<?
   session_start();
   
   include_once $_SERVER['DOCUMENT_ROOT'] . '/securimage/securimage.php';

   $securimage = new Securimage();
   
if ((isset($_POST["MM_insert"])) && ($_POST["MM_insert"] == "form1")) {
   if ($securimage->check($_POST['captcha_code']) == false) {
  // the code was incorrect
  // handle the error accordingly with your other error checking

  // or you can do something really basic like this
  $errormsg[] = "Please enter the correct captcha code.";
}

if (strlen($_POST["firstname"]) < 2)
		$errormsg[] = "Please fill in your first name.";
	if (strlen($_POST["lastname"]) < 2)
		$errormsg[] = "Please fill in your last name.";
	if (strlen($_POST["Email"]) < 8)
		$errormsg[] = "Please fill in your email address.";

//if ((isset($_POST["MM_insert"])) && ($_POST["MM_insert"] == "form1")) {
	
	if (isset($errormsg)){
		$_POST["MM_insert"] = "";
		unset($_POST["MM_insert"]);
	}
}

$editFormAction = $_SERVER['PHP_SELF'];
if (isset($_SERVER['QUERY_STRING'])) {
  $editFormAction .= "?" . htmlentities($_SERVER['QUERY_STRING']);
}

if ((isset($_POST["MM_insert"])) && ($_POST["MM_insert"] == "form1")) {
	$name = "Employment Response";
	$email  = 'darren@buttesand.com';
	$eol = "\r\n";
	$reply = $_POST["Email"];
	$name = $_POST["firstname"] . " " . $_POST["lastname"] . "$eol";

