{"id":23,"date":"2025-10-23T00:00:03","date_gmt":"2025-10-23T00:00:03","guid":{"rendered":"https:\/\/employindy.org\/goodwagesinitiative\/?page_id=23"},"modified":"2026-01-14T19:59:48","modified_gmt":"2026-01-14T19:59:48","slug":"application","status":"publish","type":"page","link":"https:\/\/employindy.org\/goodwagesinitiative\/application\/","title":{"rendered":"Application"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"23\" class=\"elementor elementor-23\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cbe070c overview-4col-v1 e-flex e-con-boxed e-con e-parent\" data-id=\"cbe070c\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-22edef9 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"22edef9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Apply for Certified Status <\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-33bb077 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"33bb077\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Good Wages Certified employers meet the $18\/hour wage threshold for all employees and offer health insurance to at least two full-time employees. Part-time employees, apprentices, interns, new hires, and minors may be excluded. Certification lasts for two years and is available for businesses with an office in Marion County, IN.<\/p><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-613d502 e-grid e-con-full e-con e-child\" data-id=\"613d502\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t<div class=\"elementor-element elementor-element-f19a079 e-con-full icon-box-wrapper e-flex elementor-invisible e-con e-child\" data-id=\"f19a079\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[],&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6bc5252 elementor-view-default elementor-position-block-start elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"6bc5252\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"30\" height=\"30\" viewBox=\"0 0 30 30\" fill=\"none\"><mask id=\"mask0_5989_25122\" style=\"mask-type:alpha\" maskUnits=\"userSpaceOnUse\" x=\"0\" y=\"0\" width=\"30\" height=\"30\"><rect width=\"30\" height=\"30\" fill=\"#099CCE\"><\/rect><\/mask><g mask=\"url(#mask0_5989_25122)\"><path d=\"M5 26.25V20.9375L21.4688 4.5C21.7188 4.25 22 4.0625 22.3125 3.9375C22.625 3.8125 22.9375 3.75 23.25 3.75C23.5833 3.75 23.901 3.8125 24.2031 3.9375C24.5052 4.0625 24.7708 4.25 25 4.5L26.75 6.25C27 6.47917 27.1875 6.74479 27.3125 7.04688C27.4375 7.34896 27.5 7.66667 27.5 8C27.5 8.3125 27.4375 8.625 27.3125 8.9375C27.1875 9.25 27 9.53125 26.75 9.78125L10.3125 26.25H5ZM7.5 23.75H9.25L21.5313 11.5L20.6563 10.5937L19.75 9.71875L7.5 22V23.75ZM20.6563 10.5937L19.75 9.71875L21.5313 11.5L20.6563 10.5937ZM17.5 26.25C19.0417 26.25 20.4688 25.8646 21.7813 25.0938C23.0938 24.3229 23.75 23.25 23.75 21.875C23.75 21.125 23.5521 20.4792 23.1563 19.9375C22.7604 19.3958 22.2292 18.9271 21.5625 18.5312L19.7188 20.375C20.1979 20.5833 20.5729 20.8125 20.8438 21.0625C21.1146 21.3125 21.25 21.5833 21.25 21.875C21.25 22.3542 20.8698 22.7865 20.1094 23.1719C19.349 23.5573 18.4792 23.75 17.5 23.75C17.1458 23.75 16.849 23.8698 16.6094 24.1094C16.3698 24.349 16.25 24.6458 16.25 25C16.25 25.3542 16.3698 25.651 16.6094 25.8906C16.849 26.1302 17.1458 26.25 17.5 26.25ZM5.71875 16.6875L7.59375 14.8125C7.17708 14.6458 6.84896 14.474 6.60938 14.2969C6.36979 14.1198 6.25 13.9375 6.25 13.75C6.25 13.5 6.4375 13.25 6.8125 13C7.1875 12.75 7.97917 12.3646 9.1875 11.8437C11.0208 11.0521 12.2396 10.3333 12.8438 9.6875C13.4479 9.04167 13.75 8.3125 13.75 7.5C13.75 6.35417 13.2917 5.44271 12.375 4.76562C11.4583 4.08854 10.25 3.75 8.75 3.75C7.8125 3.75 6.97396 3.91667 6.23438 4.25C5.49479 4.58333 4.92708 4.98958 4.53125 5.46875C4.30208 5.73958 4.20833 6.04167 4.25 6.375C4.29167 6.70833 4.44792 6.97917 4.71875 7.1875C4.98958 7.41667 5.29167 7.51042 5.625 7.46875C5.95833 7.42708 6.23958 7.29167 6.46875 7.0625C6.76042 6.77083 7.08333 6.5625 7.4375 6.4375C7.79167 6.3125 8.22917 6.25 8.75 6.25C9.60417 6.25 10.2344 6.375 10.6406 6.625C11.0469 6.875 11.25 7.16667 11.25 7.5C11.25 7.79167 11.0677 8.05729 10.7031 8.29688C10.3385 8.53646 9.5 8.95833 8.1875 9.5625C6.52083 10.2917 5.36458 10.9531 4.71875 11.5469C4.07292 12.1406 3.75 12.875 3.75 13.75C3.75 14.4167 3.92708 14.9844 4.28125 15.4531C4.63542 15.9219 5.11458 16.3333 5.71875 16.6875Z\" fill=\"#099CCE\"><\/path><\/g><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h5 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tApply\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h5>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tBeing designated as Good Wages Certified starts with completing the online application. After receiving your application and the <a href=\"https:\/\/employindy.org\/goodwagesinitiative\/wp-content\/uploads\/sites\/7\/2026\/01\/GWI-fee-table.png\">application fee<\/a>, Good Wages Initiative staff will arrange a discussion with you to ensure an accurate understanding of your application.