FARLAND PERSONNEL MANAGEMENT CORP<form method="post" action="http://www.emailmeform.com/fid.php?formid=38402" enctype="multipart/form-data" accept-charset="UTF-8">
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<font face="Verdana" size="2" color="#000000">ONLINE REGISTRATION</font>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Job Title:</font></td>
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<input type="text" name="FieldData0" value="" maxlength="100" size="25"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Last, First Middle Name:</font></td>
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<input type="text" name="FieldData1" value="" maxlength="100" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Address:</font></td>
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<input type="text" name="FieldData2" value="" maxlength="100" size="60"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Tel. No. / Cell Phone No.:</font></td>
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<input type="text" name="FieldData3" value="" maxlength="100" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Birth date:</font></td>
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<input type="text" name="FieldData4" value="" maxlength="100" size="8"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Place of Birth:</font></td>
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<input type="text" name="FieldData5" value="" maxlength="100" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Status:</font></td>
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<select name="FieldData6"><option value="Single">Single</option><option value="Married">Married</option><option value="Seperated">Seperated</option><option value="Widowed
">Widowed
</option></select> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Height:</font></td>
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<input type="text" name="FieldData7" value="" maxlength="100" size="10"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Weight:</font></td>
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<input type="text" name="FieldData8" value="" maxlength="100" size="10"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Email Address:</font></td>
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<input type="text" name="FieldData9" value="" maxlength="100" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Passport No.:</font></td>
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<input type="text" name="FieldData10" value="" maxlength="100" size="25"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Expiry Date:</font></td>
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<input type="text" name="FieldData11" value="" maxlength="100" size="8"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Highest Educational Level</font></td>
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<select name="FieldData12"><option value="Elementary">Elementary</option><option value="High School">High School</option><option value="Vocational">Vocational</option><option value="College">College</option><option value="Post Graduate
">Post Graduate
</option></select> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Educational Status</font></td>
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<select name="FieldData13"><option value="Under Graduate">Under Graduate</option><option value="Graduate">Graduate</option></select> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Course:</font></td>
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<input type="text" name="FieldData14" value="" maxlength="100" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">School:</font></td>
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<input type="text" name="FieldData15" value="" maxlength="100" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">School Address:</font></td>
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<textarea name="FieldData16" cols="60" rows="1"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Working Experience 1</font></td>
 <td>
<textarea name="FieldData17" cols="30" rows="10"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Working Experience 2</font></td>
 <td>
<textarea name="FieldData18" cols="30" rows="5"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Why do you like this Job?</font></td>
 <td>
<textarea name="FieldData19" cols="30" rows="5"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Your most difficult decision in your lif</font></td>
 <td>
<textarea name="FieldData20" cols="30" rows="5"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Why are you leaving your current job?</font></td>
 <td>
<textarea name="FieldData21" cols="30" rows="5"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">What are your plans for the future?</font></td>
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<textarea name="FieldData22" cols="30" rows="5"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">What are your weak points?</font></td>
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<textarea name="FieldData23" cols="30" rows="5"></textarea><br> </td>
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<td colspan="2"><font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font></td>
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<td style="padding: 2px;" width="10"><img src="http://www.emailmeform.com/turing.php" id="captcha"></td>
<td valign="top"><font color="#000000">Please enter the text from the image</font> &nbsp; <br><input type="text" name="Turing" value="" maxlength="100" size="10">
 [ <a href="#" onclick=" document.getElementById('captcha').src = document.getElementById('captcha').src + '?' + (new Date()).getMilliseconds()">Refresh Image</a> ] [ <a href="http://www.emailmeform.com/?v=turing&pt=popup" onClick="window.open('http://www.emailmeform.com/?v=turing&pt=popup','_blank','width=400, height=300, left=' + (screen.width-450) + ', top=100');return false;">What's This?</a> ]
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 <td>&nbsp;</td>
 <td align="right">
<input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
<input type="submit" class="btn" value="Send email" name="Submit">&nbsp; &nbsp; <input type="reset" class="btn" value="  Clear  " name="Clear"></td>
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