	$message = "Employment Application $eol";
	$message .= "On: " . $_POST["http_date"] . " at " . $_POST["http_time"] . "$eol";
	$message .= "------EMPLOYMENT APPLICATION--------$eol$eol";	
	$message .= "Submitted by: " . $_POST["firstname"] . " " . $_POST["middlename"] . " " . $_POST["lastname"] . "$eol";
	$message .= "Address: " . $_POST["address"] . "$eol";
	$message .= "City, State Zip: " . $_POST["city"] . ", " . $_POST["state"] . " " . $_POST["zip"] . "$eol";
	$message .= "Email: " . $_POST["Email"] . "$eol";
	$message .= "Day Phone: " . $_POST["dayphone"] . "$eol";
	$message .= "Mobile Phone: " . $_POST["mobile"] . "$eol";	
	$message .= "------------------------------------$eol$eol";
	$message .= "Date available to start: " . $_POST["date"] . "$eol";
	$message .= "Salary Requirements: " . $_POST["salary"] . "$eol";
	$message .= "Have Work Permit: " . $_POST["permit"] . "$eol";
	$message .= "If Yes when? " . $_POST["permit-2"] . "$eol";
	$message .= "If No explain: " . $_POST["explain"] . "$eol";
	$message .= "Are you a US citizen: " . $_POST["citizen"] . "$eol";
	$message .= "If not do you have papers: " . $_POST["papers"] . "$eol";
	$message .= "Type of employment: " . $_POST["full-time"] . " - " . $_POST["part-time"] . " - " . $_POST["temporary"] . " - " . $_POST["flex-time"] . "$eol";
	$message .= "Been convicted of a crime: " . $_POST["crime"] . "$eol";
	$message .= "Crime details: " . $_POST["crime-yes"] . "$eol";
	$message .= "Driver's license: " . $_POST["drivers-license"] . "$eol";
	$message .= "-------EDUCATION--------------$eol$eol";
	$message .= "High School: " . $_POST["highschool"] . "$eol";
	$message .= "Address: " . $_POST["hs-address"] . "$eol";
	$message .= "# of years completed: " . $_POST["hs-years"] . "$eol";
	$message .= "Did you graduate: " . $_POST["hs-graduate"] . "$eol";
	$message .= "Degree: " . $_POST["hs-degree"] . "$eol";
	$message .= "GPA: " . $_POST["hs-gpa"] . "$eol";
	$message .= "College/University: " . $_POST["college"] . "$eol";
	$message .= "Address: " . $_POST["co-address"] . "$eol";
	$message .= "# of years completed: " . $_POST["co-years"] . "$eol";
	$message .= "Did you graduate: " . $_POST["co-graduate"] . "$eol";
	$message .= "Degree: " . $_POST["co-degree"] . "$eol";
	$message .= "GPA: " . $_POST["co-gpa"] . "$eol";
	$message .= "Additional Education: " . $_POST["hs-add"] . "$eol";
	$message .= "-------REFERENCES--------------$eol$eol";
	$message .= "Name: " . $_POST["ref-name"] . "$eol";
	$message .= "Phone: " . $_POST["ref-phone"] . "$eol";
	$message .= "Address: " . $_POST["ref-address"] . " " . $_POST["ref-city"] . ", " . $_POST["ref-state"] . " " . $_POST["ref-zip"] . "$eol";
	$message .= "------------------------------------$eol$eol";
	$message .= "Name: " . $_POST["ref-name2"] . "$eol";
	$message .= "Phone: " . $_POST["ref-phone2"] . "$eol";
	$message .= "Address: " . $_POST["ref-address2"] . " " . $_POST["ref-city2"] . ", " . $_POST["ref-state2"] . " " . $_POST["ref-zip2"] . "$eol";
	$message .= "------------------------------------$eol$eol";
	$message .= "---SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS---$eol";
	$message .= "Skills: " . $_POST["skills"] . "$eol";
	$message .= "-------PREVIOUS EMPLOYMENT------$eol$eol";
	$message .= "Dates of Employment: " . $_POST["from-01"] . " to " . $_POST["to-01"] . "$eol";
	$message .= "Position held: " . $_POST["position-01"] . "$eol";
	$message .= "Firm: " . $_POST["firm-01"] . "$eol";
	$message .= "Firm Address: " . $_POST["firm-address-01"] . "$eol";
	$message .= "Firm Phone: " . $_POST["firm-phone-01"] . "$eol";
	$message .= "Supervisor: " . $_POST["supervisior-01"] . "$eol";
	$message .= "Title: " . $_POST["supervisior-title-01"] . "$eol";
	$message .= "Responsibilities: " . $_POST["responsibilities-01"] . "$eol";
	$message .= "Starting Salary and Title: " . $_POST["salary-history-01"] . "$eol";
	$message .= "Reason for Leaving: " . $_POST["reason-01"] . "$eol";
	$message .= "May we contact this employer: " . $_POST["reference-01"] . "$eol";	
	$message .= "------------------------------------$eol$eol";	
	$message .= "Dates of Employment: " . $_POST["from-2"] . " to " . $_POST["to-01"] . "$eol";
	$message .= "Position held: " . $_POST["position-2"] . "$eol";
	$message .= "Firm: " . $_POST["firm-2"] . "$eol";
	$message .= "Firm Address: " . $_POST["firm-address-2"] . "$eol";
	$message .= "Firm Phone: " . $_POST["firm-phone-2"] . "$eol";
	$message .= "Supervisor: " . $_POST["supervisior-2"] . "$eol";
	$message .= "Title: " . $_POST["supervisior-title-2"] . "$eol";
	$message .= "Responsibilities: " . $_POST["responsibilities-2"] . "$eol";
	$message .= "Starting Salary and Title: " . $_POST["salary-history-2"] . "$eol";
	$message .= "Reason for Leaving: " . $_POST["reason-2"] . "$eol";
	$message .= "May we contact this employer: " . $_POST["reference-2"] . "$eol";
	$message .= "------------------------------------$eol$eol";			
	$message .= "Dates of Employment: " . $_POST["from-3"] . " to " . $_POST["to-01"] . "$eol";
	$message .= "Position held: " . $_POST["position-3"] . "$eol";
	$message .= "Firm: " . $_POST["firm-3"] . "$eol";
	$message .= "Firm Address: " . $_POST["firm-address-3"] . "$eol";
	$message .= "Firm Phone: " . $_POST["firm-phone-3"] . "$eol";
	$message .= "Supervisor: " . $_POST["supervisior-3"] . "$eol";
	$message .= "Title: " . $_POST["supervisior-title-3"] . "$eol";
	$message .= "Responsibilities: " . $_POST["responsibilities-3"] . "$eol";
	$message .= "Starting Salary and Title: " . $_POST["salary-history-3"] . "$eol";
	$message .= "Reason for Leaving: " . $_POST["reason-3"] . "$eol";
	$message .= "May we contact this employer: " . $_POST["reference-3"] . "$eol";
	$message .= "------------------------------------$eol$eol";			
	$message .= "Dates of Employment: " . $_POST["from-4"] . " to " . $_POST["to-01"] . "$eol";
	$message .= "Position held: " . $_POST["position-4"] . "$eol";
	$message .= "Firm: " . $_POST["firm-4"] . "$eol";
	$message .= "Firm Address: " . $_POST["firm-address-4"] . "$eol";
	$message .= "Firm Phone: " . $_POST["firm-phone-4"] . "$eol";
	$message .= "Supervisor: " . $_POST["supervisior-4"] . "$eol";
	$message .= "Title: " . $_POST["supervisior-title-4"] . "$eol";
	$message .= "Responsibilities: " . $_POST["responsibilities-4"] . "$eol";
	$message .= "Starting Salary and Title: " . $_POST["salary-history-4"] . "$eol";
	$message .= "Reason for Leaving: " . $_POST["reason-4"] . "$eol";
	$message .= "May we contact this employer: " . $_POST["reference-4"] . "$eol";
	$message .= "------------------------------------$eol$eol";	
	$message .= "I certify my answers: " . $_POST["security"] . "$eol";
	
