_40'>\n\t\t\t<div class='gchoice gchoice_1_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Yes, I have worked before'  id='choice_1_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_40_0' id='label_1_40_0'>Yes, I have worked before<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='I&#039;m a Student'  id='choice_1_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_40_1' id='label_1_40_1'>I'm a Student<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_39\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Please record below the details of your full employment history beginning with your current or most recent first.<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header\"><div class=\"gfield_header_item\">Employer\/Company Name<\/div><div class=\"gfield_header_item\">Address<\/div><div class=\"gfield_header_item\">Email Address<\/div><div class=\"gfield_header_item\">Start Date - End Date<\/div><div class=\"gfield_header_item\">Nature of business<\/div><div class=\"gfield_header_item\">Position held and reason for leaving<\/div><div class=\"gfield_header_item\">Salary \/ Rate<\/div><div class=\"gfield_header_item gfield_header_item--icons\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group'><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell1' data-label='Employer\/Company Name'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_39\" aria-label='Employer\/Company Name, Row 1' data-aria-label-template='Employer\/Company Name, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell2' data-label='Address'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_39\" aria-label='Address, Row 1' data-aria-label-template='Address, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell3' data-label='Email Address'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_39\" aria-label='Email Address, Row 1' data-aria-label-template='Email Address, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell4' data-label='Start Date - End Date'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_39\" aria-label='Start Date - End Date, Row 1' data-aria-label-template='Start Date - End Date, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell5' data-label='Nature of business'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_39\" aria-label='Nature of business, Row 1' data-aria-label-template='Nature of business, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell6' data-label='Position held and reason for leaving'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_39\" aria-label='Position held and reason for leaving, Row 1' data-aria-label-template='Position held and reason for leaving, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell7' data-label='Salary \/ Rate'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_39\" aria-label='Salary \/ Rate, Row 1' data-aria-label-template='Salary \/ Rate, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_icons'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_39'>Must have at least 10 years\u2019 work history. If student, please select student<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_58' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_58' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_44\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Supporting Statement<\/h3><div class='gsection_description' id='gfield_description_1_44'>Please add here your reasons for applying. You should refer to the job description and person specification to guide you. It would also be of value to describe particular strengths and talents that set you apart from others as well as including skills gained from work, home and other activities.<\/div><\/div><div id=\"field_1_41\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_41' >Supporting Statement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_41' id='input_1_41' class='textarea large'    placeholder='Supporting statement' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_59' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_59' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_7' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_7' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_1_42\" class=\"gfield gfield--width-full field_sublabel_below field_description_above gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Professional Referees  (Please input at least 2 references)<\/legend><div class='gfield_description' id='gfield_description_1_42'>You must provide references from your two most recent employers or professionals. All will be contacted, therefore please inform the referees of the fact that you have used their name.<\/div><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header\"><div class=\"gfield_header_item\">Referee Name<\/div><div class=\"gfield_header_item\">Address<\/div><div class=\"gfield_header_item\">Email Address<\/div><div class=\"gfield_header_item\">Tel &amp; Mobile No<\/div><div class=\"gfield_header_item\">Job Title<\/div><div class=\"gfield_header_item gfield_header_item--icons\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group'><div class='gfield_list_group_item gfield_list_cell gfield_list_42_cell1' data-label='Referee Name'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_42\" aria-label='Referee Name, Row 1' data-aria-label-template='Referee Name, Row {0}' type='text' name='input_42[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_42_cell2' data-label='Address'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_42\" aria-label='Address, Row 1' data-aria-label-template='Address, Row {0}' type='text' name='input_42[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_42_cell3' data-label='Email Address'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_42\" aria-label='Email Address, Row 1' data-aria-label-template='Email Address, Row {0}' type='text' name='input_42[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_42_cell4' data-label='Tel &amp; Mobile No'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_42\" aria-label='Tel &amp; Mobile No, Row 1' data-aria-label-template='Tel &amp; Mobile No, Row {0}' type='text' name='input_42[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_42_cell5' data-label='Job Title'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_42\" aria-label='Job Title, Row 1' data-aria-label-template='Job Title, Row {0}' type='text' name='input_42[]' value=''   \/><\/div><div class='gfield_list_icons'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 4)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 4)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_1_45\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Character Reference<\/h3><div class='gsection_description' id='gfield_description_1_45'>Please provide a character reference. This can be your local religious leader, police representative or someone who can vouch your character. They must NOT be your relative.<\/div><\/div><fieldset id=\"field_1_43\" class=\"gfield gfield--width-full field_sublabel_below field_description_above gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Character Reference<\/legend><div class='gfield_description' id='gfield_description_1_43'>Please provide a character reference. This can be your local religious leader, police representative or someone who can vouch for your character. They must NOT be your relative.