{"id":118,"date":"2018-01-30T19:28:45","date_gmt":"2018-01-30T19:28:45","guid":{"rendered":"http:\/\/www.glrentalproperty.com\/rent\/?page_id=118"},"modified":"2018-01-30T19:49:17","modified_gmt":"2018-01-30T19:49:17","slug":"application","status":"publish","type":"page","link":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/application\/","title":{"rendered":"Rental Application"},"content":{"rendered":"<link rel='stylesheet' id='formidable-css' href='http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-content\/plugins\/formidable\/css\/formidableforms.css?ver=8151602' type='text\/css' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_6_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_2t3v4\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_hidden\">Rental Application<\/legend>\r\n\r\n<div class=\"frm_description\"><p><em>Please make sure you read through this application carefully and fill it out completely.<\/em><\/p>\n<\/div><div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"6\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_6\" id=\"frm_hide_fields_6\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"2t3v4\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_6\" name=\"frm_submit_entry_6\" value=\"cde235ccc4\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/rent\/wp-json\/wp\/v2\/pages\/118\" \/><div id=\"frm_field_234_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h3>The following is required to make an application:<\/h3>\n<ol>\n<li>All applications must be filled out and signed by the applicant.<\/li>\n<li>All persons to occupy the property must be listed on the application.<\/li>\n<li>All applicants\/occupants 18 years of age and older must complete an application and undergo a background check.<\/li>\n<li>Reliable documentation such as pay check stubs and telephone numbers for all income must be provided and verifiable.<\/li>\n<li>Photo id. is required (driver\u2019s license, military id, etc.).<\/li>\n<li>All pets and vehicles of any type must be disclosed on the application.<\/li>\n<li>Income: Gross monthly income must be 3 times the amount of the rent.<\/li>\n<\/ol>\n<h3>Policies and Procedures:<\/h3>\n<ul>\n<li>It is free to apply. However, if your application is chosen at that time we will collect a non-refundable $75.00 application fee for all persons 18 or older to process the background check and the deposit to hold the home for you.<\/li>\n<li>Rental history must be at least 1 year. Living in a property owned by a relative or family member does not meet the criteria considered to be a Landlord\/Tenant relationship.<\/li>\n<li>Pets, IF allowed, must be approved by landlord, must be permitted, and vaccinated. If approved, a pet deposit will be paid and a pet agreement signed before moving any pet onto the property. No exceptions.<\/li>\n<li>Qualifying is based on rental history, income, and criminal background check. A felony\/violent criminal history or eviction by a prior landlord are causes for rejection.<\/li>\n<li>If accepted, a Security Deposit is required and must be paid before taking occupancy. No exceptions. A security deposit will be the same amount as the rent. First month\u2019s rent and security deposit must be paid by certified check, money order, or cash.<\/li>\n<li>Leases require 30 day written notice to vacate, from the first day of the month to the last. Verbal notices are not accepted.<\/li>\n<li>Once the property has been vacated and keys returned, an inspection of the home will be performed. After inspection, we will begin to process the return of your security deposit. Any charges to the security deposit will be itemized and a statement with any refund due will be sent to the forwarding address provided.<\/li>\n<li>All properties are non-smoking.<\/li>\n<\/ul>\n<\/div>\n<div id=\"frm_field_69_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_q7bi4\" class=\"frm_primary_label\">Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_q7bi4\" name=\"item_meta[69]\" value=\"05\/31\/2026\"  style=\"width:150px\" maxlength=\"10\" data-frmval=\"05\/31\/2026\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_94_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_tz3d9\" class=\"frm_primary_label\">Rental Property Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_tz3d9_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tRental Property Address<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_94-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_tz3d9_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tRental Property Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_tz3d9_line1\" value=\"\" name=\"item_meta[94][line1]\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Rental Property Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_94-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_tz3d9_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tRental Property Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_tz3d9_line2\" value=\"\" name=\"item_meta[94][line2]\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Rental Property Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_94-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_tz3d9_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_tz3d9_city\" value=\"\" name=\"item_meta[94][city]\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Rental Property Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_94-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_tz3d9_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t\t<select name=\"item_meta[94][state]\" id=\"field_tz3d9_state\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Rental Property Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Alabama\">Alabama<\/option><option  value=\"Alaska\">Alaska<\/option><option  value=\"Arkansas\">Arkansas<\/option><option  value=\"Arizona\">Arizona<\/option><option  value=\"California\">California<\/option><option  value=\"Colorado\">Colorado<\/option><option  value=\"Connecticut\">Connecticut<\/option><option  value=\"Delaware\">Delaware<\/option><option  value=\"District of Columbia\">District of Columbia<\/option><option  value=\"Florida\">Florida<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Hawaii\">Hawaii<\/option><option  value=\"Idaho\">Idaho<\/option><option  value=\"Illinois\">Illinois<\/option><option  value=\"Indiana\">Indiana<\/option><option  value=\"Iowa\">Iowa<\/option><option  value=\"Kansas\">Kansas<\/option><option  value=\"Kentucky\">Kentucky<\/option><option  value=\"Louisiana\">Louisiana<\/option><option  value=\"Maine\">Maine<\/option><option  value=\"Maryland\">Maryland<\/option><option  value=\"Massachusetts\">Massachusetts<\/option><option  value=\"Michigan\">Michigan<\/option><option  value=\"Minnesota\">Minnesota<\/option><option  value=\"Mississippi\">Mississippi<\/option><option  value=\"Missouri\">Missouri<\/option><option  value=\"Montana\">Montana<\/option><option  value=\"Nebraska\">Nebraska<\/option><option  value=\"Nevada\">Nevada<\/option><option  value=\"New Hampshire\">New Hampshire<\/option><option  value=\"New Jersey\">New Jersey<\/option><option  value=\"New Mexico\">New Mexico<\/option><option  value=\"New York\">New York<\/option><option  value=\"North Carolina\">North Carolina<\/option><option  value=\"North Dakota\">North Dakota<\/option><option  value=\"Ohio\">Ohio<\/option><option  value=\"Oklahoma\">Oklahoma<\/option><option  value=\"Oregon\">Oregon<\/option><option  value=\"Pennsylvania\">Pennsylvania<\/option><option  value=\"Rhode Island\">Rhode Island<\/option><option  value=\"South Carolina\">South Carolina<\/option><option  value=\"South Dakota\">South Dakota<\/option><option  value=\"Tennessee\">Tennessee<\/option><option  value=\"Texas\">Texas<\/option><option  value=\"Utah\">Utah<\/option><option  value=\"Vermont\">Vermont<\/option><option  value=\"Virginia\">Virginia<\/option><option  value=\"Washington\">Washington<\/option><option  value=\"West Virginia\">West Virginia<\/option><option  value=\"Wisconsin\">Wisconsin<\/option><option  value=\"Wyoming\">Wyoming<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_94-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_tz3d9_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_tz3d9_zip\" value=\"\" name=\"item_meta[94][zip]\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Rental Property Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_71_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fifth\">\r\n    <label for=\"field_73edd\" class=\"frm_primary_label\">Anticipated: Move-in Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_73edd\" name=\"item_meta[71]\" value=\"\"  style=\"width:150px\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Anticipated: Move-in Date is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_72_container\" class=\"frm_form_field form-field  frm_top_container frm_fifth\">\r\n    <label for=\"field_qh4j8\" class=\"frm_primary_label\">Anticipated: Monthly Rent\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4j8\" name=\"item_meta[72]\" value=\"\"  style=\"width:150px\" placeholder=\"$\" data-invmsg=\"Anticipated: Monthly Rent is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_73_container\" class=\"frm_form_field form-field  frm_top_container frm_fifth\">\r\n    <label for=\"field_tidqi\" class=\"frm_primary_label\">Anticipated: Security Deposit\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_tidqi\" name=\"item_meta[73]\" value=\"\"  style=\"width:150px\" placeholder=\"$\" data-invmsg=\"Anticipated: Security Deposit is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<input type=\"hidden\" name=\"item_meta[248]\" id=\"field_isxzg\" value=\"\" data-frmval=\"\"\/>\n<div id=\"frm_field_92_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Applicant Information<\/h3>\r\n\r\n\r\n<div id=\"frm_field_67_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_yfw6k\" class=\"frm_primary_label\">Applicant's Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yfw6k\" name=\"item_meta[67]\" value=\"\"  data-sectionid=\"92\" style=\"width:500px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Applicant&#039;s Name is invalid\" class=\"auto_width\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_yfw6k\"\/>\r\n    <div id=\"frm_desc_field_yfw6k\" class=\"frm_description\">(First, Middle, Last)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_76_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_u0nx8\" class=\"frm_primary_label\">Applicant's former last name (maiden or married)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_u0nx8\" name=\"item_meta[76]\" value=\"\"  data-sectionid=\"92\" style=\"width:400px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Applicant&#039;s former last name (maiden or married) is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_75_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Is there a co-applicant?