<h1>Service Personnel Canada</h1>
<h2>Contact Information</h2>
<label> Your Name (required)
    [text* your-name] </label>

<label> Your Phone Number (required)
    [tel* telephone] </label>

<label> Your Email
    [email your-email] </label>

<label> City
    [text your-city] </label>

<label> Province
    [text your-province] </label>

<h2>Work Experience</h2>
Do you have previous cleaning experience?
    
[radio workexperience label_first use_label_element default:1 "No Cleaning Experience" "0 - 1 Year" "1 - 2 Years" "3 Years or More"]

<h2>Previous Employment</h2>
<h3>Employer One</h3>
<label> Employer
[text your-employer1] 
</label>

<label> Time Frame Employed
[text your-timeemployed1] 
</label>

<label> Position
[text your-position1] 
</label>

<h3>Employer Two</h3>
<label> Employer
[text your-employer2] 
</label>

<label> Time Frame Employed
[text your-timeemployed2] 
</label>

<label> Position
[text your-position2] 
</label>

<h3>Employer Three</h3>
<label> Employer
[text your-employer3] 
</label>

<label> Time Frame Employed
[text your-timeemployed3] 
</label>

<label> Position
[text your-position3] 
</label>

Please note: As a potential CleanMark employee you may be required to clear a criminal background check.

[submit "Send"]