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<title>Employment Opportunities</title>
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<tr height="477">
<td height="477" colspan="2" align="left" valign="top">
<div align="left">
<form method="post" action="http://www.biehlcollects.com/employmail.php" name="SampleForm">
<input type="hidden" name="env_report" value="REMOTE_HOST,REMOTE_ADDR,HTTP_USER_AGENT,AUTH_TYPE,REMOTE_USER">
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<input type="hidden" name="recipients" value="[email protected]" />
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<input type="hidden" name="subject" value="Sample FormMail Testing" />
<table border="0" cellpadding="0" cellspacing="0" width="937" bgcolor="white" align="left">
<tr height="13">
<td height="13" colspan="6">
<center>
<h3>Please fill out the following form and submit the Biehl & Biehl Inc.<br>
We will contact you to schedule and appointment.<br>
</h3>
</center>
</td>
</tr>
<tr height="13">
<td height="13" colspan="6"></td>
</tr>
<tr height="35">
<td width="214" height="35" align="left" valign="top">Name:</td>
<td height="35" colspan="5"><input type="text" name="Name" size="45"></td>
</tr>
<tr height="35">
<td width="214" height="35" align="left" valign="top">Address:</td>
<td height="35" colspan="5"><input type="text" name="Address" size="45"></td>
</tr>
<tr height="35">
<td width="214" height="35" align="left" valign="top">City/State/Zip:</td>
<td height="35" colspan="5"><input type="text" name="City State Zip" size="45"></td>
</tr>
<tr height="35">
<td width="214" height="35" align="left" valign="top">Who referred<br>
you to us?</td>
<td height="35" colspan="5"><input type="text" name="Who Referred You" size="45"></td>
</tr>
<tr height="40">
<td width="214" height="40" align="center" valign="bottom">Phone:<br>
<input type="text" name="Phone" size="12"></td>
<td width="201" height="40" align="center" valign="bottom">Fax:<br>
<input type="text" name="Fax" size="12"></td>
<td width="100" height="40" align="center" valign="bottom">E-Mail:<br>
<input type="text" name="E-Mail" size="20"></td>
<td width="34" height="40" align="center" valign="bottom"></td>
<td height="40" width="65" align="center" valign="bottom"></td>
<td height="40" bgcolor="white" valign="bottom" width="146"></td>
</tr>
<tr height="40">
<td height="40" colspan="6" align="left" valign="middle">
<h3>Position Desired</h3>
</td>
</tr>
<tr height="35">
<td width="214" height="35" valign="top">I am seeking:</td>
<td height="35" colspan="5" valign="top"><select name="Seeking Job" size="4" multiple>
<option value="Full time">Full Time
<option value="Part Time">Part Time
<option value="Permanent">Permanent
<option value="Temporary">Temporary
<option value="Summer">Summer
</select></td>
</tr>
<tr height="35">
<td height="35" valign="top" colspan="6">(To select more than one: press CONTROL, or COMMAND for Mac, click with mouse)</td>
</tr>
<tr height="35">
<td width="214" height="35" valign="top">Position Apply for:</td>
<td height="35" colspan="5" valign="top"><input type="text" name="Position" size="45"></td>
</tr>
<tr height="40">
<td height="40" valign="middle" colspan="6">
<h3>Educational Background</h3>
</td>
</tr>
<tr height="25">
<td width="214" height="25" valign="top">High School</td>
<td width="201" height="25" valign="top"><input type="text" name="High School" size="45"></td>
<td width="100" height="25" align="center" valign="top">Dates Attended:</td>
<td width="34" height="25" align="left" valign="top">From</td>
<td width="65" height="25" align="left" valign="top"><input type="text" name="HS From" size="8"></td>
<td width="146" height="25" align="left" valign="top">Did you graduate:</td>
</tr>
<tr height="35">
<td width="214" height="35" valign="top">School Address</td>
<td height="35" valign="top" width="201"><input type="text" name="High School Address" size="45"></td>
<td width="100" height="35" align="left" valign="top"></td>
<td width="34" height="35" align="left" valign="top">To</td>
<td width="65" height="35" align="left" valign="top"><input type="text" name="HS To" size="8"></td>