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_75-92-0\"><label for=\"field_umpe-0\">\t\t<input type=\"radio\" name=\"item_meta[75]\" id=\"field_umpe-0\" value=\"Yes\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Is there a co-applicant? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_75-92-1\"><label for=\"field_umpe-1\">\t\t<input type=\"radio\" name=\"item_meta[75]\" id=\"field_umpe-1\" value=\"No\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Is there a co-applicant? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    <div id=\"frm_desc_field_umpe\" class=\"frm_description\">If yes, co-applicant must submit separate application.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_77_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_diws3\" class=\"frm_primary_label\">Email Address:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_diws3\" name=\"item_meta[77]\" value=\"\"  data-sectionid=\"92\" style=\"width:500px\" data-invmsg=\"Email Address: is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_78_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fifth\">\r\n    <label for=\"field_n85c5\" class=\"frm_primary_label\">Preferred contact number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_n85c5\" name=\"item_meta[78]\" value=\"\"  data-sectionid=\"92\" style=\"width:150px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Preferred contact number is invalid. The phone number must include the area code.\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_81_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fifth horizontal_radio frm_other_container\">\r\n    <label  class=\"frm_primary_label\">This phone number is my:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_81-92-0\"><label for=\"field_d9zwq-0\">\t\t<input type=\"radio\" name=\"item_meta[81]\" id=\"field_d9zwq-0\" value=\"Home\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This phone number is my: is invalid\" aria-invalid=\"false\"  \/> Home<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_81-92-1\"><label for=\"field_d9zwq-1\">\t\t<input type=\"radio\" name=\"item_meta[81]\" id=\"field_d9zwq-1\" value=\"Cell\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This phone number is my: is invalid\" aria-invalid=\"false\"  \/> Cell<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_81-92-2\"><label for=\"field_d9zwq-2\">\t\t<input type=\"radio\" name=\"item_meta[81]\" id=\"field_d9zwq-2\" value=\"Work\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This phone number is my: is invalid\" aria-invalid=\"false\"  \/> Work<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_81-92-other_3\"><label for=\"field_d9zwq-other_3\">\t\t<input type=\"radio\" name=\"item_meta[81]\" id=\"field_d9zwq-other_3\" value=\"Other\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This phone number is my: is invalid\" aria-invalid=\"false\"  \/> Other<\/label><label for=\"field_d9zwq-other_3-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_d9zwq-other_3-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][81]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_83_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fifth\">\r\n    <label for=\"field_12kud\" class=\"frm_primary_label\">Secondary Phone Number\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_12kud\" name=\"item_meta[83]\" value=\"\"  data-sectionid=\"92\" style=\"width:150px\" data-invmsg=\"Additional Phone Number (if desired) is invalid. The phone number must include the area code.\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_147_container\" class=\"frm_form_field form-field  frm_top_container frm_fifth horizontal_radio frm_other_container\">\r\n    <label  class=\"frm_primary_label\">This phone number is my:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_147-92-0\"><label for=\"field_k7ax9-0\">\t\t<input type=\"radio\" name=\"item_meta[147]\" id=\"field_k7ax9-0\" value=\"Home\"\n\t\t   data-sectionid=\"92\" data-invmsg=\"This phone number is my: is invalid\" aria-invalid=\"false\"  \/> Home<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_147-92-1\"><label for=\"field_k7ax9-1\">\t\t<input type=\"radio\" name=\"item_meta[147]\" id=\"field_k7ax9-1\" value=\"Cell\"\n\t\t   data-sectionid=\"92\" data-invmsg=\"This phone number is my: is invalid\" aria-invalid=\"false\"  \/> Cell<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_147-92-2\"><label for=\"field_k7ax9-2\">\t\t<input type=\"radio\" name=\"item_meta[147]\" id=\"field_k7ax9-2\" value=\"Work\"\n\t\t   data-sectionid=\"92\" data-invmsg=\"This phone number is my: is invalid\" aria-invalid=\"false\"  \/> Work<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_147-92-other_3\"><label for=\"field_k7ax9-other_3\">\t\t<input type=\"radio\" name=\"item_meta[147]\" id=\"field_k7ax9-other_3\" value=\"Other\"\n\t\t   data-sectionid=\"92\" data-invmsg=\"This phone number is my: is invalid\" aria-invalid=\"false\"  \/> Other<\/label><label for=\"field_k7ax9-other_3-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_k7ax9-other_3-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][147]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_120_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_am6nv\" class=\"frm_primary_label\">Date of birth\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_am6nv\" name=\"item_meta[120]\" value=\"\"  data-sectionid=\"92\" style=\"width:140px\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date of birth is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_121_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_t5eq6\" class=\"frm_primary_label\">Height\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_t5eq6\" name=\"item_meta[121]\" value=\"\"  data-sectionid=\"92\" style=\"width:140px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Height is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_122_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_r7mm5\" class=\"frm_primary_label\">Weight\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_r7mm5\" name=\"item_meta[122]\" value=\"\"  data-sectionid=\"92\" style=\"width:140px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Weight is invalid\" class=\"auto_width\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_r7mm5\"\/>\r\n    <div id=\"frm_desc_field_r7mm5\" class=\"frm_description\">in pounds<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_123_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_other_container\">\r\n    <label for=\"field_93d7z\" class=\"frm_primary_label\">Eye color\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[123]\" id=\"field_93d7z\"  data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Eye color is invalid\" class=\"auto_width\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"Blue\">Blue<\/option><option  value=\"Brown\">Brown<\/option><option  value=\"Green\">Green<\/option><option  value=\"Grey\">Grey<\/option><option  value=\"Other\" class=\"frm_other_trigger\">Other<\/option>\t<\/select>\n\t<label for=\"field_93d7z-otext\" class=\"frm_screen_reader frm_hidden\">Eye color<\/label><input type=\"text\" id=\"field_93d7z-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][123]\" value=\"\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_125_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_11hmz\" class=\"frm_primary_label\">Hair color\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_11hmz\" name=\"item_meta[125]\" value=\"\"  data-sectionid=\"92\" style=\"width:140px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Hair color is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_128_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth vertical_radio frm_other_container\">\r\n    <label  class=\"frm_primary_label\">Marital status\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_128-92-0\"><label for=\"field_5igrw-0\">\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_5igrw-0\" value=\"Single\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Marital status is invalid\" aria-invalid=\"false\"  \/> Single<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_128-92-1\"><label for=\"field_5igrw-1\">\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_5igrw-1\" value=\"Married\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Marital status is invalid\" aria-invalid=\"false\"  \/> Married<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_128-92-2\"><label for=\"field_5igrw-2\">\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_5igrw-2\" value=\"Divorced\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Marital status is invalid\" aria-invalid=\"false\"  \/> Divorced<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_128-92-3\"><label for=\"field_5igrw-3\">\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_5igrw-3\" value=\"Widowed\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Marital status is invalid\" aria-invalid=\"false\"  \/> Widowed<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_128-92-other_4\"><label for=\"field_5igrw-other_4\">\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_5igrw-other_4\" value=\"Other\"\n\t\t   data-sectionid=\"92\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Marital status is invalid\" aria-invalid=\"false\"  \/> Other<\/label><label for=\"field_5igrw-other_4-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_5igrw-other_4-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][128]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_129_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_other_container\">\r\n    <label for=\"field_sf6cp\" class=\"frm_primary_label\">Citizenship\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[129]\" id=\"field_sf6cp\"  data-sectionid=\"92\" data-frmval=\"Afghanistan\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Citizenship is invalid\" class=\"auto_width\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afghanistan\" selected='selected'>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=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option  value=\"Botswana\">Botswana<\/option><option  value=\"Brazil\">Brazil<\/option><option  value=\"Brunei\">Brunei<\/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=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"C\u00f4te d&#039;Ivoire\">C\u00f4te d&#039;Ivoire<\/option><option  value=\"Croatia\">Croatia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/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=\"East Timor\">East Timor<\/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=\"Ethiopia\">Ethiopia<\/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=\"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=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/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=\"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=\"Israel\">Israel<\/option><option  