	$subject = 'Employment Response';
	//$headers  = "MIME-Version: 1.0$eol";
//	$headers .= "Content-type: text/html; charset=iso-8859-1$eol";
	//$headers .= "AmericanWhiteWater.com Reservation Request From: " . $_POST["real"] . ">$eol";

	//mail($email, "AmericanWhiteWater.com Reservation Request", $message, $headers);
	
	//$headers = 'From: info@americanwhitewater.com' . "\r\n" .
    //'Reply-To: $reply' . "\r\n" .
    //'MIME-Version: 1.0';
	
	$headers = "From: $name <$reply>\n\n";
	$headers .= "Reply-To: $name <$reply>\n";
	$headers .= "MIME-Version: 1.0";
	
	mail($email, $subject, $message, $headers);
	//mail($email,
		//'AmericanWhiteWater.com Reservation Request', $message,
		//"To: AmericanWhiteWater.com <info@americanwhitewater.com>\n" .
		//"From: AmericanWhiteWater.com <info@americanwhitewater.com>\n" .
		//$headers);

	$GLOBALS['ThankyouMsg'] = "Thank you for visiting our Web Site.<BR><BR>";
	$GLOBALS['ThankyouMsg'] .= "We appreciate this opportunity to be of service, as well as your feedback <BR><BR>";
  	$GLOBALS['ThankyouMsg'] .= "Thanks again!";
	session_register('ThankyouMsg');

  $insertGoTo = "thank-you-contact.php";
  if (isset($_SERVER['QUERY_STRING'])) {
    $insertGoTo .= (strpos($insertGoTo, '?')) ? "&" : "?";
    $insertGoTo .= $_SERVER['QUERY_STRING'];
  }
  header(sprintf("Location: %s", $insertGoTo));
}