<td width="146" height="35" valign="top"><input type="radio" value="radioValue" name="HS Grad Yes" tabindex="4"><label>Yes</label><input type="radio" value="radioValue" name="HS Grad No" tabindex="4"><label>No</label></td>
</tr>
<tr height="25" valign="top">
<td width="214" height="25" valign="top" align="left">College</td>
<td height="25" valign="top" width="201" align="left"><input type="text" name="College" size="45"></td>
<td width="100" height="25" align="center" valign="top">Dates Attended:</td>
<td width="34" height="25" align="left" valign="top">From</td>
<td width="65" height="25" align="left" valign="top"><input type="text" name="College From" size="8"></td>
<td height="25" valign="top" align="left" width="146">Did you graduate:</td>
</tr>
<tr height="35">
<td width="214" height="35" valign="top" align="left">School Address</td>
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<td width="100" height="35" align="left" valign="top"></td>
<td width="34" height="35" align="left" valign="top">To</td>
<td height="35" width="65" valign="top" align="left"><input type="text" name="College To" size="8"></td>
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</tr>
<tr height="25">
<td height="25" valign="top" align="left" width="214">Other Education</td>
<td width="201" height="25" align="left" valign="top"><input type="text" name="Other Ed" size="45"></td>
<td width="100" height="25" align="center" valign="top">Dates Attended:</td>
<td width="34" height="25" align="left" valign="top">From</td>
<td height="25" width="65" align="left" valign="top"><input type="text" name="Other From" size="8"></td>
<td height="25" valign="top" align="left" width="146">Did you graduate:</td>
</tr>
<tr height="35" align="left" valign="middle">
<td height="35" valign="top" align="left" width="214">School Address</td>
<td width="201" height="35" align="left" valign="top"><input type="text" name="Other Ed Address" size="45"></td>
<td width="100" height="35" align="center" valign="top"></td>
<td width="34" height="35" align="left" valign="top">To</td>
<td height="35" align="left" valign="top" width="65"><input type="text" name="Other To" size="8"></td>
<td width="146" height="35" align="left" valign="top"><input type="radio" value="radioValue" name="Other Yes" tabindex="4"><label>Yes</label><input type="radio" value="radioValue" name="Other No" tabindex="4"><label>No</label></td>
</tr>
<tr height="40">
<td height="40" valign="middle" bgcolor="white" colspan="6">
<h3>Previous Employment</h3>
</td>
</tr>
<tr height="25">
<td width="214" height="25" valign="top" bgcolor="white">Company Name</td>
<td height="25" valign="top" width="201" align="left"><font size="2"><input type="text" name="Prev Company Name 1" size="45"></font></td>
<td width="100" height="25" align="center" valign="top">How long were<br>
you with company?</td>
<td width="34" height="25" valign="top">From</td>
<td width="65" height="25" valign="top"><input type="text" name="HS From" size="8"></td>
<td width="146" height="25" valign="middle">Reason for leaving:</td>
</tr>
<tr height="25">
<td width="214" height="25" valign="top" bgcolor="white">Company Address</td>
<td width="201" height="25" valign="top" align="left"><input type="text" name="Prev Company Address 1" size="45"></td>
<td width="100" height="25" align="center" valign="top"></td>
<td width="34" height="25" valign="top">To</td>
<td height="25" width="65" valign="top"><input type="text" name="HS To" size="8"></td>
<td width="146" rowspan="2" valign="top"><textarea name="Reason For Leaving" cols="30" rows="4"></textarea></td>
</tr>
<tr height="45">
<td width="214" height="45" valign="top" bgcolor="white">Name & Title of immediate Supervisor</td>
<td height="45" valign="top" width="201" align="left"><input type="text" name="Prev Company Address 1" size="45"></td>
<td width="100" height="45" align="center" valign="top"></td>
<td width="34" height="45" valign="top">Salary</td>
<td width="65" height="45" valign="top"><input type="text" name="HS To" size="8"></td>
</tr>
<tr height="25">
<td width="214" height="25" valign="top" bgcolor="white" align="left">Company Name</td>