<\/div><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header\"><div class=\"gfield_header_item\">Name of person<\/div><div class=\"gfield_header_item\">Address<\/div><div class=\"gfield_header_item\">Email Address<\/div><div class=\"gfield_header_item\">Tel &amp; Mobile No<\/div><div class=\"gfield_header_item\">Relationship to you<\/div><div class=\"gfield_header_item gfield_header_item--icons\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group'><div class='gfield_list_group_item gfield_list_cell gfield_list_43_cell1' data-label='Name of person'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_43\" aria-label='Name of person, Row 1' data-aria-label-template='Name of person, Row {0}' type='text' name='input_43[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_43_cell2' data-label='Address'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_43\" aria-label='Address, Row 1' data-aria-label-template='Address, Row {0}' type='text' name='input_43[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_43_cell3' data-label='Email Address'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_43\" aria-label='Email Address, Row 1' data-aria-label-template='Email Address, Row {0}' type='text' name='input_43[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_43_cell4' data-label='Tel &amp; Mobile No'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_43\" aria-label='Tel &amp; Mobile No, Row 1' data-aria-label-template='Tel &amp; Mobile No, Row {0}' type='text' name='input_43[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_43_cell5' data-label='Relationship to you'><input aria-invalid='false'  aria-describedby=\"gfield_description_1_43\" aria-label='Relationship to you, Row 1' data-aria-label-template='Relationship to you, Row {0}' type='text' name='input_43[]' value=''   \/><\/div><div class='gfield_list_icons'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 4)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 4)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_60' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_60' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"8\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"8\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_8' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_8' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_46\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Safeguarding<\/h3><\/div><div id=\"field_1_49\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Ex-Offenders Declaration<\/h3><div class='gsection_description' id='gfield_description_1_49'>Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest of confidence\n<\/div><\/div><div id=\"field_1_47\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Rehabilitation of Offenders Act 1974<\/h3><div class='gsection_description' id='gfield_description_1_47'>Mighty Health Care Limited aims to promote equality of opportunity and is committed to treating all applicants regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Mighty Health Care Limited undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.\nAnswering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of\nthe information you provide in respect of the nature of the position and the circumstances.\n<\/div><\/div><fieldset id=\"field_1_48\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Are you currently bound over or do you have any current UNSPENT convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_48'>\n\t\t\t<div class='gchoice gchoice_1_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='Yes'  id='choice_1_48_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_48_0' id='label_1_48_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='No'  id='choice_1_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_48_1' id='label_1_48_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_50\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_50'>\n\t\t\t<div class='gchoice gchoice_1_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Yes'  id='choice_1_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_50_0' id='label_1_50_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_50_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='No'  id='choice_1_50_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_50_1' id='label_1_50_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_51\" class=\"gfield gfield--width-full field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='gform_browse_button_1_51' >Police clearance in all the countries you have lived in the past 10 years.<\/label><div class='gfield_description' id='gfield_description_1_51'>If you currently do not have the police clearance documents, you will be required to submit them after the interview stage<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_51' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_51&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_51&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_51&quot;,&quot;filelist&quot;:&quot;gform_preview_1_51&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/?gf_page=69f21c6ace0f380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/apply.mightyhealthc.co.uk\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;pdf,jpg,png,jpeg,doc,docx&quot;}],&quot;max_file_size&quot;:&quot;36700160b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:51},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;12&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_51&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_51' class='gform_drop_area'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button id='gform_browse_button_1_51' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_1_51 gfield_description_1_51\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gform_fileupload_rules' id='gfield_upload_rules_1_51'>Accepted file types: pdf, jpg, png, jpeg, doc, docx, Max. file size: 35 MB, Max. files: 12.<\/span><ul class='validation_message validation_message--hidden-on-empty gfield_validation_message gform-ul-reset' id='gform_multifile_messages_1_51'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_51'><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_62' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_62' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"9\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"9\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_9' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_9' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_61\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Equal Opportunities Monitoring<\/h3><div class='gsection_description' id='gfield_description_1_61'>Mighty Health Care Limited is committed to equality of opportunity and fair treatment in all aspects of employment. We aim to provide a working and learning environment which is free from unfair discrimination and will enable staff to fulfil their personal potential.\nThe information you provide will be treated as strictly confidential in line with the Data Protection Act 2018 and will be used only for equal opportunities monitoring. It will help us to comply with the law under the relevant Acts and to ensure that our employment policies and practices are fair and effective.<\/div><\/div><div id=\"field_1_52\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">IMPORTANT - Please Note:<\/h3><div class='gsection_description' id='gfield_description_1_52'>You do not have to complete this form. The information is given on a voluntary basis and the information provided will only be used for the monitoring purpose.\nPlease do not enter any identifying marks on this form, so that your information remains confidential. This information will be stored on a computer.