?>
<!DOCTYPE HTML PUBLIC "-//SoftQuad Software//DTD HoTMetaL PRO 6.0::19990601::extensions to HTML 4.0//EN" "hmpro6.dtd">
<HTML> 
  <HEAD> 
	 <TITLE>Butte Sand and Gravel Pit Sutter County Yuba City Marysville
		Colusa</TITLE> <LINK REL="STYLESHEET" HREF="style.css"><LINK REL="STYLESHEET"
	 HREF="style.css"> 
  </HEAD> 
  <BODY TOPMARGIN="0" MARGINHEIGHT="0"> 
	 <TABLE WIDTH="750" BGCOLOR="#FFFFFF" CELLPADDING="0"
	  CELLSPACING="0" BORDER="0" ALIGN="CENTER"> 
		<TR> 
		  <TD> 
			 <MAP NAME="map1">
				<AREA SHAPE="RECT" COORDS="245,108,313,177" HREF="sand-gravel-contact-us.htm"
				 ALT="Email us">
				<AREA SHAPE="RECT" COORDS="172,109,239,176" HREF="our-location.htm"
				 ALT="Map to our location">
				<AREA SHAPE="RECT" COORDS="99,108,166,177" HREF="sand-gravel-products.htm"
				 ALT="Our Sand and Gravel Products">
				<AREA SHAPE="RECT" COORDS="22,108,93,177" HREF="sand-gravel-services.htm"
				 ALT="Our Services"> 
			 </MAP><IMG SRC="images/header.jpg" WIDTH="750" HEIGHT="210"
			 BORDER="0" USEMAP="#map1"></TD> 
		</TR> 
	 </TABLE> 
	 <TABLE WIDTH="750" BGCOLOR="#A7BA8C" CELLPADDING="0" CELLSPACING="5"
	  ALIGN="CENTER"> 
		<TR> 
		  <TD> 
			 <TABLE WIDTH="100%" BGCOLOR="#FFFFFF" CELLPADDING="0" CELLSPACING="0"
			  ALIGN="CENTER"> 
				<TR> 
				  <TD VALIGN="BOTTOM"> 
					 <H1 ALIGN="CENTER"><IMG SRC="images/logo.gif" WIDTH="145"
						HEIGHT="54" BORDER="0"><BR>Online Employment Application</H1></TD> 
				</TR> 
				<TR> 
				  <TD VALIGN="TOP" BGCOLOR="#FCE7BC"> 
					 <TABLE WIDTH="100%" BGCOLOR="#FFFFFF" CELLPADDING="10"
					  CELLSPACING="0" BORDER="1" ALIGN="CENTER" BORDERCOLOR="#D8CBBC"> 
						<TR> 
						  <TD BGCOLOR="#FCE7BC"> 
							 <H2 ALIGN="CENTER">Serving Sutter, Yuba, Butte and Colusa
								Counties</H2> 
							 <P>We are always looking for great employees. In
								addition, we are looking for just the right person who would be able to answer
								the telephone, be articulate in explaining our products and services to those
								that inquire.</P> 
							 <P>All of our employees must have a vision for our
								business, be honest and articulate, caring and tactful.</P> 
							 <!--<P><FONT COLOR="#FF0000" SIZE="1">* Indicates required
								fields</FONT></P> 
								<P><? if (isset($errormsg)){
								echo "<p><font color='red'>";
								foreach($errormsg as $msg){
									echo "$msg<br>";
								}
								echo "</font></p>";
							 }
							 ?></p>
							 <FORM METHOD="post" ACTION="<? echo $editFormAction; ?>" enctype="multipart/form-data"> 
								<TABLE WIDTH="100%" CELLPADDING="0" CELLSPACING="1"
								 BORDER="0" ALIGN="CENTER"> 
								  <TR> 
									 <TD COLSPAN="3"
									  BGCOLOR="#A7BA8C">&nbsp;&nbsp;&nbsp;<B><FONT COLOR="#FFFFFF">Employment
										Application:</FONT></B> </TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="2">&nbsp;<I>Full Name:</I></TD> 
									 <TD>&nbsp;</TD> 
								  </TR> 
								  <TR> 
									 <TD><NOBR><FONT COLOR="#FF0000">*</FONT>Last:
										<INPUT TYPE="TEXT" NAME="lastname"></NOBR></TD> 
									 <TD><NOBR><FONT COLOR="#FF0000">*</FONT>First:
										<INPUT TYPE="TEXT" NAME="firstname"></NOBR></TD> 
									 <TD><NOBR>Middle:
										<INPUT TYPE="TEXT" NAME="middlename"></NOBR></TD> 
								  </TR> 
								  <TR> 
									 <TD><NOBR>Address:
										<INPUT TYPE="TEXT" NAME="address"></NOBR></TD> 
									 <TD>City: <INPUT TYPE="TEXT" NAME="city"></TD> 
									 <TD>State: <INPUT TYPE="TEXT" NAME="state"
										SIZE="3"> Zip: <INPUT TYPE="TEXT" NAME="zip" SIZE="5" MAXLENGTH="10"></TD> 
								  </TR> 
								  <TR> 
									 <TD>Phone:
										<INPUT TYPE="TEXT" NAME="dayphone" SIZE="12"></TD> 
									 <TD>Mobile Phone:
										<INPUT TYPE="TEXT" NAME="mobile" SIZE="12"></TD> 
									 <TD><FONT COLOR="#FF0000">*</FONT>Email:
										<INPUT TYPE="TEXT" NAME="Email"></TD> 
								  </TR> 
								  <TR> 
