{"id":1667,"date":"2023-01-09T12:46:22","date_gmt":"2023-01-09T12:46:22","guid":{"rendered":"https:\/\/www.medlabsgroup.com\/?page_id=1667"},"modified":"2024-03-19T09:25:07","modified_gmt":"2024-03-19T09:25:07","slug":"apply-now","status":"publish","type":"page","link":"https:\/\/www.medlabsgroup.com\/ar\/apply-now\/","title":{"rendered":"Apply now"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"1667\" class=\"elementor elementor-1667\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-33d1b41 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"33d1b41\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-cf3a470\" data-id=\"cf3a470\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c68fc1e elementor-widget elementor-widget-shortcode\" data-id=\"c68fc1e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><!-- HTML Forms v1.3.27 - https:\/\/wordpress.org\/plugins\/html-forms\/ --><form method=\"post\"  class=\"hf-form hf-form-1386\" data-id=\"1386\" data-title=\"Careers\" data-slug=\"careers\" data-message-success=\"Thank you! We will be in touch soon.\" data-message-invalid-email=\"Sorry, that email address looks invalid.\" data-message-required-field-missing=\"Please fill in the required fields.\" data-message-error=\"Oops. An error occurred.\" data-message-file-too-large=\"Uploaded file is too large.\" data-message-file-upload-error=\"An upload error occurred. Please try again later.\" action=\"\"><input type=\"hidden\" name=\"_hf_form_id\" value=\"1386\" \/><div style=\"display: none;\"><input type=\"text\" name=\"_hf_h1386\" value=\"\" \/><\/div><div class=\"hf-fields-wrap\"><div class='careers-form'>\r\n    <div class='personal-information item'>\r\n        <div class=\"item-row d-flex justify-content-between\">\r\n            <div>\r\n                <div>\r\n                  <h4>\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0634\u062e\u0635\u064a\u0629 <span>(\u064a\u0631\u062c\u0649 \u062a\u0639\u0628\u0626\u0629 \u062c\u0645\u064a\u0639 \u0627\u0644\u062d\u0642\u0648\u0644 \u0627\u0644\u0645\u0637\u0644\u0648\u0628\u0629)<\/span><\/h4>\r\n                    <label for=\"full_name\" class='d-block'>\u0627\u0644\u0627\u0633\u0645 \u0628\u0627\u0644\u0643\u0627\u0645\u0644 <span class='required'> *<\/span><\/label>\r\n                    <input type=\"text\" name=\"full_name\" required id=\"full_name\" placeholder='Enter your full name' \/>\r\n                <\/div>\r\n                <div class='mt-5 d-flex'>\r\n                    <label for=\"gender\" class='radio-label'>\u0627\u0644\u062c\u0646\u0633 <span class='required'> *<\/span><\/label>\r\n                    <label class='radio-input'>\r\n                      <input type=\"radio\" name=\"gender\" value=\"Male\"  required \/>\r\n                      \t\u0630\u0643\u0631\r\n                    <\/label>\r\n                    <label class='radio-input'>\r\n                      <input type=\"radio\" name=\"gender\" value=\"Female\" required \/>\r\n                      \u0627\u0646\u062b\u0649\r\n                   <\/label>\r\n                <\/div>\r\n            <\/div>\r\n            <div class='preview'>\r\n              <img decoding=\"async\" id=\"img-preview\" src=\"\/wp-content\/themes\/medlab-theme\/assets\/images\/img-preview.webp\" alt=\"Image preview\">\r\n              <input type=\"file\" name='picture' id=\"fileInput\" accept=\"image\/*\">\r\n              <label for=\"fileInput\" class=\"file-upload\">\r\n                <img src='\/wp-content\/uploads\/2023\/01\/upload-file.webp'> \r\n                 &nbsp; \r\n                \u062a\u062d\u0645\u064a\u0644 \u0635\u0648\u0631\u0629\r\n              <\/label>\r\n            <\/div>\r\n        <\/div>\r\n        <div class='d-flex justify-content-between mt-4 item-row'>\r\n            <div>\r\n                <label for=\"position_applied\" class='d-block'>\u0627\u0644\u0648\u0638\u0627\u0626\u0641 \u0627\u0644\u0645\u0637\u0644\u0648\u0628\u0629 <span class='required'> *<\/span><\/label>\r\n                <input type=\"text\" name=\"position_applied\" placeholder='\u0627\u0644\u0645\u0646\u0635\u0628 \u0627\u0644\u0645\u062a\u0642\u062f\u0645 \u0644\u0634\u063a\u0644\u0647' required id=\"position_applied\" \/>\r\n            <\/div>\r\n            <div>\r\n                <label for=\"expected_salary\" class='d-block'>\u0627\u0644\u0631\u0627\u062a\u0628 \u0627\u0644\u0645\u062a\u0648\u0642\u0639 <span class='required'> *<\/span><\/label>\r\n                <input type=\"text\" name=\"expected_salary\" placeholder='\u0627\u0644\u0631\u0627\u062a\u0628 \u0627\u0644\u0645\u062a\u0648\u0642\u0639' required id=\"expected_salary\" \/>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n    <div class='address-information item'>\r\n        <h4>\u0627\u0644\u0639\u0646\u0648\u0627\u0646 <span>(\u064a\u0631\u062c\u0649 \u062a\u0639\u0628\u0626\u0629 \u062c\u0645\u064a\u0639 \u0627\u0644\u062d\u0642\u0648\u0644 \u0627\u0644\u0645\u0637\u0644\u0648\u0628\u0629)<\/span><\/h4>\r\n        <div class='d-flex justify-content-between'>\r\n            <div>\r\n                <label for=\"city\" class='d-block'>\u0627\u0644\u0645\u062f\u064a\u0646\u0629 <span class='required'> *<\/span><\/label>\r\n                <input type=\"text\" name=\"city\" id=\"city\" placeholder='\u0627\u0644\u0645\u062f\u064a\u0646\u0629' required \/>\r\n            <\/div>\r\n            <div>\r\n                <label for=\"area\" class='d-block'>Area <span class='required'> *<\/span><\/label>\r\n                <input type=\"text\" name=\"area\" id=\"area\" placeholder='Area' required \/>\r\n            <\/div>\r\n            <div>\r\n                <label for=\"street\" class='d-block'>\u0627\u0644\u0634\u0627\u0631\u0639 <span class='required'> *<\/span><\/label>\r\n                <input type=\"text\" name=\"street\" id=\"street\" placeholder='\u0627\u0644\u0634\u0627\u0631\u0639' required \/>\r\n            <\/div>\r\n        <\/div>\r\n        <div class='d-flex justify-content-between my-3'>\r\n            <div>\r\n                <label for=\"building\" class='d-block'>\u0627\u0644\u0628\u0646\u0627\u064a\u0629<\/label>\r\n                <input type=\"text\" name=\"building\" id=\"building\" placeholder='\u0627\u0644\u0628\u0646\u0627\u064a\u0629' \/>\r\n            <\/div>\r\n            <div>\r\n                <label for=\"phone_number\" class='d-block'>\u0631\u0642\u0645 \u0627\u0644\u0647\u0627\u062a\u0641 <span class='required'> *<\/span><\/label>\r\n                <input type=\"text\" name=\"phone_number\" pattern=\"[0-9]*\" title='Only digits will be accepted'\r\n                       id=\"phone_number\" placeholder='\u0631\u0642\u0645 \u0627\u0644\u0647\u0627\u062a\u0641' required \/>\r\n            <\/div>\r\n            <div>\r\n                <label for=\"mobile\" class='d-block'>\u0631\u0642\u0645 \u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646<\/label>\r\n                <input type=\"text\" name=\"mobile\" pattern=\"[0-9]*\" id=\"mobile\" placeholder='Your Mobile Number' title='Only digits will be accepted' \/>\r\n            <\/div>\r\n        <\/div>\r\n        <div class='d-flex justify-content-between my-3 item-row'>\r\n            <div>\r\n                <label for=\"email\" class='d-block'>\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a <span class='required'> *<\/span><\/label>\r\n                <input type=\"email\" name=\"email\" id=\"email\" placeholder='\u0628\u0631\u064a\u062f\u0643 \u0627\u0644\u0627\u0644\u0643\u062a\u0631\u0648\u0646\u064a' required \/>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n    <div class='address-information item'>\r\n        <h4>\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0639\u0627\u0645\u0629: <span>(\u064a\u0631\u062c\u0649 \u062a\u0639\u0628\u0626\u0629 \u062c\u0645\u064a\u0639 \u0627\u0644\u062d\u0642\u0648\u0644 \u0627\u0644\u0645\u0637\u0644\u0648\u0628\u0629)<\/span><\/h4>\r\n        <div class='d-flex justify-content-between my-3 item-row'>\r\n            <div>\r\n                <label for=\"nationality\" class='d-block'>\u0627\u0644\u062c\u0646\u0633\u064a\u0629 <span class='required'> *<\/span><\/label>\r\n                <input type=\"text\" name=\"nationality\" id=\"nationality\" placeholder='\u0627\u0644\u062c\u0646\u0633\u064a\u0629' required \/>\r\n            <\/div>\r\n            <div>\r\n                <label for=\"dob\" class='d-block'>\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f <span class='required'> *<\/span><\/label>\r\n                <input type=\"date\" name=\"dob\" id=\"dob\" placeholder='\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f' required \/>\r\n            <\/div>\r\n        <\/div>\r\n        <div class='d-flex justify-content-between my-3 item-row'>\r\n            <div class='d-flex'>\r\n                <label for=\"martial_status\" class='d-block radio-label'>\u0627\u0644\u062d\u0627\u0644\u0629 \u0627\u0644\u0627\u062c\u062a\u0645\u0627\u0639\u064a\u0629 \r\n                  <span class='required'> *<\/span>\r\n              <\/label>\r\n                <label class='radio-input'>\r\n                    <input type=\"radio\" name=\"martial_status\" value=\"Single\" required \/> \u0623\u0639\u0632\u0628\r\n                <\/label>\r\n                <label class='radio-input'>\r\n                    <input