value=\"Italy\">Italy<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Japan\">Japan<\/option><option  value=\"Jordan\">Jordan<\/option><option  value=\"Kazakhstan\">Kazakhstan<\/option><option  value=\"Kenya\">Kenya<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"North Korea\">North Korea<\/option><option  value=\"South Korea\">South Korea<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/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=\"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=\"Mauritania\">Mauritania<\/option><option  value=\"Mauritius\">Mauritius<\/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 Zealand\">New Zealand<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Niger\">Niger<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Norway\">Norway<\/option><option  value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option><option  value=\"Oman\">Oman<\/option><option  value=\"Pakistan\">Pakistan<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestine\">Palestine<\/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=\"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=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/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 and Montenegro\">Serbia and Montenegro<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leone\">Sierra Leone<\/option><option  value=\"Singapore\">Singapore<\/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 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=\"Swaziland\">Swaziland<\/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=\"Togo\">Togo<\/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=\"Tuvalu\">Tuvalu<\/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=\"Vatican City\">Vatican City<\/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=\"Yemen\">Yemen<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabwe\">Zimbabwe<\/option><option  value=\"Other\" class=\"frm_other_trigger\">Other<\/option>\t<\/select>\n\t<label for=\"field_sf6cp-otext\" class=\"frm_screen_reader frm_hidden\">Citizenship<\/label><input type=\"text\" id=\"field_sf6cp-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][129]\" value=\"\" \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_74_container\" class=\"frm_form_field form-field  frm_required_field frm_left_container vertical_radio frm_other_container\">\r\n    <label  class=\"frm_primary_label\">Applicant was referred to landlord by:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_74-other_2\"><label for=\"field_fhsz-other_2\"><input type=\"checkbox\" name=\"item_meta[74][other_2]\" id=\"field_fhsz-other_2\" value=\"Real Estate Agent\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Applicant was referred to landlord by: is invalid\" aria-invalid=\"false\"   \/> Real Estate Agent<\/label><label for=\"field_fhsz-other_2-otext\" class=\"frm_screen_reader frm_hidden\">Real Estate Agent<\/label><input type=\"text\" id=\"field_fhsz-other_2-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][74][other_2]\" value=\"\" \/><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_74-3\"><label for=\"field_fhsz-3\"><input type=\"checkbox\" name=\"item_meta[74][]\" id=\"field_fhsz-3\" value=\"Newspaper\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Applicant was referred to landlord by: is invalid\" aria-invalid=\"false\"   \/> Newspaper<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_74-4\"><label for=\"field_fhsz-4\"><input type=\"checkbox\" name=\"item_meta[74][]\" id=\"field_fhsz-4\" value=\"Sign\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Applicant was referred to landlord by: is invalid\" aria-invalid=\"false\"   \/> Sign<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_74-5\"><label for=\"field_fhsz-5\"><input type=\"checkbox\" name=\"item_meta[74][]\" id=\"field_fhsz-5\" value=\"Internet\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Applicant was referred to landlord by: is invalid\" aria-invalid=\"false\"   \/> Internet<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_74-other_6\"><label for=\"field_fhsz-other_6\"><input type=\"checkbox\" name=\"item_meta[74][other_6]\" id=\"field_fhsz-other_6\" value=\"Other\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Applicant was referred to landlord by: is invalid\" aria-invalid=\"false\"   \/> Other<\/label><label for=\"field_fhsz-other_6-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_fhsz-other_6-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][74][other_6]\" value=\"\" \/><\/div>\n<\/div>\r\n    <div id=\"frm_desc_field_fhsz\" class=\"frm_description\">If you select Real Estate Agent, please include their name and phone number.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_89_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Emergency Contact Information<\/h3>\r\n\r\n\r\n<div id=\"frm_field_84_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_elhzg\" class=\"frm_primary_label\">Emergency Contact Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_elhzg\" name=\"item_meta[84]\" value=\"\"  data-sectionid=\"89\" style=\"width:500px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Name is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_86_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_7d24o\" class=\"frm_primary_label\">Emergency Contact Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_7d24o\" name=\"item_meta[86]\" value=\"\"  data-sectionid=\"89\" style=\"width:150px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Phone Number is invalid. The phone number must include the area code.\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_95_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_6yzjt\" class=\"frm_primary_label\">Emergency Contact Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_6yzjt_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tEmergency Contact Address<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_95-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_6yzjt_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tEmergency Contact Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_6yzjt_line1\" value=\"\" name=\"item_meta[95][line1]\"  data-sectionid=\"89\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_95-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_6yzjt_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tEmergency Contact Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_6yzjt_line2\" value=\"\" name=\"item_meta[95][line2]\"  data-sectionid=\"89\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_95-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_6yzjt_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_6yzjt_city\" value=\"\" name=\"item_meta[95][city]\"  data-sectionid=\"89\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_95-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_6yzjt_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_6yzjt_state\" value=\"\" name=\"item_meta[95][state]\"  data-sectionid=\"89\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_95-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_6yzjt_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_6yzjt_zip\" value=\"\" name=\"item_meta[95][zip]\"  data-sectionid=\"89\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<div id=\"frm_field_95-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_6yzjt_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tCountry\t<\/label>\n\t\t\t<select name=\"item_meta[95][country]\" id=\"field_6yzjt_country\"  data-sectionid=\"89\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Address is invalid\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Aland Islands\">Aland Islands<\/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\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"C&ocirc;te d&#039;Ivoire\">C&ocirc;te d&#039;Ivoire<\/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 (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/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=\"Curacao\">Curacao<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/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=\"East Timor\">East Timor<\/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=\"Ethiopia\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/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 Island and McDonald Islands\">Heard Island 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=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/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=\"Macao\">Macao<\/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\">Palestine<\/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=\"Reunion\">Reunion<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Barthelemy\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/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 (Dutch part)\">Sint Maarten (Dutch part)<\/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 and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/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\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\">Swaziland<\/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=\"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=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/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>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_96_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Other Occupants<\/h3>\r\n<div id=\"frm_desc_field_le1no\" class=\"frm_description frm_section_spacing\">Please name all other persons who will occupy the property.