									 <TD>Date available to start:
										<INPUT TYPE="TEXT" NAME="date" SIZE="5"></TD> 
									 <TD>Salary Requirements:
										<INPUT TYPE="TEXT" NAME="salary" VALUE="$" SIZE="6"></TD> 
									 <TD></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">If you are under 18 and we require
										a work permit, can you furnish one? &nbsp;<INPUT TYPE="RADIO" NAME="permit"
										VALUE="Yes"> Yes <INPUT TYPE="RADIO" NAME="permit" VALUE="No"> No</TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">If Yes, when?
										<INPUT TYPE="TEXT" NAME="permit-2" SIZE="6"> &nbsp; If No explain:
										<INPUT TYPE="TEXT" NAME="explain" SIZE="45"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">Are you a citizen of the US?
										<INPUT TYPE="RADIO" NAME="citizen" VALUE="Yes"> Yes
										<INPUT TYPE="RADIO" NAME="citizen" VALUE="No"> No &nbsp; If not do you have
										work papers? <INPUT TYPE="RADIO" NAME="papers" VALUE="Yes"> Yes
										<INPUT TYPE="RADIO" NAME="papers" VALUE="No"> No</TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">Type of employment desired:
										<INPUT TYPE="CHECKBOX" NAME="full-time" VALUE="Full-time"> Full-time&nbsp;
										<INPUT TYPE="CHECKBOX" NAME="part-time" VALUE="Part time"> Part time&nbsp;
										<INPUT TYPE="CHECKBOX" NAME="temporary" VALUE="Temporary"> Temporary
										&nbsp;<INPUT TYPE="CHECKBOX" NAME="flex-time" VALUE="Flex time"> Flex time</TD>
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">Have you ever pled "guilty" or "no
										contest" to or been convicted of a crime? &nbsp;
										<INPUT TYPE="RADIO" NAME="crime" VALUE="Yes"> Yes
										<INPUT TYPE="RADIO" NAME="crime" VALUE="No"> No</TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">If "Yes" give dates and details:
										<INPUT TYPE="TEXT" NAME="crime-yes" SIZE="55"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"><FONT SIZE="1">Answering Yes to
										these questions does not constitute an automatic rejection to employment. Date
										of the offense, seriousness and nature of the violation, rehabilitation and
										position applied for will be considered.</FONT></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">Driver's license number if
										applicable to the position: &nbsp; <INPUT TYPE="TEXT"
										NAME="drivers-license"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3" BGCOLOR="#A7BA8C">&nbsp; &nbsp;
										&nbsp;<B><FONT COLOR="#FFFFFF">Education:</FONT></B></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">High School:
										<INPUT TYPE="TEXT" NAME="highschool"> Address:
										<INPUT TYPE="TEXT" NAME="hs-address"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"># of years completed:
										<INPUT TYPE="TEXT" NAME="hs-years" SIZE="2"> &nbsp;Did you graduate?
										<INPUT TYPE="RADIO" NAME="hs-graduate" VALUE="Yes"> Yes
										<INPUT TYPE="RADIO" NAME="hs-graduate" VALUE="No"> No &nbsp;&nbsp;Degree:<INPUT
										TYPE="TEXT" NAME="hs-degree" SIZE="6"> &nbsp;GPA:
										<INPUT TYPE="TEXT" NAME="hs-gpa" SIZE="2"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">College/University:
										<INPUT TYPE="TEXT" NAME="college" SIZE="25">&nbsp;&nbsp; Address:
										<INPUT TYPE="TEXT" NAME="co-address" SIZE="25"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"># of years completed:
										<INPUT TYPE="TEXT" NAME="co-years" SIZE="2"> &nbsp;Did you graduate?
										<INPUT TYPE="RADIO" NAME="co-graduate" VALUE="Yes"> Yes
										<INPUT TYPE="RADIO" NAME="co-graduate" VALUE="No"> No &nbsp;&nbsp;Degree:<INPUT
										TYPE="TEXT" NAME="co-degree" SIZE="6"> &nbsp;GPA:
										<INPUT TYPE="TEXT" NAME="co-gpa" SIZE="2"></TD> 
								  </TR> 
								  <TR> 
								    <TD COLSPAN="3">Additional Education: 
							        <textarea name="hs-add" rows="2" cols="45"