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8b89fe5 e-con-full icon-box-wrapper e-flex elementor-invisible e-con e-child\" data-id=\"8b89fe5\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[],&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2bd73a2 elementor-view-default elementor-position-block-start elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"2bd73a2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"30\" height=\"30\" viewBox=\"0 0 30 30\" fill=\"none\"><mask id=\"mask0_5989_25134\" style=\"mask-type:alpha\" maskUnits=\"userSpaceOnUse\" x=\"0\" y=\"0\" width=\"30\" height=\"30\"><rect width=\"30\" height=\"30\" fill=\"#099CCE\"><\/rect><\/mask><g mask=\"url(#mask0_5989_25134)\"><path d=\"M17.4063 13.8125L12.0938 8.5L13.875 6.75L17.4063 10.2813L24.5 3.21875L26.25 4.96875L17.4063 13.8125ZM10 23.125L18.6875 25.5L26.125 23.1875C26.0208 23 25.8698 22.8385 25.6719 22.7031C25.474 22.5677 25.25 22.5 25 22.5H18.6875C18.125 22.5 17.6771 22.4792 17.3438 22.4375C17.0104 22.3958 16.6667 22.3125 16.3125 22.1875L13.4063 21.2188L14.0938 18.7813L16.625 19.625C16.9792 19.7292 17.3958 19.8125 17.875 19.875C18.3542 19.9375 19.0625 19.9792 20 20C20 19.7708 19.9323 19.5521 19.7969 19.3438C19.6615 19.1354 19.5 19 19.3125 18.9375L12 16.25H10V23.125ZM2.5 27.5V13.75H12C12.1458 13.75 12.2917 13.7656 12.4375 13.7969C12.5833 13.8281 12.7188 13.8646 12.8438 13.9063L20.1875 16.625C20.875 16.875 21.4323 17.3125 21.8594 17.9375C22.2865 18.5625 22.5 19.25 22.5 20H25C26.0417 20 26.9271 20.3438 27.6562 21.0313C28.3854 21.7188 28.75 22.625 28.75 23.75V25L18.75 28.125L10 25.6875V27.5H2.5ZM5 25H7.5V16.25H5V25Z\" fill=\"#099CCE\"><\/path><\/g><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h5 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tReceive\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h5>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tOnce approved, you will receive a GWI Marketing Toolkit complete with door signage, digital Good Wages Initiative design assets, press release template, sample social media announcements, as well as networking, recruiting, and idea exchange opportunities, helping you attract and retain a highly qualified workforce.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-c68e988 e-con-full icon-box-wrapper e-flex elementor-invisible e-con e-child\" data-id=\"c68e988\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[],&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b0b21c4 elementor-view-default elementor-position-block-start elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"b0b21c4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"30\" height=\"30\" viewBox=\"0 0 30 30\" fill=\"none\"><mask id=\"mask0_5989_25146\" style=\"mask-type:alpha\" maskUnits=\"userSpaceOnUse\" x=\"0\" y=\"0\" width=\"30\" height=\"30\"><rect width=\"30\" height=\"30\" fill=\"#099CCE\"><\/rect><\/mask><g mask=\"url(#mask0_5989_25146)\"><path d=\"M22.5 16.25V13.75H27.5V16.25H22.5ZM24 25L20 22L21.5 20L25.5 23L24 25ZM21.5 10L20 8L24 5L25.5 7L21.5 10ZM6.25 23.75V18.75H5C4.3125 18.75 3.72396 18.5052 3.23438 18.0156C2.74479 17.526 2.5 16.9375 2.5 16.25V13.75C2.5 13.0625 2.74479 12.474 3.23438 11.9844C3.72396 11.4948 4.3125 11.25 5 11.25H10L16.25 7.5V22.5L10 18.75H8.75V23.75H6.25ZM13.75 18.0625V11.9375L10.6875 13.75H5V16.25H10.6875L13.75 18.0625ZM17.5 19.1875V10.8125C18.0625 11.3125 18.5156 11.9219 18.8594 12.6406C19.2031 13.3594 19.375 14.1458 19.375 15C19.375 15.8542 19.2031 16.6406 18.8594 17.3594C18.5156 18.0781 18.0625 18.6875 17.5 19.1875Z\" fill=\"#099CCE\"><\/path><\/g><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h5 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tPromote\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h5>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tShare your Good Wages Certified status with the community! Please include your updated information on your website\u2019s homepage and include your GWI status in job postings to promote your commitment to employee well-being and the community.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-59976e9 elementor-widget__width-initial custom-form elementor-widget elementor-widget-shortcode\" data-id=\"59976e9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/goodwagesinitiative\/wp-json\/wp\/v2\/pages\/23#gf_1' data-formid='1' novalidate><div id=\"payments-sdk__contingency-lightbox\"><\/div>\n        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>7<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_14' style='width:14%;'><span>14%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' >\n                                    <div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_7\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_7\"><h3 class=\"gsection_title\">Employer Basics<\/h3><\/div><div id=\"field_1_1\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_1\"><label class='gfield_label gform-field-label' for='input_1_1' >Business\/Organization Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_1_1' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_1\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_1'>Please input the business\/organization name.<\/div><\/div><div id=\"field_1_6\"  class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_6\"><label class='gfield_label gform-field-label' for='input_1_6' >Structure<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_1_6' class='large gfield_select'  aria-describedby=\"gfield_description_1_6\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Structure*<\/option><option value='For-profit' >For-profit<\/option><option value='Non-profit' >Non-profit<\/option><option value='Faith Organization' >Faith Organization<\/option><option value='Government Agency' >Government Agency<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_1_6'>Please select the structure of the business\/organization.