<\/div>\r\n<input type=\"hidden\" name=\"item_meta[96][form]\" value=\"7\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_96-0\" class=\"frm_repeat_sec frm_repeat_96 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[96][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[96][0][0]\" value=\"\" \/><div id=\"frm_field_98-96-0_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_third frm_field_98_container\">\r\n    <label for=\"field_q7g6d-0\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_q7g6d-0\" name=\"item_meta[96][0][98]\" value=\"\"  data-sectionid=\"96\" style=\"width:300px\" data-invmsg=\"Name is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_104-96-0_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_field_104_container\">\r\n    <label for=\"field_3vazl-0\" class=\"frm_primary_label\">Relationship\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3vazl-0\" name=\"item_meta[96][0][104]\" value=\"\"  data-sectionid=\"96\" style=\"width:250px\" data-invmsg=\"Relationship is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_110-96-0_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_field_110_container\">\r\n    <label for=\"field_j7mtr-0\" class=\"frm_primary_label\">Age\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_j7mtr-0\" name=\"item_meta[96][0][110]\" value=\"\"  data-sectionid=\"96\" style=\"width:150px\" data-invmsg=\"Age is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"96\" aria-label=\"Add\"><i class=\"frm_icon_font frm_plus_icon\"> <\/i> Add another person<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"96\" aria-label=\"Remove\"><i class=\"frm_icon_font frm_minus_icon\"> <\/i> Remove a person<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_114_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Applicant's Current Address<\/h3>\r\n\r\n\r\n<div id=\"frm_field_116_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_yh4we\" class=\"frm_primary_label\">Current Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_yh4we_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tCurrent Address<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_116-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_yh4we_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tCurrent Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_yh4we_line1\" value=\"\" name=\"item_meta[116][line1]\"  data-sectionid=\"114\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Current Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_116-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_yh4we_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tCurrent Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_yh4we_line2\" value=\"\" name=\"item_meta[116][line2]\"  data-sectionid=\"114\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Current Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_116-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_yh4we_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_yh4we_city\" value=\"\" name=\"item_meta[116][city]\"  data-sectionid=\"114\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Current Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_116-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_yh4we_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_yh4we_state\" value=\"\" name=\"item_meta[116][state]\"  data-sectionid=\"114\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Current Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_116-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_yh4we_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_yh4we_zip\" value=\"\" name=\"item_meta[116][zip]\"  data-sectionid=\"114\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Current Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<div id=\"frm_field_116-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_yh4we_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tCountry\t<\/label>\n\t\t\t<select name=\"item_meta[116][country]\" id=\"field_yh4we_country\"  data-sectionid=\"114\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Current Address is invalid\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Aland Islands\">Aland Islands<\/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\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"C&ocirc;te d&#039;Ivoire\">C&ocirc;te d&#039;Ivoire<\/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 (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/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=\"Curacao\">Curacao<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/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=\"East Timor\">East Timor<\/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=\"Ethiopia\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/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 Island and McDonald Islands\">Heard Island 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=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/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=\"Macao\">Macao<\/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\">Palestine<\/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=\"Reunion\">Reunion<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Barthelemy\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/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 (Dutch part)\">Sint Maarten (Dutch part)<\/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 and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/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\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\">Swaziland<\/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=\"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=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/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>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_117_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_kdr4w\" class=\"frm_primary_label\">Current Landlord's Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_kdr4w\" name=\"item_meta[117]\" value=\"\"  data-sectionid=\"114\" style=\"width:180px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Current Landlord&#039;s Name is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_118_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_qrvgg\" class=\"frm_primary_label\">Landlord's Primary Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_qrvgg\" name=\"item_meta[118]\" value=\"\"  data-sectionid=\"114\" style=\"width:140px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Landlord&#039;s Phone Number is invalid. The phone number must include the area code.\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_132_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_d8zk9\" class=\"frm_primary_label\">Date moved in\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_d8zk9\" name=\"item_meta[132]\" value=\"\"  data-sectionid=\"114\" style=\"width:150px\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date moved in is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_133_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_s8xym\" class=\"frm_primary_label\">Move-out Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_s8xym\" name=\"item_meta[133]\" value=\"\"  data-sectionid=\"114\" style=\"width:150px\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Move-out Date is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_134_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_dsnnb\" class=\"frm_primary_label\">Rent\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dsnnb\" name=\"item_meta[134]\" value=\"$\"  data-sectionid=\"114\" style=\"width:150px\" data-frmval=\"$\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Rent is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_135_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_y9cdo\" class=\"frm_primary_label\">Reason for move\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[135]\" id=\"field_y9cdo\" rows=\"5\"  data-sectionid=\"114\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Reason for move is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_136_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Applicant's Previous Address<\/h3>\r\n\r\n\r\n<div id=\"frm_field_137_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_etliy\" class=\"frm_primary_label\">Previous Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_etliy_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tPrevious Address<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_137-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_etliy_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tPrevious Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_etliy_line1\" value=\"\" name=\"item_meta[137][line1]\"  data-sectionid=\"136\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Previous Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_137-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_etliy_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tPrevious Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_etliy_line2\" value=\"\" name=\"item_meta[137][line2]\"  data-sectionid=\"136\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Previous Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_137-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_etliy_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_etliy_city\" value=\"\" name=\"item_meta[137][city]\"  data-sectionid=\"136\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Previous Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_137-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_etliy_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_etliy_state\" value=\"\" name=\"item_meta[137][state]\"  data-sectionid=\"136\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Previous Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_137-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_etliy_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_etliy_zip\" value=\"\" name=\"item_meta[137][zip]\"  data-sectionid=\"136\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Previous Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<div id=\"frm_field_137-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_etliy_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tCountry\t<\/label>\n\t\t\t<select name=\"item_meta[137][country]\" id=\"field_etliy_country\"  data-sectionid=\"136\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Previous Address is invalid\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Aland Islands\">Aland Islands<\/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\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"C&ocirc;te d&#039;Ivoire\">C&ocirc;te d&#039;Ivoire<\/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 (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/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=\"Curacao\">Curacao<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/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=\"East Timor\">East Timor<\/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=\"Ethiopia\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/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 Island and McDonald Islands\">Heard Island 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=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/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=\"Macao\">Macao<\/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\">Palestine<\/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=\"Reunion\">Reunion<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Barthelemy\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/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 (Dutch part)\">Sint Maarten (Dutch part)<\/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 and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/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\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\">Swaziland<\/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=\"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=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/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>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_138_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_s1g6l\" class=\"frm_primary_label\">Previous Landlord's Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_s1g6l\" name=\"item_meta[138]\" value=\"\"  data-sectionid=\"136\" style=\"width:180px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Previous Landlord&#039;s Name is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_139_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_a5hwy\" class=\"frm_primary_label\">Landlord's Primary Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_a5hwy\" name=\"item_meta[139]\" value=\"\"  data-sectionid=\"136\" style=\"width:140px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Landlord&#039;s Phone Number is invalid. The phone number must include the area code.