\n<\/div><\/div><fieldset id=\"field_1_64\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><legend class='gfield_label'  >Ethnic Origin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_64'>Please select your Ethnic Origin<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_64'>\n\t\t\t<div class='gchoice gchoice_1_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Bangladeshi'  id='choice_1_64_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_64\"   \/>\n\t\t\t\t\t<label for='choice_1_64_0' id='label_1_64_0'>Bangladeshi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Indian'  id='choice_1_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_1' id='label_1_64_1'>Indian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Pakistani'  id='choice_1_64_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_2' id='label_1_64_2'>Pakistani<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Any other Asian'  id='choice_1_64_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_3' id='label_1_64_3'>Any other Asian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='White &amp; Asian'  id='choice_1_64_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_4' id='label_1_64_4'>White & Asian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='White &amp; Black African'  id='choice_1_64_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_5' id='label_1_64_5'>White & Black African<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='White &amp; Black Caribbean'  id='choice_1_64_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_6' id='label_1_64_6'>White & Black Caribbean<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Any other mixed'  id='choice_1_64_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_7' id='label_1_64_7'>Any other mixed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Chinese'  id='choice_1_64_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_8' id='label_1_64_8'>Chinese<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Any other Chinese'  id='choice_1_64_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_9' id='label_1_64_9'>Any other Chinese<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Any other ethnic'  id='choice_1_64_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_10' id='label_1_64_10'>Any other ethnic<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='African'  id='choice_1_64_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_11' id='label_1_64_11'>African<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Caribbean'  id='choice_1_64_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_12' id='label_1_64_12'>Caribbean<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Any other Black'  id='choice_1_64_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_13' id='label_1_64_13'>Any other Black<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='British'  id='choice_1_64_14' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_14' id='label_1_64_14'>British<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Irish'  id='choice_1_64_15' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_15' id='label_1_64_15'>Irish<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Any other white'  id='choice_1_64_16' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_16' id='label_1_64_16'>Any other white<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_17'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='I do not wish to disclose my ethnic origin'  id='choice_1_64_17' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_17' id='label_1_64_17'>I do not wish to disclose my ethnic origin<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_65\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Gender<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_65'>\n\t\t\t<div class='gchoice gchoice_1_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Female'  id='choice_1_65_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_65\"   \/>\n\t\t\t\t\t<label for='choice_1_65_0' id='label_1_65_0'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Male'  id='choice_1_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_65_1' id='label_1_65_1'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_65_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Transgender Female'  id='choice_1_65_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_65_2' id='label_1_65_2'>Transgender Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_65_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Transgender Male'  id='choice_1_65_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_65_3' id='label_1_65_3'>Transgender Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_65_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='I do not wish to disclose my gender'  id='choice_1_65_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_65_4' id='label_1_65_4'>I do not wish to disclose my gender<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_65_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='gf_other_choice'  id='choice_1_65_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_65_5' id='label_1_65_5'>Other<\/label><br \/><input id='input_1_65_other' name='input_65_other' type='text' value='Other' aria-label='Other Choice, please specify'   disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_65'>Please select your Gender<\/div><\/fieldset><fieldset id=\"field_1_66\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><legend class='gfield_label'  >Sexual Orientation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_66'>Please select your Sexual Orientation<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_66'>\n\t\t\t<div class='gchoice gchoice_1_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Bisexual'  id='choice_1_66_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_66\"   \/>\n\t\t\t\t\t<label for='choice_1_66_0' id='label_1_66_0'>Bisexual<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Heterosexual'  id='choice_1_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_66_1' id='label_1_66_1'>Heterosexual<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_66_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Gay'  id='choice_1_66_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_66_2' id='label_1_66_2'>Gay<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_66_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Lesbian'  id='choice_1_66_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_66_3' id='label_1_66_3'>Lesbian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_66_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='I do not wish to disclose my sexual orientation'  id='choice_1_66_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_66_4' id='label_1_66_4'>I do not wish to disclose my sexual orientation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_66_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='gf_other_choice'  id='choice_1_66_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_66_5' id='label_1_66_5'>Other<\/label><br \/><input id='input_1_66_other' name='input_66_other' type='text' value='Other' aria-label='Other Choice, please specify'   disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_67\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><legend class='gfield_label'  >Religion or Belief<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_67'>Please select your Religion or Belief<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_67'>\n\t\t\t<div class='gchoice gchoice_1_67_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Buddhist'  id='choice_1_67_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_67\"   \/>\n\t\t\t\t\t<label for='choice_1_67_0' id='label_1_67_0'>Buddhist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Christian'  id='choice_1_67_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_1' id='label_1_67_1'>Christian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Jewish'  