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id=\"jsExecutionTracker\" name=\"jsExecutionTracker\" value=\"build-date-1708946281914\" \/><input type=\"hidden\" id=\"submitSource\" name=\"submitSource\" value=\"unknown\" \/><input type=\"hidden\" id=\"buildDate\" name=\"buildDate\" value=\"1708946281914\" \/>\n  <div role=\"main\" class=\"form-all\">\n    <ul class=\"form-section page-section\">\n      <li id=\"cid_1\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div style=\"display:table;width:100%\">\n          <div class=\"form-header-group hasImage header-small\" data-imagealign=\"Left\">\n            <div class=\"header-logo\"><img src=\"https:\/\/www.jotform.com\/uploads\/dperica\/form_files\/IBEW logo small.6037feddf2e163.65268951.png\" alt=\"IBEW AUTHORIZATION FOR REPRESENTATION\" width=\"50\" class=\"header-logo-left\" \/><\/div>\n            <div class=\"header-text httac htvam\">\n              <h3 id=\"header_1\" class=\"form-header\" data-component=\"header\">IBEW AUTHORIZATION FOR REPRESENTATION<\/h3>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_3\">\n        <div id=\"cid_3\" class=\"form-input-wide\" data-layout=\"full\">\n          <div id=\"text_3\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p>I authorize the International Brotherhood of Electrical Workers to represent me as my bargaining representative in collective bargaining with my employer.<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_datetime\" id=\"id_5\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_5\" for=\"lite_mode_5\" aria-hidden=\"false\"> Date<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_5\" class=\"form-input-wide jf-required\" data-layout=\"half\">\n          <div data-wrapper-react=\"true\">\n            <div style=\"display:none\"><span 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style=\"min-height:13px\">Day<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" class=\"form-textbox validate[required, limitDate]\" id=\"year_5\" name=\"q5_date[year]\" size=\"4\" data-maxlength=\"4\" data-age=\"\" maxLength=\"4\" value=\"\" required=\"\" autoComplete=\"off\" aria-labelledby=\"label_5 sublabel_5_year\" \/><label class=\"form-sub-label\" for=\"year_5\" id=\"sublabel_5_year\" style=\"min-height:13px\">Year<\/label><\/span><\/div><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" class=\"form-textbox validate[required, limitDate, validateLiteDate]\" id=\"lite_mode_5\" size=\"12\" data-maxlength=\"12\" maxLength=\"12\" data-age=\"\" value=\"\" required=\"\" data-format=\"mmddyyyy\" data-seperator=\"-\" placeholder=\"MM-DD-YYYY\" data-placeholder=\"MM-DD-YYYY\" autoComplete=\"off\" aria-labelledby=\"label_5 sublabel_5_litemode\" \/><img class=\" newDefaultTheme-dateIcon icon-liteMode\" alt=\"Pick a Date\" id=\"input_5_pick\" src=\"https:\/\/cdn.jotfor.ms\/images\/calendar.png\" data-component=\"datetime\" aria-hidden=\"true\" data-allow-time=\"No\" data-version=\"v2\" \/><label class=\"form-sub-label\" for=\"lite_mode_5\" id=\"sublabel_5_litemode\" style=\"min-height:13px\">Date<\/label><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_4\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_4\" for=\"first_4\" aria-hidden=\"false\"> Name<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_4\" class=\"form-input-wide jf-required\" data-layout=\"full\">\n          <div data-wrapper-react=\"true\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\"><input type=\"text\" id=\"first_4\" name=\"q4_name[first]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"section-input_4 given-name\" size=\"10\" data-component=\"first\" aria-labelledby=\"label_4 sublabel_4_first\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"first_4\" id=\"sublabel_4_first\" style=\"min-height:13px\">First Name<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\"><input type=\"text\" id=\"last_4\" name=\"q4_name[last]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"section-input_4 family-name\" size=\"15\" data-component=\"last\" aria-labelledby=\"label_4 sublabel_4_last\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"last_4\" id=\"sublabel_4_last\" style=\"min-height:13px\">Last Name<\/label><\/span><\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-1 jf-required\" data-type=\"control_email\" id=\"id_13\"><label class=\"form-label form-label-top\" id=\"label_13\" for=\"input_13\" aria-hidden=\"false\"> Email<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_13\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"email\" id=\"input_13\" name=\"q13_email\" class=\"form-textbox validate[required, Email]\" data-defaultvalue=\"\" autoComplete=\"section-input_13 email\" style=\"width:310px\" size=\"310\" data-component=\"email\" aria-labelledby=\"label_13 