\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_142_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_g5vie\" class=\"frm_primary_label\">Date moved in\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_g5vie\" name=\"item_meta[142]\" value=\"\"  data-sectionid=\"136\" style=\"width:150px\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date moved in is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_143_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_78co\" class=\"frm_primary_label\">Move-out Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_78co\" name=\"item_meta[143]\" value=\"\"  data-sectionid=\"136\" style=\"width:150px\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Move-out Date is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_144_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_ngg27\" class=\"frm_primary_label\">Rent\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ngg27\" name=\"item_meta[144]\" value=\"$\"  data-sectionid=\"136\" style=\"width:150px\" data-frmval=\"$\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Rent is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_145_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_50kdj\" class=\"frm_primary_label\">Reason for move\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[145]\" id=\"field_50kdj\" rows=\"5\"  data-sectionid=\"136\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Reason for move is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_148_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Applicant's Current Employer<\/h3>\r\n\r\n\r\n<div id=\"frm_field_150_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_3ljdc\" class=\"frm_primary_label\">Name of Current Employer\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3ljdc\" name=\"item_meta[150]\" value=\"\"  data-sectionid=\"148\" style=\"width:180px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name of Current Employer is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_149_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_uspck\" class=\"frm_primary_label\">Employer's Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_uspck_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tEmployer&#039;s Address<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_149-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_uspck_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tEmployer&#039;s Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_uspck_line1\" value=\"\" name=\"item_meta[149][line1]\"  data-sectionid=\"148\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_149-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_uspck_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tEmployer&#039;s Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_uspck_line2\" value=\"\" name=\"item_meta[149][line2]\"  data-sectionid=\"148\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_149-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_uspck_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_uspck_city\" value=\"\" name=\"item_meta[149][city]\"  data-sectionid=\"148\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_149-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_uspck_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_uspck_state\" value=\"\" name=\"item_meta[149][state]\"  data-sectionid=\"148\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_149-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_uspck_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_uspck_zip\" value=\"\" name=\"item_meta[149][zip]\"  data-sectionid=\"148\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<div id=\"frm_field_149-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_uspck_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tCountry\t<\/label>\n\t\t\t<select name=\"item_meta[149][country]\" id=\"field_uspck_country\"  data-sectionid=\"148\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Aland Islands\">Aland Islands<\/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\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"C&ocirc;te d&#039;Ivoire\">C&ocirc;te d&#039;Ivoire<\/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 (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/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=\"Curacao\">Curacao<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/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=\"East Timor\">East Timor<\/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=\"Ethiopia\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/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 Island and McDonald Islands\">Heard Island 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=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/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=\"Macao\">Macao<\/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\">Palestine<\/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=\"Reunion\">Reunion<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Barthelemy\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/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 (Dutch part)\">Sint Maarten (Dutch part)<\/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 and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/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\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\">Swaziland<\/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=\"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=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/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>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_159_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_dtwrn\" class=\"frm_primary_label\">Supervisor's Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dtwrn\" name=\"item_meta[159]\" value=\"\"  data-sectionid=\"148\" style=\"width:200px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Supervisor&#039;s Name is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_151_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_bx2y6\" class=\"frm_primary_label\">Supervisor's Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_bx2y6\" name=\"item_meta[151]\" value=\"\"  data-sectionid=\"148\" style=\"width:200px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Supervisor&#039;s Phone Number is invalid. The phone number must include the area code.\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_161_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_2wxr4\" class=\"frm_primary_label\">Start Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2wxr4\" name=\"item_meta[161]\" value=\"\"  data-sectionid=\"148\" style=\"width:200px\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Start Date is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_162_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_7kbd3\" class=\"frm_primary_label\">Gross Monthly Income\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7kbd3\" name=\"item_meta[162]\" value=\"\"  data-sectionid=\"148\" style=\"width:200px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Gross Monthly Income is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_163_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_799qe\" class=\"frm_primary_label\">Position\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_799qe\" name=\"item_meta[163]\" value=\"\"  data-sectionid=\"148\" style=\"width:200px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Position is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_164_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Applicant's Previous Employer<\/h3>\r\n\r\n\r\n<div id=\"frm_field_165_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_pujiz\" class=\"frm_primary_label\">Name of Previous Employer\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_pujiz\" name=\"item_meta[165]\" value=\"\"  data-sectionid=\"164\" style=\"width:180px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name of Previous Employer is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_166_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_smlm5\" class=\"frm_primary_label\">Employer's Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_smlm5_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tEmployer&#039;s Address<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_166-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_smlm5_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tEmployer&#039;s Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_smlm5_line1\" value=\"\" name=\"item_meta[166][line1]\"  data-sectionid=\"164\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_166-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_smlm5_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tEmployer&#039;s Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_smlm5_line2\" value=\"\" name=\"item_meta[166][line2]\"  data-sectionid=\"164\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_166-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_smlm5_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_smlm5_city\" value=\"\" name=\"item_meta[166][city]\"  data-sectionid=\"164\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_166-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_smlm5_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_smlm5_state\" value=\"\" name=\"item_meta[166][state]\"  