<p>Your Name (required)<br />
    [text* your-name] </p>

<p>Your Email (required)<br />
    [email* your-email] </p>

<p>Your Phone (required)<br />

    [text* your-phone] </p>

<p>Your Company (optional)<br />
    [text your-company] </p>

<p>Preferred Work Location (city)<br />
    [text your-location] </p>

<p>Attach Resume or Company Brochure<br />
[file file-resume limit:30000000 filetypes:.doc|.docx|.pdf]
   </p>

<p>Please leave your comments <br />
[textarea your-comments]
</p>

<p>Are you human?<br />
[recaptcha]
</p>

<p>[submit "Send"]</p>