type=\"radio\" name=\"martial_status\" value=\"Married\" required> \u0645\u062a\u0632\u0648\u062c\r\n                <\/label>\r\n                <label class='radio-input'>\r\n                    <input type=\"radio\" name=\"martial_status\" value=\"Other\" required \/> \u0627\u062e\u0631\r\n                <\/label>\r\n            <\/div>\r\n        <\/div>\r\n        <div class='d-flex justify-content-betwee item-row'>\r\n            <div class='d-flex'>\r\n                <label for=\"have_car\" class='d-block radio-label'>\u0647\u0644 \u062a\u0645\u0644\u0643 \u0633\u064a\u0627\u0631\u0629 \r\n                  <span class='required'> *<\/span>\r\n              <\/label>\r\n                <label class='radio-input'>\r\n                    <input type=\"radio\" name=\"have_car\" value=\"Yes\" required \/> \u0646\u0639\u0645\r\n                <\/label>\r\n                <label class='radio-input'>\r\n                    <input type=\"radio\" name=\"have_car\" value=\"No\" required \/> \u0644\u0627\r\n                <\/label>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n  \r\n  <div class='responsive-table item'>\r\n        <table>\r\n            <thead>\r\n                <tr>\r\n                    <th colspan=\"5\">\u0627\u0644\u0645\u0624\u0647\u0644\u0627\u062a \u0627\u0644\u0639\u0644\u0645\u064a\u0629<\/th>\r\n                <\/tr>\r\n            <\/thead>\r\n            <tbody>\r\n                <tr>\r\n                    <th data-label=\"Degree\">\u0627\u0644\u062f\u0631\u062c\u0629 \u0627\u0644\u0639\u0644\u0645\u064a\u0629<\/th>\r\n                    <th data-label=\"Institution\">\u0627\u0644\u0645\u0639\u0647\u062f<\/th>\r\n                    <th data-label=\"Graduation Date\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u062e\u0631\u062c<\/th>\r\n                    <th data-label=\"Major\">\u0627\u0644\u062a\u062e\u0635\u0635<\/th>\r\n                    <th data-label=\"GPA\">\u0627\u0644\u0645\u0639\u062f\u0644 \u0627\u0644\u062a\u0631\u0627\u0643\u0645\u064a<\/th>\r\n                <\/tr>\r\n                <tr>\r\n                    <td data-label=\"Degree\" class='first-col'>\r\n                        \u0627\u0644\u0645\u062f\u0631\u0633\u0629 \u0627\u0644\u062b\u0627\u0646\u0648\u064a\u0629\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_high_school_institution\" id=\"academic_high_school_institution\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_high_school_grad_date\" id=\"academic_high_school_grad_date\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_high_school_major\"  id=\"academic_high_school_major\" \/>\r\n                    <\/td>\r\n\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_high_school_gpa\"  id=\"academic_high_school_gpa\" \/>\r\n                    <\/td>\r\n                <\/tr>\r\n                <tr>\r\n                    <td data-label=\"Degree\" class='first-col'>\r\n                        \u0634\u0647\u0627\u062f\u0629 \u062f\u0628\u0644\u0648\u0645\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_diploma_institution\" id=\"academic_diploma_institution\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_diploma_grad_date\" id=\"academic_diploma_grad_date\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_diploma_major\"  id=\"academic_diploma_major\" \/>\r\n                    <\/td>\r\n\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_diploma_gpa\"  id=\"academic_diploma_gpa\" \/>\r\n                    <\/td>\r\n                <\/tr>\r\n                 <tr>\r\n                    <td data-label=\"Degree\" class='first-col'>\r\n                        \u0627\u0644\u0628\u0643\u0627\u0644\u0648\u0631\u064a\u0648\u0633\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_bachelor_institution\" id=\"academic_bachelor_institution\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_bachelor_grad_date\" id=\"academic_bachelor_grad_date\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_bachelor_major\"  id=\"academic_bachelor_major\" \/>\r\n                    <\/td>\r\n\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_bachelor_gpa\"  id=\"academic_bachelor_gpa\" \/>\r\n                    <\/td>\r\n                <\/tr>\r\n                 <tr>\r\n                    <td data-label=\"Degree\" class='first-col'>\r\n                       \u0627\u0644\u0645\u0627\u062c\u0633\u062a\u064a\u0631\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_masters_institution\" id=\"academic_masters_institution\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_masters_grad_date\" id=\"academic_masters_grad_date\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_masters_major\"  id=\"academic_masters_major\" \/>\r\n                    <\/td>\r\n\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_masters_gpa\"  id=\"academic_masters_gpa\" \/>\r\n                    <\/td>\r\n                <\/tr>\r\n                 <tr>\r\n                    <td data-label=\"Degree\" class='first-col'>\r\n                        Ph. D\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_phd_institution\" id=\"academic_phd_institution\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_phd_grad_date\" id=\"academic_phd_grad_date\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_phd_major\"  id=\"academic_phd_major\" \/>\r\n                    <\/td>\r\n\r\n                    <td>\r\n                        <input type=\"text\" name=\"academic_phd_gpa\"  id=\"academic_phd_gpa\" \/>\r\n                    <\/td>\r\n                <\/tr>\r\n            <\/tbody>\r\n        <\/table>\r\n        <\/div>\r\n  \r\n   <div class='responsive-table item'>\r\n        <table>\r\n            <thead>\r\n                <tr>\r\n                    <th colspan=\"10\">\u0627\u0644\u0644\u063a\u0627\u062a<\/th>\r\n                <\/tr>\r\n            <\/thead>\r\n            <tbody>\r\n                <tr>\r\n                    <th data-label=\"Language\" rowspan=\"2\">\u0627\u0644\u0644\u063a\u0627\u062a<\/th>\r\n                    <th data-label=\"Degree of speaking\" colspan='3'>\u062f\u0631\u062c\u0629 \u0627\u0644\u062a\u062d\u062f\u062b<\/th>\r\n                    <th data-label=\"Writing degree\" colspan='3'>\u062f\u0631\u062c\u0629 \u0627\u0644\u0643\u062a\u0627\u0628\u0629<\/th>\r\n                    <th data-label=\"Reading degree\" colspan='3'>\u062f\u0631\u062c\u0629 \u0627\u0644\u0642\u0631\u0627\u0621\u0629<\/th>\r\n                <\/tr>\r\n                 <tr>\r\n                    <th data-label=\"Excellent\">\u0645\u0645\u062a\u0627\u0632<\/th>\r\n                    <th data-label=\"Good\">\u062c\u064a\u062f<\/th>\r\n                    <th data-label=\"Fair\">\u0645\u062a\u0648\u0633\u0637<\/th>\r\n                    <th data-label=\"Excellent\">\u0645\u0645\u062a\u0627\u0632<\/th>\r\n                    <th data-label=\"Good\">\u062c\u064a\u062f<\/th>\r\n                    <th data-label=\"Fair\">\u0645\u062a\u0648\u0633\u0637<\/th>\r\n                    <th data-label=\"Excellent\">\u0645\u0645\u062a\u0627\u0632<\/th>\r\n                    <th data-label=\"Good\">\u062c\u064a\u062f<\/th>\r\n                    <th data-label=\"Fair\">\u0645\u062a\u0648\u0633\u0637<\/th>\r\n                <\/tr>\r\n                <tr>\r\n                    <td data-label=\"Language\" class='first-col'>\r\n                        English\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                        <input type=\"radio\" name=\"english_speak\" value=\"Excellent\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                          <input type=\"radio\" name=\"english_speak\" value=\"Good\" required \/>\r\n                      <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"english_speak\" value=\"Fair\" required \/>\r\n                    <\/td>\r\n                 \t<td class='text-center'>\r\n                      <input type=\"radio\" name=\"english_write\" value=\"Excellent\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"english_write\" value=\"Good\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"english_write\" value=\"Fair\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"english_read\" value=\"Excellent\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"english_read\" value=\"Good\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"english_read\" value=\"Fair\" required \/>\r\n                    <\/td>\r\n                <\/tr>\r\n                <tr>\r\n                    <td data-label=\"Language\" class='first-col'>\r\n                        \u0639\u0631\u0628\u0649\r\n                    <\/td>\r\n                   <td class='text-center'>\r\n                        <input type=\"radio\" name=\"arabic_speak\" value=\"Excellent\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                          <input type=\"radio\" name=\"arabic_speak\" value=\"Good\" required \/>\r\n                      <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"arabic_speak\" value=\"Fair\" required \/>\r\n                    <\/td>\r\n                 \t<td class='text-center'>\r\n                      <input type=\"radio\" name=\"arabic_write\" value=\"Excellent\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"arabic_write\" value=\"Good\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"arabic_write\" value=\"Fair\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"arabic_read\" value=\"Excellent\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"arabic_read\" value=\"Good\" required \/>\r\n                    <\/td>\r\n                    <td class='text-center'>\r\n                      <input type=\"radio\" name=\"arabic_read\" value=\"Fair\" required \/>\r\n                    <\/td>\r\n                <\/tr>\r\n                \r\n            <\/tbody>\r\n        <\/table>\r\n        <\/div>\r\n  \r\n     <div class='responsive-table item'>\r\n        <table>\r\n            <thead>\r\n                <tr>\r\n                    <th colspan=\"5\">\u0627\u0644\u062e\u0628\u0631\u0627\u062a \u0627\u0644\u0639\u0645\u0644\u064a\u0640\u0640\u0640\u0640\u0629<\/th>\r\n                <\/tr>\r\n            <\/thead>\r\n            <tbody>\r\n                <tr>\r\n                  <th rowspan=\"2\" data-label=\"Organization\">\u0627\u0644\u0634\u0631\u0643\u0629<\/th>\r\n                  <th data-label=\"Position\" rowspan=\"2\">\u0627\u0644\u0645\u0633\u0645\u0649 \u0627\u0644\u0648\u0638\u064a\u0641\u064a<\/th>\r\n                  <th data-label=\"Employment\" colspan=\"2\">\u062a\u0648\u0638\u064a\u0641<\/th>\r\n                  <th data-label=\"Reason for Leaving\" rowspan=\"2\">\u0623\u0633\u0628\u0627\u0628 \u062a\u0631\u0643 \u0627\u0644\u0639\u0645\u0644<\/th>\r\n                <\/tr>\r\n                 <tr>\r\n                    <th data-label=\"From (dd\/mm\/yyyy)\">\u0645\u0646 (\u064a\u0648\u0645\/\u0634\u0647\u0631\/\u0633\u0646\u0629)<\/th>\r\n                    <th data-label=\"To (dd\/mm\/yyyy)\">\u0625\u0644\u0649 (\u064a\u0648\u0645\/\u0634\u0647\u0631\/\u0633\u0646\u0629)<\/th>\r\n                <\/tr>\r\n                <tr>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_organization_1\" id=\"employment_organization_1\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_position_1\" id=\"employment_position_1\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"date\" name=\"employment_from_1\" id=\"employment_from_1\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"date\" name=\"employment_to_1\" id=\"employment_to_1\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_leaving_reason_1\" id=\"employment_leaving_reason_1\" \/>\r\n                    <\/td>\r\n                    \r\n                <\/tr>\r\n                <tr>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_organization_2\" id=\"employment_organization_2\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_position_2\" id=\"employment_position_2\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"date\" name=\"employment_from_2\" id=\"employment_from_2\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"date\" name=\"employment_to_2\" id=\"employment_to_2\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_leaving_reason_2\" id=\"employment_leaving_reason_2\" \/>\r\n                    <\/td>\r\n                    \r\n                <\/tr>\r\n                 <tr>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_organization_3\" id=\"employment_organization_3\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_position_3\" id=\"employment_position_3\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"date\" name=\"employment_from_3\" id=\"employment_from_3\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"date\" name=\"employment_to_3\" id=\"employment_to_3\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_leaving_reason_3\" id=\"employment_leaving_reason_3\" \/>\r\n                    <\/td>\r\n                    \r\n                <\/tr>\r\n                 <tr>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_organization_4\" id=\"employment_organization_4\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_position_4\" id=\"employment_position_4\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"date\" name=\"employment_from_4\" id=\"employment_from_4\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"date\" name=\"employment_to_4\" id=\"employment_to_4\" \/>\r\n                    <\/td>\r\n                     <td>\r\n                        <input type=\"text\" name=\"employment_leaving_reason_4\" id=\"employment_leaving_reason_4\" \/>\r\n                    <\/td>\r\n                    \r\n                <\/tr>\r\n                \r\n            <\/tbody>\r\n        <\/table>\r\n        <\/div>\r\n\r\n    <div class='other-information item'>\r\n        <div class='my-3'>\r\n            <label for=\"qualified_work_jo\" class='d-block my-2'>\u0647\u0644 \u0623\u0646\u062a \u0645\u0624\u0647\u0644 \u0644\u0644\u0639\u0645\u0644 \u0641\u064a \u0627\u0644\u0645\u0645\u0644\u0643\u0629 \u0627\u0644\u0623\u0631\u062f\u0646\u064a\u0629 \u0627\u0644\u0647\u0627\u0634\u0645\u064a\u0629\u061f <span