data-sectionid=\"164\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_166-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_smlm5_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_smlm5_zip\" value=\"\" name=\"item_meta[166][zip]\"  data-sectionid=\"164\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<div id=\"frm_field_166-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_smlm5_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tCountry\t<\/label>\n\t\t\t<select name=\"item_meta[166][country]\" id=\"field_smlm5_country\"  data-sectionid=\"164\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employer&#039;s Address is invalid\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Aland Islands\">Aland Islands<\/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\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"C&ocirc;te d&#039;Ivoire\">C&ocirc;te d&#039;Ivoire<\/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 (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/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=\"Curacao\">Curacao<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/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=\"East Timor\">East Timor<\/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=\"Ethiopia\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/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 Island and McDonald Islands\">Heard Island 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=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/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=\"Macao\">Macao<\/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\">Palestine<\/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=\"Reunion\">Reunion<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Barthelemy\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/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 (Dutch part)\">Sint Maarten (Dutch part)<\/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 and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/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\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\">Swaziland<\/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=\"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=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/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>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_167_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_qd3mn\" class=\"frm_primary_label\">Supervisor's Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qd3mn\" name=\"item_meta[167]\" value=\"\"  data-sectionid=\"164\" style=\"width:200px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Supervisor&#039;s Name is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_168_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_hj323\" class=\"frm_primary_label\">Supervisor's Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_hj323\" name=\"item_meta[168]\" value=\"\"  data-sectionid=\"164\" style=\"width:200px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Supervisor&#039;s Phone Number is invalid. The phone number must include the area code.\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_171_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_2y9m2\" class=\"frm_primary_label\">Start Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2y9m2\" name=\"item_meta[171]\" value=\"\"  data-sectionid=\"164\" style=\"width:200px\" maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Start Date is invalid\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_172_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_1fkch\" class=\"frm_primary_label\">Gross Monthly Income\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1fkch\" name=\"item_meta[172]\" value=\"\"  data-sectionid=\"164\" style=\"width:200px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Gross Monthly Income is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_251_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_81mhw\" class=\"frm_primary_label\">Lookup\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    \r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_173_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_2eial\" class=\"frm_primary_label\">Position\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2eial\" name=\"item_meta[173]\" value=\"\"  data-sectionid=\"164\" style=\"width:200px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Position is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_175_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_wjdyz\" class=\"frm_primary_label\">Describe any other income Applicant wants considered\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[175]\" id=\"field_wjdyz\" rows=\"5\"  data-sectionid=\"164\" data-invmsg=\"Describe any other income Applicant wants considered is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_176_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Vehicles<\/h3>\r\n<div id=\"frm_desc_field_63eyk\" class=\"frm_description frm_section_spacing\">List all vehicles to be parked on the property.<\/div>\r\n<input type=\"hidden\" name=\"item_meta[176][form]\" value=\"8\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_176-0\" class=\"frm_repeat_sec frm_repeat_176 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[176][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[176][0][0]\" value=\"\" \/><div id=\"frm_field_180-176-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_sixth frm_field_180_container\">\r\n    <label for=\"field_cjwg-0\" class=\"frm_primary_label\">Type\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cjwg-0\" name=\"item_meta[176][0][180]\" value=\"\"  data-sectionid=\"176\" style=\"width:130px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Type is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_178-176-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_sixth frm_field_178_container\">\r\n    <label for=\"field_of95m-0\" class=\"frm_primary_label\">Year\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_of95m-0\" name=\"item_meta[176][0][178]\" value=\"\"  data-sectionid=\"176\" style=\"width:130px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Year is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_181-176-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_sixth frm_field_181_container\">\r\n    <label for=\"field_8bhxr-0\" class=\"frm_primary_label\">Make\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_8bhxr-0\" name=\"item_meta[176][0][181]\" value=\"\"  data-sectionid=\"176\" style=\"width:130px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Make is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_179-176-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_sixth frm_field_179_container\">\r\n    <label for=\"field_1pl5x-0\" class=\"frm_primary_label\">Model\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1pl5x-0\" name=\"item_meta[176][0][179]\" value=\"\"  data-sectionid=\"176\" style=\"width:130px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Model is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_184-176-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_sixth frm_field_184_container\">\r\n    <label for=\"field_pqb0r-0\" class=\"frm_primary_label\">License\/State\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_pqb0r-0\" name=\"item_meta[176][0][184]\" value=\"\"  data-sectionid=\"176\" style=\"width:130px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"License\/State is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_183-176-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_sixth frm_field_183_container\">\r\n    <label for=\"field_yuua0-0\" class=\"frm_primary_label\">Monthly Payment\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yuua0-0\" name=\"item_meta[176][0][183]\" value=\"$\"  data-sectionid=\"176\" style=\"width:130px\" data-frmval=\"$\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Monthly Payment is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"176\" aria-label=\"Add\"><i class=\"frm_icon_font frm_plus_icon\"> <\/i> Add another vehicle<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"176\" aria-label=\"Remove\"><i class=\"frm_icon_font frm_minus_icon\"> <\/i> Remove the last vehicle<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_186_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Pets<\/h3>\r\n<div id=\"frm_desc_field_l8xnb\" class=\"frm_description frm_section_spacing\">List all pets that will be kept on the property.<\/div>\r\n<input type=\"hidden\" name=\"item_meta[186][form]\" value=\"9\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_186-0\" class=\"frm_repeat_sec frm_repeat_186 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[186][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[186][0][0]\" value=\"\" \/><div id=\"frm_field_188-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_sixth frm_field_188_container\">\r\n    <label for=\"field_32c54-0\" class=\"frm_primary_label\">Type & Breed\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_32c54-0\" name=\"item_meta[186][0][188]\" value=\"\"  data-sectionid=\"186\" style=\"width:120px\" data-invmsg=\"Type &amp; Breed is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_189-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth frm_field_189_container\">\r\n    <label for=\"field_r63jl-0\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_r63jl-0\" name=\"item_meta[186][0][189]\" value=\"\"  data-sectionid=\"186\" style=\"width:120px\" data-invmsg=\"Name is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_193-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth frm_field_193_container\">\r\n    <label for=\"field_xb5gs-0\" class=\"frm_primary_label\">Color\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xb5gs-0\" name=\"item_meta[186][0][193]\" value=\"\"  data-sectionid=\"186\" style=\"width:120px\" data-invmsg=\"Color is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_192-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth frm_field_192_container\">\r\n    <label for=\"field_gap6l-0\" class=\"frm_primary_label\">Weight\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gap6l-0\" name=\"item_meta[186][0][192]\" value=\"\"  data-sectionid=\"186\" style=\"width:120px\" data-invmsg=\"Weight is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_191-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth frm_field_191_container\">\r\n    <label for=\"field_ikr2x-0\" class=\"frm_primary_label\">Age\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ikr2x-0\" name=\"item_meta[186][0][191]\" value=\"\"  data-sectionid=\"186\" style=\"width:120px\" data-invmsg=\"Age is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_190-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth frm_field_190_container\">\r\n    <label for=\"field_impne-0\" class=\"frm_primary_label\">Gender\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_impne-0\" name=\"item_meta[186][0][190]\" value=\"\"  data-sectionid=\"186\" style=\"width:120px\" data-invmsg=\"Gender is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_194-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth vertical_radio frm_field_194_container\">\r\n    <label  class=\"frm_primary_label\">Is this pet spayed\/neutered?