id='choice_1_67_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_2' id='label_1_67_2'>Jewish<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Muslim'  id='choice_1_67_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_3' id='label_1_67_3'>Muslim<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Hindu'  id='choice_1_67_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_4' id='label_1_67_4'>Hindu<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Sikh'  id='choice_1_67_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_5' id='label_1_67_5'>Sikh<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='None'  id='choice_1_67_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_6' id='label_1_67_6'>None<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='I do not wish to disclose my religion or belief'  id='choice_1_67_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_7' id='label_1_67_7'>I do not wish to disclose my religion or belief<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value=''  id='choice_1_67_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_8' id='label_1_67_8'><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value=''  id='choice_1_67_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_9' id='label_1_67_9'><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_67_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='gf_other_choice'  id='choice_1_67_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_67_10' id='label_1_67_10'>Other<\/label><br \/><input id='input_1_67_other' name='input_67_other' type='text' value='Other' aria-label='Other Choice, please specify'   disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_68\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Marital Status<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_68'>\n\t\t\t<div class='gchoice gchoice_1_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Common Law Partnership'  id='choice_1_68_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_68\"   \/>\n\t\t\t\t\t<label for='choice_1_68_0' id='label_1_68_0'>Common Law Partnership<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Married\/Civil Partnership'  id='choice_1_68_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_68_1' id='label_1_68_1'>Married\/Civil Partnership<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_68_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Widowed'  id='choice_1_68_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_68_2' id='label_1_68_2'>Widowed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_68_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Divorced'  id='choice_1_68_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_68_3' id='label_1_68_3'>Divorced<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_68_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Single'  id='choice_1_68_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_68_4' id='label_1_68_4'>Single<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_68_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='gf_other_choice'  id='choice_1_68_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_68_5' id='label_1_68_5'>Other<\/label><br \/><input id='input_1_68_other' name='input_68_other' type='text' value='Other' aria-label='Other Choice, please specify'   disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_68'>Please select your Marital Status<\/div><\/fieldset><div id=\"field_1_69\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">As per Equality Act 2010:<\/h3><div class='gsection_description' id='gfield_description_1_69'>Under the terms of the Act a disability is defined as a \u201cphysical or mental impairment which has a substantial and long-term effect on a person\u2019s ability to carry out day-to-day activities\u201d.<\/div><\/div><fieldset id=\"field_1_70\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you consider yourself to have a Disability?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_70'>\n\t\t\t<div class='gchoice gchoice_1_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Yes'  id='choice_1_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_70_0' id='label_1_70_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='No'  id='choice_1_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_70_1' id='label_1_70_1'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_70_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='I do not wish to disclose whether or not I have a disability'  id='choice_1_70_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_70_2' id='label_1_70_2'>I do not wish to disclose whether or not I have a disability<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_71\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have any care responsibilities for anyone?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_71'>\n\t\t\t<div class='gchoice gchoice_1_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='Yes'  id='choice_1_71_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_71\"   \/>\n\t\t\t\t\t<label for='choice_1_71_0' id='label_1_71_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='No'  id='choice_1_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_71_1' id='label_1_71_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_71'>Caring Responsibilities<\/div><\/fieldset><fieldset id=\"field_1_73\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Are they<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_73'>\n\t\t\t<div class='gchoice gchoice_1_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Children under 16'  id='choice_1_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_73_0' id='label_1_73_0'>Children under 16<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Disables'  id='choice_1_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_73_1' id='label_1_73_1'>Disables<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_73_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Sick or Elderly'  id='choice_1_73_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_73_2' id='label_1_73_2'>Sick or Elderly<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_74' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"8\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"8\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_74' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"10\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"10\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_10' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_10' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_75\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Health and Fitness Questionnaire<\/h3><div class='gsection_description' id='gfield_description_1_75'>Please answer the following questions:<\/div><\/div><fieldset id=\"field_1_76\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have or have you ever had any significant health problem, impairment\/disability (physical or mental) or learning difficulties that may affect your ability to undertake the tasks set out in the job description of the post offered?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_76'>\n\t\t\t<div class='gchoice gchoice_1_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Yes'  id='choice_1_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_76_0' id='label_1_76_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='No'  id='choice_1_76_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_76_1' id='label_1_76_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_81\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_81' >Please provide details<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_81' id='input_1_81' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_1_77\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have or have you ever had any illness, impairment of disability that may have been caused or made worse by your work?