Note : - Please enter name exactly as displayed on your federal or state ID. Please be sure to include middle or initial if applicable.
fname)) { echo $nurse->fname; } ?>' required data-error="Please enter a valid first name.">
mid_name)) { echo $nurse->mid_name; } ?>' data-error="Please enter a valid middle name." mid_name)) { echo $nurse->mid_name; } else { echo "required"; } if ($nurse->mid_name =="") { echo "disabled"; } ?>>
lname)) { echo $nurse->lname; } ?>' required data-error="Please enter a valid last name.">
phone)) { echo $nurse->phone; } ?>' placeholder="" required data-error="Please enter a valid mobile number.">
dob)) { echo $nurse->dob; } ?>' placeholder="" data-error="Please enter a valid date." required>
maiden_name)) { echo $nurse->maiden_name; } ?>' placeholder="" data-error="Please enter a valid email.">
soc_sec!=""){ $actual_ssn=$nurse->soc_sec; $ssn_arr=explode("-", $actual_ssn); $view_ssn="XXX-XX-".$ssn_arr[2]; } ?>
address1)) { echo $nurse->address1; } ?>' placeholder="" required data-error="Please enter your permanent address.">
apartment1)) { echo $nurse->apartment1; } ?>' placeholder="" data-error="Please enter your permanent address.">
zipcode1)) { echo $nurse->zipcode1; } ?>' placeholder="" data-error="Please enter your zip code." required>
address2)) { echo $nurse->address2; } ?>' placeholder="">
apartment2)) { echo $nurse->apartment2; } ?>' placeholder="">
zipcode2)) { echo $nurse->zipcode2; } ?>' placeholder="">
citizen); ?>
citizen) && $citizen->citizen==1) { echo "checked"; } ?>>
citizen) && $citizen->citizen==0) { echo "checked"; } ?>>
citizen)){ echo ''; }else if($citizen->citizen==0){ echo ''; }else{ echo 'style="display: none;"'; } ?>>
remain_permanently) && $citizen->remain_permanently==1) { echo "checked"; } ?>>
remain_permanently) && $citizen->remain_permanently==0) { echo "checked"; } ?>>
remain_permanently)){ echo ''; }else if($citizen->remain_permanently==0){ echo ''; }else{echo 'style="display: none;"'; } ?>
remain_permanently)||($citizen->remain_permanently==1)){echo 'style="display: none;"'; } ?>>
authorization_to_work) && $citizen->authorization_to_work==1) { echo "checked"; } ?>>
authorization_to_work) && $citizen->authorization_to_work==0) { echo "checked"; } ?>>
involved_as_defendant) && $citizen->involved_as_defendant==1) { echo "checked"; } ?> required>
involved_as_defendant) && $citizen->involved_as_defendant==0) { echo "checked"; } ?> required>
involved_as_defendant)) || ($citizen->involved_as_defendant==0)){ echo 'style="display:none;"'; } ?>>
convicted) && $citizen->convicted==1) { echo "checked"; } ?> required>
convicted) && $citizen->convicted==0) { echo "checked"; } ?> required>
convicted)) || ($citizen->convicted==0)){ echo 'style="display:none;"'; } ?>>
convicted_for_negligence) && $citizen->convicted_for_negligence==1) { echo "checked"; } ?> required>
convicted_for_negligence) && $citizen->convicted_for_negligence==0) { echo "checked"; } ?> required>
convicted_for_negligence)) || ($citizen->convicted_for_negligence==0)){ echo 'style="display:none;"'; } ?>>
criminal_convictions) && $citizen->criminal_convictions==1) { echo "checked"; } ?> required>
criminal_convictions) && $citizen->criminal_convictions==0) { echo "checked"; } ?> required>
criminal_convictions ==0 ) {?> style="display:none" >
documents_no)) { echo $nurse->documents_no; } ?>' required data-error="Please enter a valid uscis.">
documents_type=="Birth Certificate"){ $exp_display='style="display: none;"'; $exp_required=""; }else{ $exp_display=""; $exp_required="required"; } ?>
> documents_expire_date)) { $date=date_create("$nurse->documents_expire_date"); echo date_format($date,"Y-m-d"); } ?>' >
*/ ?>
availability_borough); ?>
pref_type == 'shift' && $datas->day == '1') { echo "checked"; break; } }?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '1') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '1') { $htime = explode(',', $datas->time); $fromTime = $htime[0]; $toTime = $htime[1]; } } ?>
pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '1') { echo "block"; break; } } ?>;"> -To-
pref_type == 'shift' && $datas->day == '3') { echo "checked"; break; } } ?> attr_type="shift" attr_day="3"> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '3') { echo "checked"; break; } } ?> attr_type="hourly" attr_day="3"> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '3') { $htime = explode(',', $datas->time); $fromTime = $htime[0]; $toTime = $htime[1]; } } ?>
pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '3') { echo "block"; break; } } ?>;"> -To-
pref_type == 'shift' && $datas->day == '4') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '4') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '4') { $htime = explode(',', $datas->time); $fromTime = $htime[0]; $toTime = $htime[1]; } } ?>
pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '4') { echo "block"; break; } } ?>;"> -To-
pref_type == 'shift' && $datas->day == '5') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '5') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '5') { $htime = explode(',', $datas->time); $fromTime = $htime[0]; $toTime = $htime[1]; } } ?>
pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '5') { echo "block"; break; } } ?>;"> -To-
pref_type == 'shift' && $datas->day == '6') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '6') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '6') { $htime = explode(',', $datas->time); $fromTime = $htime[0]; $toTime = $htime[1]; } } ?>
pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '6') { echo "block"; break; } } ?>;"> -To-
pref_type == 'shift' && $datas->day == '7') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '7') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '7') { $htime = explode(',', $datas->time); $fromTime = $htime[0]; $toTime = $htime[1]; } } ?>
pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '7') { echo "block"; break; } } ?>;"> -To-
pref_type == 'shift' && $datas->day == '8') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '8') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '8') { $htime = explode(',', $datas->time); $fromTime = $htime[0]; $toTime = $htime[1]; } } ?>
pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '8') { echo "block"; break; } } ?>;"> -To-
pref_type == 'shift' && $datas->day == '2') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '2') { echo "checked"; break; } } ?>> pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '2') { $htime = explode(',', $datas->time); $fromTime = $htime[0]; $toTime = $htime[1]; } } ?>
pref_type == 'hourly' || $datas->pref_type == 'Hourly') && $datas->day == '2') { echo "block"; break; } } ?>;"> -To-
ny_drive_info==1) { echo "checked"; } ?>>
ny_drive_info==0) { echo "checked"; } ?>>
ny_drive_info ==0 ) {?> style="display:none" > lic_no)) { echo $nurse->lic_no; } ?>' data-error="Please enter a valid last name.">
ny_drive_info ==0 ) {?> style="display:none" >
ny_drive_info ==0 ) {?> style="display:none" > lic_exp_date)) { echo $nurse->lic_exp_date; } ?>' placeholder="">
*/ ?>
drive_info!="Yes"){ echo "Style='Display:none;'"; } ?>>
*/ ?>
Emergency_Contact_Address); // var_dump($Emergency_Contact); // echo "
";
                // print_r($nurse->Emergency_Contact_Address);
            ?>
Emergency_Contact_zipcode)) { echo $Emergency_Contact->Emergency_Contact_zipcode; } ?>' placeholder="" data-error="Please enter your zip code." required>
Emergency_Contact_Address1); ?>