										wrap="Physical"></textarea></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3" BGCOLOR="#A7BA8C">&nbsp; &nbsp;
										&nbsp;<B><FONT COLOR="#FFFFFF">References:</FONT></B></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"><FONT SIZE="1">Please furnish the
										names, address and phone numbers of two people to whom you are not related and
										by whom you have not been employed :</FONT></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">Name:
										<INPUT TYPE="TEXT" NAME="ref-name"> &nbsp;&nbsp;Phone:
										<INPUT TYPE="TEXT" NAME="ref-phone"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">Address:
										<INPUT TYPE="TEXT" NAME="ref-address"> &nbsp;&nbsp;City:
										<INPUT TYPE="TEXT" NAME="ref-city">&nbsp;&nbsp; State:
										<INPUT TYPE="TEXT" NAME="ref-state" SIZE="3"> Zip:
										<INPUT TYPE="TEXT" NAME="ref-zip" SIZE="5" MAXLENGTH="10"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">&nbsp;</TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">Name:
										<INPUT TYPE="TEXT" NAME="ref-name2"> &nbsp;&nbsp;Phone:
										<INPUT TYPE="TEXT" NAME="ref-phone2"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3">Address:
										<INPUT TYPE="TEXT" NAME="ref-address2"> &nbsp;&nbsp;City:
										<INPUT TYPE="TEXT" NAME="ref-city2">&nbsp;&nbsp; State:
										<INPUT TYPE="TEXT" NAME="ref-state2" SIZE="3"> Zip:
										<INPUT TYPE="TEXT" NAME="ref-zip2" SIZE="5" MAXLENGTH="10"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3" BGCOLOR="#A7BA8C">&nbsp; &nbsp;
										&nbsp;<B><FONT COLOR="#FFFFFF">Summarize your special skills or
										qualifications:</FONT></B></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"><TEXTAREA NAME="skills" ROWS="4" COLS="65" WRAP="Physical"></TEXTAREA></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3" BGCOLOR="#A7BA8C">&nbsp; &nbsp;
										&nbsp;<B><FONT COLOR="#FFFFFF">Previous Employment: &nbsp;&nbsp;(begin with
										most recent positions)</FONT></B></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"> 
										<TABLE WIDTH="100%" CELLPADDING="0"
										CELLSPACING="0"> 
										  <TR> 
											 <TD COLSPAN="3">Dates of Employment:
												&nbsp;&nbsp;From: <INPUT TYPE="TEXT" NAME="from-01" SIZE="8"> &nbsp;&nbsp;To
												<INPUT TYPE="TEXT" NAME="to-01" SIZE="8">&nbsp; Position held:
												<INPUT TYPE="TEXT" NAME="position-01" SIZE="16"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3"> Firm:
												<INPUT TYPE="TEXT" NAME="firm-01">&nbsp;&nbsp; Address:
												<INPUT TYPE="TEXT" NAME="firm-address-01" SIZE="40"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Phone:
												<INPUT TYPE="TEXT" NAME="firm-phone-01">&nbsp; &nbsp;Supervisor:
												<INPUT TYPE="TEXT" NAME="supervisior-01">&nbsp; &nbsp;Title:
												<INPUT TYPE="TEXT" NAME="supervisior-title-01" SIZE="15"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3"> Responsibilities:
												<INPUT TYPE="TEXT" NAME="responsibilities-01" SIZE="74"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Starting Salary and Title:
												<INPUT TYPE="TEXT" NAME="salary-history-01">&nbsp;&nbsp; Ending Salary and
												Title: <INPUT TYPE="TEXT" NAME="ending-salary-01"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Reason for Leaving:
												<INPUT TYPE="TEXT" NAME="reason-01" SIZE="65"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">May we contact this employer
												for references?
												<INPUT TYPE="RADIO" NAME="reference-01" VALUE="Yes" CHECKED="CHECKED"> Yes
												<INPUT TYPE="RADIO" NAME="reference-01" VALUE="No"> No</TD> 
										  </TR> 
										</TABLE></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"><HR SIZE="3" COLOR="#CCCCCC"
										ALIGN="CENTER" WIDTH="100%"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"> 
										<TABLE WIDTH="100%" CELLPADDING="0"