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_77'>\n\t\t\t<div class='gchoice gchoice_1_77_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='Yes'  id='choice_1_77_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_77_0' id='label_1_77_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_77_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='No'  id='choice_1_77_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_77_1' id='label_1_77_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_82\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_82' >Please provide details<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_82' id='input_1_82' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_1_78\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Have you ever left or been denied employment in an organisation on the grounds of ill health or been medically retired on the grounds of ill health?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_78'>\n\t\t\t<div class='gchoice gchoice_1_78_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='Yes'  id='choice_1_78_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_78_0' id='label_1_78_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_78_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='No'  id='choice_1_78_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_78_1' id='label_1_78_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_83\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_83' >Please provide details<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_83' id='input_1_83' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_1_79\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Are you having, or waiting for any medical treatment or investigations at present?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_79'>\n\t\t\t<div class='gchoice gchoice_1_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Yes'  id='choice_1_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_79_0' id='label_1_79_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='No'  id='choice_1_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_79_1' id='label_1_79_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_84\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_84' >Please provide details<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_84' id='input_1_84' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_1_80\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Will you need any special aids or adjustments or assistance to enable you to undertake the tasks set out in the job description of the post offered?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_80'>\n\t\t\t<div class='gchoice gchoice_1_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Yes'  id='choice_1_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_80_0' id='label_1_80_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='No'  id='choice_1_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_80_1' id='label_1_80_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_85\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_85' >Please provide details<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_85' id='input_1_85' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_86\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Applicants Declaration<\/h3><div class='gsection_description' id='gfield_description_1_86'>Read and understand before signing.<\/div><\/div><fieldset id=\"field_1_88\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >I confirm that the information given above is complete and correct, and that I understand that any incomplete, untrue or misleading information given to Mighty Health Care Limited will entitle the employer to reject my application, withdraw any employment offer made, or, if I am employed, dismiss me without notice<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_88'>\n\t\t\t<div class='gchoice gchoice_1_88_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='Yes'  id='choice_1_88_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_88_0' id='label_1_88_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_88_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='No'  id='choice_1_88_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_88_1' id='label_1_88_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_89\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >By clicking submit, I give authority to the employer to contact my GP for further details regarding any of the potential health problems I have declared above.<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_89'>\n\t\t\t<div class='gchoice gchoice_1_89_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='Yes'  id='choice_1_89_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_89_0' id='label_1_89_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_89_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='No'  id='choice_1_89_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_89_1' id='label_1_89_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_90\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >I agree that Mighty Health Care Limited reserves the right to require me to undergo a medical examination to assess my suitability for work.<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_90'>\n\t\t\t<div class='gchoice gchoice_1_90_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Yes'  id='choice_1_90_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_0' id='label_1_90_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_90_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='No'  id='choice_1_90_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_1' id='label_1_90_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_91\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >I do not wish to complete the questionnaire, and I do not wish to have a free health assessment.<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_91'>\n\t\t\t<div class='gchoice gchoice_1_91_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Yes'  id='choice_1_91_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_91_0' id='label_1_91_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_91_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='No'  id='choice_1_91_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_91_1' id='label_1_91_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_63\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Privacy<\/h3><div class='gsection_description' id='gfield_description_1_63'>Mighty Health Care Limited will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to Mighty Health Care Limited holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post. You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw\nyour consent at any time, please contact our team.<\/div><\/div><div id=\"field_1_96\" class=\"gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_96' >Comments<\/label><div class='ginput_container'><input name='input_96' id='input_1_96' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_96'>This field is for validation purposes and should be left unchanged.<\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button button' value='Previous'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ 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