class='required'> *<\/span><\/label>\r\n          <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"qualified_work_jo\" value=\"Yes\" required \/> \u0646\u0639\u0645\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"qualified_work_jo\" value=\"No\" required \/> \u0644\u0627\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"currently_working\" class='d-block my-2'>\u0647\u0644 \u062a\u0639\u0645\u0644 \u062d\u0627\u0644\u064a\u0627\u061f <span class='required'> *<\/span><\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"currently_working\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"currently_working\" value=\"No\" required \/>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"company_name\" class='d-block'>\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0646\u0639\u0645 \u060c \u064a\u0631\u062c\u0649 \u062a\u0642\u062f\u064a\u0645 \u0627\u0633\u0645 \u0634\u0631\u0643\u062a\u0643<\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <input type=\"text\" name=\"company_name\" placeholder=\"Company name\" id=\"company_name\" \/>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"contact_old_employer\" class='d-block my-2'>\u0647\u0644 \u062a\u0645\u0627\u0646\u0639 \u0641\u064a \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0628\u062c\u0647\u0629 \u0639\u0645\u0644\u0643 \u0627\u0644\u062d\u0627\u0644\u064a\u0629\u061f <span class='required'> *<\/span><\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"contact_old_employer\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"contact_old_employer\" value=\"No\" required \/>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"have_another_job\" class='d-block my-2'>\u0647\u0644 \u062a\u0639\u0645\u0644 \u0641\u064a \u0623\u064a \u0648\u0638\u064a\u0641\u0629 \u0623\u062e\u0631\u0649 \u060c \u0633\u0648\u0627\u0621 \u0641\u064a \u0627\u0644\u0642\u0637\u0627\u0639 \u0627\u0644\u062d\u0643\u0648\u0645\u064a \u0623\u0648 \u0627\u0644\u0642\u0637\u0627\u0639 \u0627\u0644\u062e\u0627\u0635\u061f <span class='required'> *<\/span> <\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"have_another_job\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"have_another_job\" value=\"No\" required \/>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"have_entry\" class='d-block'>\u0647\u0644 \u0644\u062f\u064a\u0643 \u0623\u064a \u0642\u064a\u0648\u062f \u0641\u064a \u0648\u0632\u0627\u0631\u0629 \u0627\u0644\u0635\u0646\u0627\u0639\u0629 \u0648\u0627\u0644\u062a\u062c\u0627\u0631\u0629 \u0648\u0627\u0644\u062a\u0648\u0631\u064a\u062f \u0627\u0644\u0623\u0631\u062f\u0646\u064a\u0629 \u062a\u062a\u0639\u0644\u0642 \u0628\u0627\u0644\u0648\u0638\u064a\u0641\u0629 \u0627\u0644\u0645\u0637\u0644\u0648\u0628\u0629\u061f <span class='required'> *<\/span> <\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"have_entry\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"have_entry\" value=\"No\"  required>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"requested_resign\" class='d-block my-2'>\u0647\u0644 \u0637\u0644\u0628 \u0645\u0646\u0643 \u0627\u0644\u0627\u0633\u062a\u0642\u0627\u0644\u0629 \u0645\u0646 \u0642\u0628\u0644 \u0635\u0627\u062d\u0628 \u0627\u0644\u0639\u0645\u0644 \u0623\u0648 \u062a\u0645 \u0625\u0646\u0647\u0627\u0624\u0647\u0627\u061f <span class='required'> *<\/span> <\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"requested_resign\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"requested_resign\" value=\"No\" required \/>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"company\u0640names\u0640reasons\" class='d-block my-2'> \u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0646\u0639\u0645 \u060c \u064a\u0631\u062c\u0649 \u062a\u0642\u062f\u064a\u0645 \u0623\u0633\u0645\u0627\u0621 \u0627\u0644\u0634\u0631\u0643\u0629 \u0648\u0623\u0633\u0628\u0627\u0628\u0647\u0627: <\/label>\r\n           <\/div>\r\n          <div>\r\n            <div class='my-3 d-flex justify-content-between item-row'>\r\n                <div>\r\n                    <label for=\"company_name_1\" class='d-block'>\u0627\u0633\u0645 \u0627\u0644\u0634\u0631\u0643\u0629<\/label>\r\n                    <input type=\"text\" name=\"company_name_1\" id=\"company_name_1\" placeholder='\u0627\u0633\u0645 \u0627\u0644\u0634\u0631\u0643\u0629'  \/>\r\n                <\/div>\r\n                <div>\r\n                    <label for=\"reasons_1\" class='d-block'>\u0627\u0644\u0633\u0628\u0628<\/label>\r\n                    <input type=\"text\" name=\"reasons_1\" id=\"reasons_1\" placeholder='\u0627\u0644\u0633\u0628\u0628' \/>\r\n                <\/div>\r\n            <\/div>\r\n            <div class='my-3 d-flex justify-content-between