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_194-186-0\"><label for=\"field_9mxcm-0-0\">\t\t<input type=\"radio\" name=\"item_meta[186][0][194]\" id=\"field_9mxcm-0-0\" value=\"Yes\"\n\t\t   data-sectionid=\"186\" data-invmsg=\"Is this pet spayed\/neutered? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_194-186-1\"><label for=\"field_9mxcm-0-1\">\t\t<input type=\"radio\" name=\"item_meta[186][0][194]\" id=\"field_9mxcm-0-1\" value=\"No\"\n\t\t   data-sectionid=\"186\" data-invmsg=\"Is this pet spayed\/neutered? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_195-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth vertical_radio frm_field_195_container\">\r\n    <label  class=\"frm_primary_label\">Is this pet declawd?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_195-186-0\"><label for=\"field_1grdc-0-0\">\t\t<input type=\"radio\" name=\"item_meta[186][0][195]\" id=\"field_1grdc-0-0\" value=\"Yes\"\n\t\t   data-sectionid=\"186\" data-invmsg=\"Is this pet declawd? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_195-186-1\"><label for=\"field_1grdc-0-1\">\t\t<input type=\"radio\" name=\"item_meta[186][0][195]\" id=\"field_1grdc-0-1\" value=\"No\"\n\t\t   data-sectionid=\"186\" data-invmsg=\"Is this pet declawd? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_196-186-0_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth vertical_radio frm_field_196_container\">\r\n    <label  class=\"frm_primary_label\">Rabies shot current on this pet?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_196-186-0\"><label for=\"field_1gozd-0-0\">\t\t<input type=\"radio\" name=\"item_meta[186][0][196]\" id=\"field_1gozd-0-0\" value=\"Yes\"\n\t\t   data-sectionid=\"186\" data-invmsg=\"Rabies shot current on this pet? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_196-186-1\"><label for=\"field_1gozd-0-1\">\t\t<input type=\"radio\" name=\"item_meta[186][0][196]\" id=\"field_1gozd-0-1\" value=\"No\"\n\t\t   data-sectionid=\"186\" data-invmsg=\"Rabies shot current on this pet? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"186\" aria-label=\"Add\"><i class=\"frm_icon_font frm_plus_icon\"> <\/i> Add another pet<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"186\" aria-label=\"Remove\"><i class=\"frm_icon_font frm_minus_icon\"> <\/i> Remove the last pet<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_197_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Additional Questions<\/h3>\r\n\r\n\r\n<div id=\"frm_field_199_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Will any water beds or water-filled furniture be on the property?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_199-197-0\"><label for=\"field_gyz22-0\">\t\t<input type=\"radio\" name=\"item_meta[199]\" id=\"field_gyz22-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Will any water beds or water-filled furniture be on the property? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_199-197-1\"><label for=\"field_gyz22-1\">\t\t<input type=\"radio\" name=\"item_meta[199]\" id=\"field_gyz22-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Will any water beds or water-filled furniture be on the property? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_200_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_1dln8\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[200]\" id=\"field_1dln8\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_201_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Will anyone who will occupy the property smoke?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_201-197-0\"><label for=\"field_tqacr-0\">\t\t<input type=\"radio\" name=\"item_meta[201]\" id=\"field_tqacr-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Will anyone who will occupy the property smoke? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_201-197-1\"><label for=\"field_tqacr-1\">\t\t<input type=\"radio\" name=\"item_meta[201]\" id=\"field_tqacr-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Will anyone who will occupy the property smoke? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_202_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds frm_half\">\r\n    <label for=\"field_9j16n\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[202]\" id=\"field_9j16n\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_203_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Will Applicant maintain renter's insurance?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_203-197-0\"><label for=\"field_5wucv-0\">\t\t<input type=\"radio\" name=\"item_meta[203]\" id=\"field_5wucv-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Will Applicant maintain renter&#039;s insurance? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_203-197-1\"><label for=\"field_5wucv-1\">\t\t<input type=\"radio\" name=\"item_meta[203]\" id=\"field_5wucv-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Will Applicant maintain renter&#039;s insurance? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_204_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_k973v\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[204]\" id=\"field_k973v\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_205_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Is Applicant or Applicant's spouse in the military?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_205-197-0\"><label for=\"field_z2f0q-0\">\t\t<input type=\"radio\" name=\"item_meta[205]\" id=\"field_z2f0q-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Is Applicant or Applicant&#039;s spouse in the military? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_205-197-1\"><label for=\"field_z2f0q-1\">\t\t<input type=\"radio\" name=\"item_meta[205]\" id=\"field_z2f0q-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Is Applicant or Applicant&#039;s spouse in the military? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_209_container\" class=\"frm_form_field form-field  frm_top_container frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">If yes, is the military person serving under orders limiting the military person's stay to one year or less?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_209-197-0\"><label for=\"field_m2xeu-0\">\t\t<input type=\"radio\" name=\"item_meta[209]\" id=\"field_m2xeu-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-invmsg=\"If yes, is the military person serving under orders limiting the military person&#039;s stay to one year or less? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_209-197-1\"><label for=\"field_m2xeu-1\">\t\t<input type=\"radio\" name=\"item_meta[209]\" id=\"field_m2xeu-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-invmsg=\"If yes, is the military person serving under orders limiting the military person&#039;s stay to one year or less? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_206_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_68z3c\" class=\"frm_primary_label\">Explanation.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[206]\" id=\"field_68z3c\"  data-sectionid=\"197\" data-invmsg=\"Explanation. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_207_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Has Applicant ever been evicted?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_207-197-0\"><label for=\"field_uzh39-0\">\t\t<input type=\"radio\" name=\"item_meta[207]\" id=\"field_uzh39-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever been evicted? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_207-197-1\"><label for=\"field_uzh39-1\">\t\t<input type=\"radio\" name=\"item_meta[207]\" id=\"field_uzh39-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever been evicted? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_208_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds frm_half\">\r\n    <label for=\"field_dzxa\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[208]\" id=\"field_dzxa\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_210_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Has Applicant ever been asked to move out by a landlord?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_210-197-0\"><label for=\"field_qf95w-0\">\t\t<input type=\"radio\" name=\"item_meta[210]\" id=\"field_qf95w-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever been asked to move out by a landlord? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_210-197-1\"><label for=\"field_qf95w-1\">\t\t<input type=\"radio\" name=\"item_meta[210]\" id=\"field_qf95w-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever been asked to move out by a landlord? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_211_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_h2sc\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[211]\" id=\"field_h2sc\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_212_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Has Applicant ever breached a lease or rental agreement?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_212-197-0\"><label for=\"field_g8hc1-0\">\t\t<input type=\"radio\" name=\"item_meta[212]\" id=\"field_g8hc1-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever breached a lease or rental agreement? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_212-197-1\"><label for=\"field_g8hc1-1\">\t\t<input type=\"radio\" name=\"item_meta[212]\" id=\"field_g8hc1-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever breached a lease or rental agreement? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_213_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_wi21v\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[213]\" id=\"field_wi21v\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_214_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Has Applicant ever filed bankruptcy?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_214-197-0\"><label for=\"field_6fypd-0\">\t\t<input type=\"radio\" name=\"item_meta[214]\" id=\"field_6fypd-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever filed bankruptcy? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_214-197-1\"><label for=\"field_6fypd-1\">\t\t<input type=\"radio\" name=\"item_meta[214]\" id=\"field_6fypd-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever filed bankruptcy? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_215_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_9mttv\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[215]\" id=\"field_9mttv\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_216_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Has Applicant ever lost property in a foreclosure?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_216-197-0\"><label for=\"field_sefxv-0\">\t\t<input type=\"radio\" name=\"item_meta[216]\" id=\"field_sefxv-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever lost property in a foreclosure? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_216-197-1\"><label for=\"field_sefxv-1\">\t\t<input type=\"radio\" name=\"item_meta[216]\" id=\"field_sefxv-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever lost property in a foreclosure? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_217_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_28iei\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[217]\" id=\"field_28iei\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_218_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Has Applicant ever had any credit problems, slow pays, or delinquencies?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_218-197-0\"><label for=\"field_y36sn-0\">\t\t<input type=\"radio\" name=\"item_meta[218]\" id=\"field_y36sn-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever had any credit problems, slow pays, or delinquencies? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_218-197-1\"><label for=\"field_y36sn-1\">\t\t<input type=\"radio\" name=\"item_meta[218]\" id=\"field_y36sn-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever had any credit problems, slow pays, or delinquencies? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_219_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_ajufk\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[219]\" id=\"field_ajufk\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_220_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Has Applicant ever been convicted of a crime?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_220-197-0\"><label for=\"field_k9421-0\">\t\t<input type=\"radio\" name=\"item_meta[220]\" id=\"field_k9421-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever been convicted of a crime? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_220-197-1\"><label for=\"field_k9421-1\">\t\t<input type=\"radio\" name=\"item_meta[220]\" id=\"field_k9421-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Has Applicant ever been convicted of a crime? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_221_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_xjvow\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[221]\" id=\"field_xjvow\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_222_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Is Applicant or any occupant a registered sex offender?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_222-197-0\"><label for=\"field_ltftl-0\">\t\t<input type=\"radio\" name=\"item_meta[222]\" id=\"field_ltftl-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Is Applicant or any occupant a registered sex offender? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_222-197-1\"><label for=\"field_ltftl-1\">\t\t<input type=\"radio\" name=\"item_meta[222]\" id=\"field_ltftl-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Is Applicant or any occupant a registered sex offender? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_223_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_428u5\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[223]\" id=\"field_428u5\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_224_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Are there any criminal matters pending against any occupant?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_224-197-0\"><label for=\"field_mhxro-0\">\t\t<input type=\"radio\" name=\"item_meta[224]\" id=\"field_mhxro-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Are there any criminal matters pending against any occupant? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_224-197-1\"><label for=\"field_mhxro-1\">\t\t<input type=\"radio\" name=\"item_meta[224]\" id=\"field_mhxro-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Are there any criminal matters pending against any occupant? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_225_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_6kwkl\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[225]\" id=\"field_6kwkl\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_226_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Is there additional information Applicant wants considered?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_226-197-0\"><label for=\"field_az3rj-0\">\t\t<input type=\"radio\" name=\"item_meta[226]\" id=\"field_az3rj-0\" value=\"Yes\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Is there additional information Applicant wants considered? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_226-197-1\"><label for=\"field_az3rj-1\">\t\t<input type=\"radio\" name=\"item_meta[226]\" id=\"field_az3rj-1\" value=\"No\"\n\t\t   data-sectionid=\"197\" data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Is there additional information Applicant wants considered? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_227_container\" class=\"frm_form_field form-field  frm_top_container frm_two_thirds\">\r\n    <label for=\"field_ptxuk\" class=\"frm_primary_label\">If yes, please explain.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[227]\" id=\"field_ptxuk\"  data-sectionid=\"197\" data-invmsg=\"If yes, please explain. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_232_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Authorization<\/h3>\r\n\r\n\r\n<div id=\"frm_field_235_container\" class=\"frm_form_field  frm_html_container form-field\">Applicant authorizes Landlord and Landlord's agent at any time before, during, or after any tenancy, to:<br \/>\n<\/p>\n<ol>\n<li>obtain a copy of Applicant's credit report;<\/li>\n<li>obtain a criminal background check related to Applicant and any occupant;<\/li>\n<li>verify any rental or employment history or to verify any other information related to this application with persons knowledge of such information.<\/li>\n<li>Applicant represents that the statements in this application are true and complete.<\/li>\n<\/ol>\n<p>Notice of Landlord's Rights to Continue to Show the Property: Unless Landlord and Applicant enter into a separate written agreement otherwise, the Property remains on the market until a lease is signed by all parties and the Landlord may continue to show the Property to other prospective tenants and accept another offer\/tenant.<\/p>\n<p><strong><center>Authorization to Release Information Related to a Residential Lease Applicant<\/center><\/strong><br \/>\n<br \/>\nI, Applicant, have submitted an application to lease a property located at this address stated above. <br \/>\nThe landlord, broker, or landlord's representative is:<br \/>\n<br \/>\nDale and Vicki Hall<br \/>\n817-614-2988<br \/>\nFax: 817-423-2630<br \/>\nDaleghallhomes@hotmail.com<\/p>\n<p>I give my permission:<br \/>\n<\/p>\n<ol>\n<li>to my current and former employers to release any information about my employment and income history to the above named person.<\/li>\n<li>to my current and former landlords to release any information about my rental history to the above named person.<\/li>\n<li>to my current and former mortgage lenders on property that I own or have owned to release any information about my mortgage payment history to the above named person.<\/li>\n<li>to my bank, savings and loan, or credit union to provide a verification of funds that I have on deposit to the above named person.<\/li>\n<li>to the above named person to obtain a copy of my consumer credit report from any consumer reporting agency and to obtain a criminal background information about me.<\/li>\n<\/ol>\n<\/div>\n<div id=\"frm_field_236_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_zukfx\" class=\"frm_primary_label\">Applicant Signature: By typing your name in the box below, you are agreeing to all terms given within this application.\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zukfx\" name=\"item_meta[236]\" value=\"\"  data-sectionid=\"232\" style=\"width:500px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Applicant Signature: By typing your name in the box below, you are agreeing to all terms given within this application. is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_237_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ayycm\" class=\"frm_primary_label\">Spouse Signature: By typing your name in the box below, you are agreeing to all terms given within this application.\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ayycm\" name=\"item_meta[237]\" value=\"\"  data-sectionid=\"232\" style=\"width:500px\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Spouse Signature: By typing your name in the box below, you are agreeing to all terms given within this application. is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_238_container\" class=\"frm_form_field  frm_html_container form-field\">You have completed the application. You may now Print or Submit your application.<\/p>\n<style type=\"text\/css\" media=\"print\">\n.printbutton {\n  visibility: hidden;\n  display: none;\n}\n<\/style>\n<p><script>\ndocument.write(\"<input type='button' \" +\n\"onClick='window.print()' \" +\n\"class='printbutton' \" +\n\"value='Print This Application'\/>\");\n<\/script><\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm_verify\" aria-hidden=\"true\">\n\t\t\t\t<label for=\"frm_email_6\">\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input type=\"text\" class=\"frm_verify\" id=\"frm_email_6\" name=\"frm_verify\" value=\"\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"1HgrbfFcspiyFfLsYNXCCi7nD3+\/K7JJ3wUhigdCej8=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit this Application<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-json\/wp\/v2\/pages\/118"}],"collection":[{"href":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-json\/wp\/v2\/comments?post=118"}],"version-history":[{"count":3,"href":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-json\/wp\/v2\/pages\/118\/revisions"}],"predecessor-version":[{"id":122,"href":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-json\/wp\/v2\/pages\/118\/revisions\/122"}],"wp:attachment":[{"href":"http:\/\/www.gerrylynnrentalproperties.com\/rent\/wp-json\/wp\/v2\/media?parent=118"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}