<\/div><\/div><div id=\"field_1_8\"  class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_8\"><label class='gfield_label gform-field-label' for='input_1_8' >Industry<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_1_8' class='large gfield_select'  aria-describedby=\"gfield_description_1_8\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Industry*<\/option><option value='Advanced Manufacturing' >Advanced Manufacturing<\/option><option value='Agriculture, Food &amp; Natural Resources' >Agriculture, Food &amp; Natural Resources<\/option><option value='Architecture and Construction' >Architecture and Construction<\/option><option value='Arts, Audio - Visual Technology, and Communications' >Arts, Audio - Visual Technology, and Communications<\/option><option value='Business Management and Administration' >Business Management and Administration<\/option><option value='Education and Training' >Education and Training<\/option><option value='Finance' >Finance<\/option><option value='Government and Public Administration' >Government and Public Administration<\/option><option value='Health Sciences' >Health Sciences<\/option><option value='Hospitality and Tourism' >Hospitality and Tourism<\/option><option value='Human Services' >Human Services<\/option><option value='Information Technology  (IT)' >Information Technology  (IT)<\/option><option value='Law, Public Safety, Corrections and Security' >Law, Public Safety, Corrections and Security<\/option><option value='Manufacturing' >Manufacturing<\/option><option value='Marketing, Sales and Service' >Marketing, Sales and Service<\/option><option value='Science, Technology, Engineering and Mathematics' >Science, Technology, Engineering and Mathematics<\/option><option value='Transportation, Distribution and Logistics' >Transportation, Distribution and Logistics<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_1_8'>Please select the sector\/industry that the business\/organization works in.<\/div><\/div><div id=\"field_1_9\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_9\"><label class='gfield_label gform-field-label' for='input_1_9' >First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_9\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_9'>Please input your first name.<\/div><\/div><div id=\"field_1_95\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_95\"><label class='gfield_label gform-field-label' for='input_1_95' >Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_1_95' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_95\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_95'>Please input your last name.<\/div><\/div><div id=\"field_1_10\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_10\"><label class='gfield_label gform-field-label' for='input_1_10' >Title<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_1_10' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_10\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_10'>Please input your job title.<\/div><\/div><div id=\"field_1_96\"  class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_96\"><label class='gfield_label gform-field-label' for='input_1_96' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_96' id='input_1_96' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_96\"  \/><\/div><div class='gfield_description' id='gfield_description_1_96'>Please input a good contact phone number.<\/div><\/div><div id=\"field_1_2\"  class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_2\"><label class='gfield_label gform-field-label' for='input_1_2' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_1_2' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_2\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_1_2'>Please input a good contact email address.<\/div><\/div><div id=\"field_1_11\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_11\"><label class='gfield_label gform-field-label' for='input_1_11' >CEO First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_1_11' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_11\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_11'>Please input the business\/organization CEO's first name.<\/div><\/div><div id=\"field_1_97\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_97\"><label class='gfield_label gform-field-label' for='input_1_97' >CEO Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_97' id='input_1_97' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_97\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_97'>Please input the business\/organization CEO's last name.<\/div><\/div><div id=\"field_1_89\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_89\"><label class='gfield_label gform-field-label' for='input_1_89' >Marketing Contact First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_1_89' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_89\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_89'>Please input your marketing\/communications lead's first name.