item-row'>\r\n                <div>\r\n                    <label for=\"company_name_2\" class='d-block'>\u0627\u0633\u0645 \u0627\u0644\u0634\u0631\u0643\u0629<\/label>\r\n                    <input type=\"text\" name=\"company_name_2\" id=\"company_name_2\" placeholder='\u0627\u0633\u0645 \u0627\u0644\u0634\u0631\u0643\u0629' \/>\r\n                <\/div>\r\n                <div>\r\n                    <label for=\"reasons_2\" class='d-block'>\u0627\u0644\u0633\u0628\u0628<\/label>\r\n                    <input type=\"text\" name=\"reasons_2\" id=\"reasons_2\" placeholder='\u0627\u0644\u0633\u0628\u0628' \/>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"working_different_shifts\" class='d-block my-2'>\u064a\u0645\u0643\u0646\u0643 \u0627\u0644\u0639\u0645\u0644 \u0641\u064a \u063a\u0636\u0648\u0646 \u0633\u0627\u0639\u0627\u062a \u0627\u0644\u0639\u0645\u0644 \u0627\u0644\u0645\u062e\u062a\u0644\u0641\u0629 (\u0646\u0638\u0627\u0645 \u0627\u0644\u062a\u062d\u0648\u0644)\u061f <span class='required'> *<\/span> <\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"working_different_shifts\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"working_different_shifts\" value=\"No\" required \/>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"working_after_hours\" class='d-block my-2'>\u0647\u0644 \u064a\u0645\u0643\u0646\u0643 \u0627\u0644\u0639\u0645\u0644 \u0644\u0633\u0627\u0639\u0627\u062a \u0625\u0636\u0627\u0641\u064a\u0629 \u060c \u0628\u0645\u0627 \u0641\u064a \u0630\u0644\u0643 \u0639\u0637\u0644\u0627\u062a \u0646\u0647\u0627\u064a\u0629 \u0627\u0644\u0623\u0633\u0628\u0648\u0639\u061f <span class='required'> *<\/span><\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"working_after_hours\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"working_after_hours\" value=\"No\" required \/>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"performing_main_tasks\" class='d-block my-2'>\u0647\u0644 \u0623\u0646\u062a \u0642\u0627\u062f\u0631 \u0639\u0644\u0649 \u0623\u062f\u0627\u0621 \u0627\u0644\u0648\u0627\u062c\u0628\u0627\u062a \u0627\u0644\u0623\u0633\u0627\u0633\u064a\u0629 \u0644\u0644\u0648\u0638\u064a\u0641\u0629 \u0627\u0644\u062a\u064a \u062a\u062a\u0642\u062f\u0645 \u0644\u0647\u0627\u061f <span class='required'> *<\/span> <\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"performing_main_tasks\" value=\"Yes\" required>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"performing_main_tasks\" value=\"No\" required>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"hear_about_us\" class='d-block my-2'>\u0643\u064a\u0641 \u0633\u0645\u0639\u062a \u0639\u0646\u0627\u061f <span class='required'> *<\/span><\/label>\r\n            <select name=\"hear_about_us\" required id=\"hear_about_us\">\r\n               <option selected=\"true\" disabled=\"disabled\">\u0627\u062e\u062a\u0631<\/option>\r\n                <option value='Ad'>\u0627\u0639\u0644\u0627\u0646<\/option>\r\n                <option value='Internet'>\u0627\u0644\u0627\u0646\u062a\u0631\u0646\u062a<\/option>\r\n                <option value='Friends'>\u0645\u0639\u0631\u0641\u0629 \/ \u0627\u0635\u062f\u0642\u0627\u0621<\/option>\r\n                <option value='Social Media'>\u0648\u0633\u0627\u0626\u0644 \u0627\u0644\u062a\u0648\u0627\u0635\u0644 \u0627\u0644\u0627\u062c\u062a\u0645\u0627\u0639\u064a<\/option>\r\n                <option value='MedLabs Employee'>\u0627\u062d\u062f \u0645\u0648\u0638\u0641\u064a\u0646\u0627<\/option>\r\n            <\/select>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"previously_work_for_us\" class='d-block my-2'>\u0647\u0644 \u0639\u0645\u0644\u062a \u0645\u0646 \u0642\u0628\u0644 \u0644\u0646\u0627\u061f <span class='required'> *<\/span><\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"previously_work_for_us\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"previously_work_for_us\" value=\"No\" required \/>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n        <div class='my-3'>\r\n            <label for=\"relatives_work_with_us\" class='d-block my-2'>\u0647\u0644 \u0644\u062f\u064a\u0643 \u0645\u0639\u0627\u0631\u0641 \u0623\u0648 \u0623\u0642\u0627\u0631\u0628 \u064a\u0639\u0645\u0644\u0648\u0646 \u0641\u064a \u0646\u0641\u0633 \u0627\u0644\u0645\u062c\u0627\u0644\u061f <span class='required'> *<\/span><\/label>\r\n           <\/div>\r\n          <div class='d-flex'>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"relatives_work_with_us\" value=\"Yes\" required \/>\r\n                <span>\u0646\u0639\u0645<\/span>\r\n            <\/label>\r\n            <label class='radio-input'>\r\n                <input type=\"radio\" name=\"relatives_work_with_us\" value=\"No\" required \/>\r\n                <span>\u0644\u0627<\/span>\r\n            <\/label>\r\n        <\/div>\r\n\r\n        <div class='my-3 my-2'>\r\n            <label for=\"company\u0640names\u0640reasons\" class='d-block mb-3'>\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0646\u0639\u0645 \u060c \u064a\u0631\u062c\u0649 \u062a\u0642\u062f\u064a\u0645 \u0623\u0633\u0645\u0627\u0621 \u0627\u0644\u0623\u0634\u062e\u0627\u0635 \u0648\u062f\u0631\u062c\u0629 \u0627\u0644\u0642\u0631\u0627\u0628\u0629 \u0648\u0645\u0643\u0627\u0646 \u0627\u0644\u0639\u0645\u0644:<\/label>\r\n            <div class='d-flex justify-content-between'>\r\n                <div>\r\n                    <label for=\"relation_name_1\" class='d-block'>\u0627\u0644\u0627\u0633\u0645<\/label>\r\n                    <input type=\"text\" name=\"relation_name_1\" id=\"relation_name_1\" placeholder='\u0627\u0644\u0627\u0633\u0645'\/>\r\n                <\/div>\r\n                <div>\r\n                    <label for=\"relation_type_1\" class='d-block'>\u062f\u0631\u062c\u0629 \u0627\u0644\u0642\u0631\u0627\u0628\u0629<\/label>\r\n                    <input type=\"text\" name=\"relation_type_1\" id=\"relation_type_1\" placeholder='\u062f\u0631\u062c\u0629 \u0627\u0644\u0642\u0631\u0627\u0628\u0629' \/>\r\n          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id=\"relation_type_2\" placeholder='\u062f\u0631\u062c\u0629 \u0627\u0644\u0642\u0631\u0627\u0628\u0629' \/>\r\n                <\/div>\r\n                <div>\r\n                    <label for=\"work_place_1\" class='d-block'>\u0645\u0643\u0627\u0646 \u0627\u0644\u0639\u0645\u0644<\/label>\r\n                    <input type=\"text\" name=\"work_place_2\" id=\"work_place_2\" placeholder='\u0645\u0643\u0627\u0646 \u0627\u0644\u0639\u0645\u0644' \/>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n\r\n\r\n    <\/div>\r\n   <div class='responsive-table item'>\r\n        <table>\r\n            <thead>\r\n                <tr>\r\n                    <th colspan=\"4\">\u0645\u0639\u0631\u0641\u0627\u062a \u0636\u0639 \u0642\u0627\u0626\u0645\u0629 \u0628\u0623\u0633\u0645\u0627\u0621 \u062b\u0644\u0627\u062b\u0629 \u0623\u0642\u0627\u0631\u0628 (\u0645\u062b\u0644 \u0645\u062f\u064a\u0631\u0643 \u0627\u0644\u0633\u0627\u0628\u0642 \u060c \u0637\u0628\u064a\u0628 \u0627\u0644\u062c\u0627\u0645\u0639\u0629 \u060c ...)\r\n                    <\/th>\r\n                <\/tr>\r\n            <\/thead>\r\n            <tbody>\r\n                <tr>\r\n                    <th data-label=\"Name\">\u0627\u0644\u0627\u0633\u0645<\/th>\r\n                    <th data-label=\"Relationship\">\u0635\u0644\u0629<\/th>\r\n                    <th data-label=\"Occupation\">\u0627\u0644\u0645\u0647\u0646\u0629<\/th>\r\n                    <th data-label=\"Phone Number\">\u0631\u0642\u0645 \u0627\u0644\u0647\u0627\u062a\u0641<\/th>\r\n                <\/tr>\r\n                <tr>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_first_name\" id=\"ref_first_name\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_first_relation\" id=\"ref_first_relation\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_first_occupation\" id=\"ref_first_occupation\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_first_phone\" id=\"ref_first_phone\" pattern=\"[0-9]*\" title='Only digits will be accepted' \/>\r\n                    <\/td>\r\n                <\/tr>\r\n                <tr>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_second_name\" id=\"ref_second_name\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_second_relation\" id=\"ref_second_relation\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_second_occupation\" id=\"ref_second_occupation\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_second_phone\" id=\"ref_second_phone\" pattern=\"[0-9]*\" title='Only digits will be accepted' \/>\r\n                    <\/td>\r\n                <\/tr>\r\n               <tr>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_third_name\" id=\"ref_third_name\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_third_relation\" id=\"ref_third_relation\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_third_occupation\" id=\"ref_third_occupation\" \/>\r\n                    <\/td>\r\n                    <td>\r\n                        <input type=\"text\" name=\"ref_third_phone\" id=\"ref_third_phone\" pattern=\"[0-9]*\" title='Only digits will be accepted' \/>\r\n                    <\/td>\r\n                <\/tr>\r\n            <\/tbody>\r\n        <\/table>\r\n  <\/div>\r\n    <div class='address-information item'>\r\n        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