<td height="25" valign="top" width="201"><font size="2"><input type="text" name="Prev Company Name 2" size="45"></font></td>
<td width="100" height="25" align="center">How long were<br>
you with company?</td>
<td width="34" height="25" valign="top">From</td>
<td width="65" height="25" valign="top"><input type="text" name="HS From" size="8"></td>
<td width="146" height="25" valign="middle">Reason for leaving:</td>
</tr>
<tr height="25">
<td width="214" height="25" bgcolor="white" align="left" valign="top">Company Address</td>
<td height="25" valign="top" width="201" align="left"><input type="text" name="Prev Company Name 2" size="45"></td>
<td width="100" height="25"></td>
<td width="34" height="25" valign="top">To</td>
<td width="65" height="25" valign="top"><input type="text" name="HS From" size="8"></td>
<td width="146" rowspan="2"><textarea name="Reason For Leaving" cols="30" rows="4"></textarea></td>
</tr>
<tr height="45">
<td width="214" height="45" bgcolor="white" align="left" valign="top">Name & Title of immediate Supervisor</td>
<td height="45" width="201" align="left" valign="top"><input type="text" name="Prev Company Name 2" size="45"></td>
<td width="100" height="45"></td>
<td width="34" height="45" valign="top">Salary</td>
<td width="65" height="45" valign="top"><input type="text" name="HS From" size="8"></td>
</tr>
<tr height="25">
<td height="25" width="214" align="left" valign="top">Company Name</td>
<td width="201" height="25" align="left" valign="top"><input type="text" name="Prev Company Name 3" size="45"></td>
<td width="100" height="25" align="center" valign="top">How long were<br>
you with company?</td>
<td width="34" height="25" valign="top">From</td>
<td width="65" height="25" valign="top"><input type="text" name="HS From" size="8"></td>
<td width="146" height="25" valign="middle">Reason for leaving:</td>
</tr>
<tr height="25">
<td width="214" height="25" align="left" valign="top">Company Address</td>
<td width="201" height="25" align="left" valign="top"><input type="text" name="Prev Company Name 3" size="45"></td>
<td width="100" height="25"></td>
<td width="34" height="25" valign="top">To</td>
<td width="65" height="25" valign="top"><input type="text" name="HS From" size="8"></td>
<td width="146" rowspan="2"><textarea name="Reason For Leaving" cols="30" rows="4" wrap="physical"></textarea></td>
</tr>
<tr height="45">
<td height="45" width="214" align="left" valign="top">
<div align="left">
Name & Title of immediate Supervior</div>
</td>
<td width="201" height="45" align="left" valign="top"><input type="text" name="Prev Company Name 3" size="45"></td>
<td width="100" height="45"></td>
<td width="34" height="45" valign="top">Salary</td>
<td width="65" height="45" valign="top"><input type="text" name="HS From" size="8"></td>
</tr>
<tr height="50">
<td height="50" colspan="6" align="left" valign="middle" bgcolor="white">Comments or Special Issues</td>
</tr>
<tr height="50">
<td height="50" colspan="6" bgcolor="white"><textarea name="Comments Issues" cols="73" rows="4" wrap="physical"></textarea></td>
</tr>
<tr height="50">
<td width="214" height="50" bgcolor="white"></td>
<td width="201" height="50" align="center" valign="bottom"><input type="submit" value="Send To Biehl & Biehl Collections" name="Submit"></td>
<td width="100" height="50" align="center" valign="bottom" bgcolor="white"></td>
<td width="34" height="50" align="center" valign="bottom" bgcolor="white"></td>
<td width="65" height="50" align="center" bgcolor="white" valign="bottom"><input type="reset" value="Clear Form"></td>
<td height="50" bgcolor="white" align="center" valign="bottom" width="146"></td>
</tr>
<tr height="22">
<td height="22" bgcolor="white" colspan="6">
<center>
<a href="index.html">Home</a> | <a href="contact.html">Contact Us</a> | <a href="overview.html">Corporate Overview</a> | <a href="services.html">Collection Services</a> | <a href="submit_claim.html">Submit a Claim</a> | <a href="employ_opps.html">Employment </a></center>
</td>
</tr>
</table>
</form>
</div>
</td>
</tr>
<tr height="30">
<td height="30" colspan="5" bgcolor="white"></td>
</tr>
</table>
</body>
</html>