<\/div><\/div><div id=\"field_1_98\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_98\"><label class='gfield_label gform-field-label' for='input_1_98' >Marketing Contact Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_98' id='input_1_98' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_98\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_98'>Please input your marketing\/communications lead's last name.<\/div><\/div><div id=\"field_1_100\"  class=\"gfield gfield--type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_100\"><label class='gfield_label gform-field-label' for='input_1_100' >Marketing Contact Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_100' id='input_1_100' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_100\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_1_100'>Please input your marketing\/communications lead's contact email.<\/div><\/div><div id=\"field_1_94\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_94\">Organization Logo (upload high resolution .jpg or .png)<\/div><div id=\"field_1_90\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_90\"><label class='gfield_label gform-field-label' for='gform_browse_button_1_90' >Organization Logo (upload high resolution .jpg or .png)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_90' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_90&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_90&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_90&quot;,&quot;filelist&quot;:&quot;gform_preview_1_90&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/employindy.org\\\/goodwagesinitiative\\\/?gf_page=2f4be9a05710729&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/employindy.org\\\/goodwagesinitiative\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/employindy.org\\\/goodwagesinitiative\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,jpeg,png&quot;}],&quot;max_file_size&quot;:&quot;51200000b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:90},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_1_90&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_90' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_90' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_1_90\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_90'>Accepted file types: jpg, jpeg, png, Max. file size: 49 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_90'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_90' class='ginput_preview_list'><\/div><\/div><div id=\"field_1_13\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_13\">Your answers to the next two questions do not impact your application, but are helpful for the efforts of the Good Wages Initiative. <\/div><div id=\"field_1_17\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_17\"><label class='gfield_label gform-field-label' for='input_1_17' >Good Wages Discovery<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_1_17' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_17\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_17'>Please describe how you learned about the GWI (Good Wages Initiative) program.<\/div><\/div><div id=\"field_1_102\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_102\"><label class='gfield_label gform-field-label' for='input_1_102' >Good Wages Importance<\/label><div class='ginput_container ginput_container_text'><input name='input_102' id='input_1_102' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_102\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_102'>Please explain why a good wages certification is important to your business\/organization.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_138' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_16\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_16\"><h3 class=\"gsection_title\">Location(s) &amp; Workforce<\/h3><\/div><fieldset id=\"field_1_18\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_18\"><legend class='gfield_label gform-field-label'  >Business GWI Certification?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_18'>\n\t\t\t<div class='gchoice gchoice_1_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Yes'  id='choice_1_18_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_18\"   \/>\n\t\t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='No'  id='choice_1_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_18'>Does the business seek certification for employees based out of the primary business location? Please select yes or no.<\/div><\/fieldset><fieldset id=\"field_1_103\"  class=\"gfield gfield--type-address gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_103\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Primary Business Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_103' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_103_1_container' >\n                                        <input type='text' name='input_103.1' id='input_1_103_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_103_1' id='input_1_103_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_103_2_container' >\n                                        <input type='text' name='input_103.2' id='input_1_103_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_103_2' id='input_1_103_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_103_3_container' >\n                                    <input type='text' name='input_103.3' id='input_1_103_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_103_3' id='input_1_103_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_103_4_container' >\n                                        <select name='input_103.4' id='input_1_103_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_1_103_4' id='input_1_103_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_103_5_container' >\n                                    <input type='text' name='input_103.5' id='input_1_103_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_103_5' id='input_1_103_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_103.6' id='input_1_103_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_1_103'>Please input the business\/organization primary place of business.