sublabel_input_13\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_13\" id=\"sublabel_input_13\" style=\"min-height:13px\">example@example.com<\/label><\/span> <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-2 jf-required\" data-type=\"control_phone\" id=\"id_14\"><label class=\"form-label form-label-top\" id=\"label_14\" for=\"input_14_full\"> Phone Number<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_14\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" id=\"input_14_full\" name=\"q14_phoneNumber[full]\" data-type=\"mask-number\" class=\"mask-phone-number form-textbox validate[required, Fill Mask]\" data-defaultvalue=\"\" autoComplete=\"section-input_14 tel-national\" style=\"width:310px\" data-masked=\"true\" placeholder=\"(000) 000-0000\" data-component=\"phone\" aria-labelledby=\"label_14 sublabel_14_masked\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_14_full\" id=\"sublabel_14_masked\" style=\"min-height:13px\">Please enter a valid phone number.<\/label><\/span> <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_address\" id=\"id_6\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_6\" for=\"input_6_addr_line1\" aria-hidden=\"false\"> Address<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_6\" class=\"form-input-wide jf-required\" data-layout=\"full\">\n          <div summary=\"\" class=\"form-address-table jsTest-addressField\">\n            <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\"><span class=\"form-address-line form-address-street-line jsTest-address-lineField\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_6_addr_line1\" name=\"q6_address[addr_line1]\" class=\"form-textbox validate[required] form-address-line\" data-defaultvalue=\"\" autoComplete=\"section-input_6 address-line1\" data-component=\"address_line_1\" aria-labelledby=\"label_6 sublabel_6_addr_line1\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_6_addr_line1\" id=\"sublabel_6_addr_line1\" style=\"min-height:13px\">Street Address<\/label><\/span><\/span><\/div>\n            <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\"><span class=\"form-address-line form-address-street-line jsTest-address-lineField\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_6_addr_line2\" name=\"q6_address[addr_line2]\" class=\"form-textbox form-address-line\" data-defaultvalue=\"\" autoComplete=\"section-input_6 address-line2\" data-component=\"address_line_2\" aria-labelledby=\"label_6 sublabel_6_addr_line2\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_6_addr_line2\" id=\"sublabel_6_addr_line2\" style=\"min-height:13px\">Street Address Line 2<\/label><\/span><\/span><\/div>\n            <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\"><span class=\"form-address-line form-address-city-line jsTest-address-lineField \"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_6_city\" name=\"q6_address[city]\" class=\"form-textbox validate[required] form-address-city\" data-defaultvalue=\"\" autoComplete=\"section-input_6 address-level2\" data-component=\"city\" aria-labelledby=\"label_6 sublabel_6_city\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_6_city\" id=\"sublabel_6_city\" style=\"min-height:13px\">City<\/label><\/span><\/span><span class=\"form-address-line form-address-state-line jsTest-address-lineField \"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_6_state\" name=\"q6_address[state]\" class=\"form-textbox validate[required] form-address-state\" data-defaultvalue=\"\" autoComplete=\"section-input_6 address-level1\" data-component=\"state\" aria-labelledby=\"label_6 sublabel_6_state\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_6_state\" id=\"sublabel_6_state\" style=\"min-height:13px\">State \/ Province<\/label><\/span><\/span><\/div>\n            <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\"><span class=\"form-address-line form-address-zip-line jsTest-address-lineField \"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_6_postal\" name=\"q6_address[postal]\" class=\"form-textbox validate[required] form-address-postal\" data-defaultvalue=\"\" autoComplete=\"section-input_6 postal-code\" data-component=\"zip\" aria-labelledby=\"label_6 sublabel_6_postal\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_6_postal\" id=\"sublabel_6_postal\" style=\"min-height:13px\">Postal \/ Zip Code<\/label><\/span><\/span><\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-1 jf-required\" data-type=\"control_textbox\" id=\"id_7\"><label class=\"form-label form-label-top\" id=\"label_7\" for=\"input_7\" aria-hidden=\"false\"> Employer<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_7\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <input type=\"text\" id=\"input_7\" name=\"q7_employer\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" style=\"width:310px\" size=\"310\" data-component=\"textbox\" aria-labelledby=\"label_7\" required=\"\" value=\"\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-2 jf-required\" data-type=\"control_textbox\" id=\"id_8\"><label class=\"form-label form-label-top\" id=\"label_8\" for=\"input_8\" aria-hidden=\"false\"> Location<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_8\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <input type=\"text\" id=\"input_8\" name=\"q8_location\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" style=\"width:310px\" size=\"310\" data-component=\"textbox\" aria-labelledby=\"label_8\" required=\"\" value=\"\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-3 jf-required\" data-type=\"control_textbox\" id=\"id_9\"><label class=\"form-label form-label-top\" id=\"label_9\" for=\"input_9\" aria-hidden=\"false\"> Department<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_9\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <input type=\"text\" id=\"input_9\" name=\"q9_department\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" style=\"width:310px\" size=\"310\" data-component=\"textbox\" aria-labelledby=\"label_9\" required=\"\" value=\"\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-4 jf-required\" data-type=\"control_textbox\" id=\"id_10\"><label class=\"form-label form-label-top\" id=\"label_10\" for=\"input_10\" aria-hidden=\"false\"> Job Title<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_10\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <input type=\"text\" id=\"input_10\" name=\"q10_jobTitle\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" style=\"width:310px\" size=\"310\" data-component=\"textbox\" aria-labelledby=\"label_10\" required=\"\" value=\"\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_18\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_18\" for=\"input_18_0\" aria-hidden=\"false\"> IBEW Authorization<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_18\" class=\"form-input-wide jf-required\" data-layout=\"full\">\n          <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_18\" data-component=\"checkbox\"><span class=\"form-checkbox-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"checkbox\" aria-describedby=\"label_18\" class=\"form-checkbox validate[required]\" id=\"input_18_0\" name=\"q18_ibewAuthorization18[]\" value=\"I Agree -\u00a0By checking this box I understand and acknowledge that I am authorizing the International Brotherhood of Electrical Workers to represent me as my bargaining representative in collective bargaining with my employer. This Authorization is non-expiring binding and valid until such time as I submit a written revocation.\" required=\"\" \/><label id=\"label_input_18_0\" for=\"input_18_0\">I Agree -\u00a0By checking this box I understand and acknowledge that I am authorizing the International Brotherhood of Electrical Workers to represent me as my bargaining representative in collective bargaining with my employer. This Authorization is non-expiring binding and valid until such time as I submit a written revocation.<\/label><\/span><\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_2\">\n        <div id=\"cid_2\" class=\"form-input-wide\" data-layout=\"full\">\n          <div data-align=\"auto\" class=\"form-buttons-wrapper form-buttons-auto   jsTest-button-wrapperField\"><button id=\"input_2\" type=\"submit\" class=\"form-submit-button submit-button jf-form-buttons jsTest-submitField\" data-component=\"button\" data-content=\"\">Submit<\/button><\/div>\n        <\/div>\n      <\/li>\n      <li style=\"clear:both\"><\/li>\n      <li style=\"display:none\">Should be Empty: <input type=\"text\" name=\"website\" value=\"\" type=\"hidden\" \/><\/li>\n    <\/ul>\n  <\/div>\n  <script>\n    JotForm.showJotFormPowered = \"new_footer\";\n  <\/script>\n  <script>\n    JotForm.poweredByText = \"Powered by Jotform\";\n  <\/script><input type=\"hidden\" class=\"simple_spc\" id=\"simple_spc\" name=\"simple_spc\" value=\"221454299555161\" \/>\n  <script type=\"text\/javascript\">\n    var all_spc = document.querySelectorAll(\"form[id='221454299555161'] .si\" + \"mple\" + \"_spc\");\n    for (var i = 0; i < all_spc.length; i++)\n    {\n      all_spc[i].value = \"221454299555161-221454299555161\";\n    }\n  <\/script>\n<\/form><\/body>\n<\/html><script type=\"text\/javascript\">JotForm.isNewSACL=true;<\/script>"," IBEW AUTHORIZATION FOR REPRESENTATION",Array);var permittedDomains=[];try{var renderURLDomain=new URL("https://form.jotform.com/221454299555161").hostname;permittedDomains=[renderURLDomain];}catch(e){permittedDomains=['jotform.com','jotform.pro'];}
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