										CELLSPACING="0"> 
										  <TR> 
											 <TD COLSPAN="3">Dates of Employment:
												&nbsp;&nbsp;From: <INPUT TYPE="TEXT" NAME="from-2" SIZE="8"> &nbsp;&nbsp;To
												<INPUT TYPE="TEXT" NAME="to-2" SIZE="8">&nbsp; Position held:
												<INPUT TYPE="TEXT" NAME="position-2" SIZE="16"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3"> Firm:
												<INPUT TYPE="TEXT" NAME="firm-2">&nbsp;&nbsp; Address:
												<INPUT TYPE="TEXT" NAME="firm-address-2" SIZE="40"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Phone:
												<INPUT TYPE="TEXT" NAME="firm-phone-2">&nbsp; &nbsp;Supervisor:
												<INPUT TYPE="TEXT" NAME="supervisior-2">&nbsp; &nbsp;Title:
												<INPUT TYPE="TEXT" NAME="supervisior-title-2" SIZE="15"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3"> Responsibilities:
												<INPUT TYPE="TEXT" NAME="responsibilities-2" SIZE="74"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Starting Salary and Title:
												<INPUT TYPE="TEXT" NAME="salary-history-2">&nbsp;&nbsp; Ending Salary and
												Title: <INPUT TYPE="TEXT" NAME="ending-salary-2"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Reason for Leaving:
												<INPUT TYPE="TEXT" NAME="reason-2" SIZE="65"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">May we contact this employer
												for references?
												<INPUT TYPE="RADIO" NAME="reference-2" VALUE="Yes" CHECKED="CHECKED"> Yes
												<INPUT TYPE="RADIO" NAME="reference-2" VALUE="No"> No</TD> 
										  </TR> 
										</TABLE></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"><HR SIZE="3" COLOR="#CCCCCC"
										ALIGN="CENTER" WIDTH="100%"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"> 
										<TABLE WIDTH="100%" CELLPADDING="0"
										CELLSPACING="0"> 
										  <TR> 
											 <TD COLSPAN="3">Dates of Employment:
												&nbsp;&nbsp;From: <INPUT TYPE="TEXT" NAME="from-3" SIZE="8"> &nbsp;&nbsp;To
												<INPUT TYPE="TEXT" NAME="to-3" SIZE="8">&nbsp; Position held:
												<INPUT TYPE="TEXT" NAME="position-3" SIZE="16"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3"> Firm:
												<INPUT TYPE="TEXT" NAME="firm-3">&nbsp;&nbsp; Address:
												<INPUT TYPE="TEXT" NAME="firm-address-3" SIZE="40"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Phone:
												<INPUT TYPE="TEXT" NAME="firm-phone-3">&nbsp; &nbsp;Supervisor:
												<INPUT TYPE="TEXT" NAME="supervisior-3">&nbsp; &nbsp;Title:
												<INPUT TYPE="TEXT" NAME="supervisior-title-3" SIZE="15"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3"> Responsibilities:
												<INPUT TYPE="TEXT" NAME="responsibilities-3" SIZE="74"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Starting Salary and Title:
												<INPUT TYPE="TEXT" NAME="salary-history-3">&nbsp;&nbsp; Ending Salary and
												Title: <INPUT TYPE="TEXT" NAME="ending-salary-3"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Reason for Leaving:
												<INPUT TYPE="TEXT" NAME="reason-3" SIZE="65"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">May we contact this employer
												for references?
												<INPUT TYPE="RADIO" NAME="reference-3" VALUE="Yes" CHECKED="CHECKED"> Yes
												<INPUT TYPE="RADIO" NAME="reference-3" VALUE="No"> No</TD> 
										  </TR> 
										</TABLE></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"><HR SIZE="3" COLOR="#CCCCCC"
										ALIGN="CENTER" WIDTH="100%"></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"> 
										<TABLE WIDTH="100%" CELLPADDING="0"
										CELLSPACING="0"> 
										  <TR> 
											 <TD COLSPAN="3">Dates of Employment:
												&nbsp;&nbsp;From: <INPUT TYPE="TEXT" NAME="from-4" SIZE="8"> &nbsp;&nbsp;To
												<INPUT TYPE="TEXT" NAME="to-4" SIZE="8">&nbsp; Position held:
												<INPUT TYPE="TEXT" NAME="position-4" SIZE="16"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3"> Firm:
												<INPUT TYPE="TEXT" NAME="firm-4">&nbsp;&nbsp; Address:
												<INPUT TYPE="TEXT" NAME="firm-address-4" SIZE="40"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Phone:
												<INPUT TYPE="TEXT" NAME="firm-phone-4">&nbsp; &nbsp;Supervisor:
												<INPUT TYPE="TEXT" NAME="supervisior-4">&nbsp; &nbsp;Title:
												<INPUT TYPE="TEXT" NAME="supervisior-title-4" SIZE="15"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3"> Responsibilities:
												<INPUT TYPE="TEXT" NAME="responsibilities-4" SIZE="74"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Starting Salary and Title:
												<INPUT TYPE="TEXT" NAME="salary-history-4">&nbsp;&nbsp; Ending Salary and
												Title: <INPUT TYPE="TEXT" NAME="ending-salary-4"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">Reason for Leaving:
												<INPUT TYPE="TEXT" NAME="reason-4" SIZE="65"></TD> 
										  </TR> 
										  <TR> 
											 <TD COLSPAN="3">May we contact this employer
												for references?
												<INPUT TYPE="RADIO" NAME="reference-4" VALUE="Yes" CHECKED="CHECKED"> Yes
												<INPUT TYPE="RADIO" NAME="reference-4" VALUE="No"> No</TD> 
										  </TR> 
										</TABLE></TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3" BGCOLOR="#A7BA8C">&nbsp;</TD> 
								  </TR> 
								  <TR> 
									 <TD COLSPAN="3"><FONT SIZE="1">I certify that my
										answers are true and complete to the best of my knowledge. I authorize Bartelt
										Education Center to make such investigations and inquiries of my personal,
										employment, educational, Financial, or medical history and other related
										matters as may be necessary for an employment decision. I hereby release
										employers, schools or persons from all liability in the event I am employed, I
										understand that false or misleading information given in my application or
										interview(s) may result in my discharge. <BR><FONT COLOR="#FF0000"
										SIZE="2">*Check this box to indicate you certify your answers:</FONT>
										<INPUT TYPE="CHECKBOX" NAME="security"
										VALUE="YES - I certify my answers"></FONT></TD> 
								  </TR>
								  <TR>
									 <TD COLSPAN="3">&nbsp;</TD>
								  </TR>
								  <TR>
									 <TD COLSPAN="3" ALIGN="CENTER">
										<TABLE WIDTH="75%" CELLPADDING="2" CELLSPACING="0"
				 BORDER="0" ALIGN="CENTER"> 
				  <TR> 
					 								  <td ALIGN="CENTER"><B>Please enter the captcha image as shown.</B></td>
										<td ALIGN="CENTER"><img id="captcha" src="/securimage/securimage_show.php" alt="CAPTCHA Image" />
										<input type="text" name="captcha_code" size="10" maxlength="6" /></td>
										<td><a href="#" onClick="document.getElementById('captcha').src = '/securimage/securimage_show.php?' + Math.random(); return false">Reload Image</a></td>
								</tr>
<tr><td><p><BR><BR><BR><BR></p></td>
									 <TD COLSPAN="2" ALIGN="CENTER"><INPUT TYPE="SUBMIT"
										VALUE="Submit to Butte Sand & Gravel"><input type="hidden" name="MM_insert" value="form1"></TD> 
								  </TR> 
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								  </TR> 
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							 <H1 ALIGN="CENTER"><FONT
								COLOR="#A82E16">CALL 530-696-2486</FONT></H1> 
							 <FORM> 
								<P ALIGN="CENTER"><INPUT TYPE="BUTTON"
								  VALUE=" Return to Previous Page " ONCLICK="history.go(-1)"></P></FORM> 
							 <P>&nbsp;</P></TD> 
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				  <TD VALIGN="TOP" BGCOLOR="#D8CBBC"> 
					 <P ALIGN="CENTER"><FONT SIZE="1">Copyright &copy; 2005 All
						Rights Reserved by Butte Sand and Gravel Inc. - <A HREF="privacy.htm"><FONT
						SIZE="1">privacy policy</FONT></A></FONT></P></TD> 
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