<\/div><\/fieldset><fieldset id=\"field_1_19\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_19\"><legend class='gfield_label gform-field-label'  >Other Location for GWI Certification?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_19'>\n\t\t\t<div class='gchoice gchoice_1_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_1_19_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_19\"   \/>\n\t\t\t\t\t<label for='choice_1_19_0' id='label_1_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_1_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_19_1' id='label_1_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_19'>Is there another business address in Marion County, IN that seeks certification? Please select yes or no.<\/div><\/fieldset><fieldset id=\"field_1_104\"  class=\"gfield gfield--type-address gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_104\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Other Business Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_104' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_104_1_container' >\n                                        <input type='text' name='input_104.1' id='input_1_104_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_104_1' id='input_1_104_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_104_2_container' >\n                                        <input type='text' name='input_104.2' id='input_1_104_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_104_2' id='input_1_104_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_104_3_container' >\n                                    <input type='text' name='input_104.3' id='input_1_104_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_104_3' id='input_1_104_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_104_4_container' >\n                                        <select name='input_104.4' id='input_1_104_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_1_104_4' id='input_1_104_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_104_5_container' >\n                                    <input type='text' name='input_104.5' id='input_1_104_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_104_5' id='input_1_104_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_104.6' id='input_1_104_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_1_104'>Please input the business\/organization other place of business.<\/div><\/fieldset><fieldset id=\"field_1_123\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_123\"><legend class='gfield_label gform-field-label'  >Other Location for GWI Certification? (2)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_123'>\n\t\t\t<div class='gchoice gchoice_1_123_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_123' type='radio' value='Yes'  id='choice_1_123_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_123\"   \/>\n\t\t\t\t\t<label for='choice_1_123_0' id='label_1_123_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_123_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_123' type='radio' value='No'  id='choice_1_123_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_123_1' id='label_1_123_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_123'>Is there another business address in Marion County, IN that seeks certification? Please select yes or no.<\/div><\/fieldset><fieldset id=\"field_1_124\"  class=\"gfield gfield--type-address gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_124\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Other Business Address (2)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_124' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_124_1_container' >\n                                        <input type='text' name='input_124.1' id='input_1_124_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_124_1' id='input_1_124_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_124_2_container' >\n                                        <input type='text' name='input_124.2' id='input_1_124_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_124_2' id='input_1_124_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_124_3_container' >\n                                    <input type='text' name='input_124.3' id='input_1_124_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_124_3' id='input_1_124_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_124_4_container' >\n                                        <select name='input_124.4' id='input_1_124_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_1_124_4' id='input_1_124_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_124_5_container' >\n                                    <input type='text' name='input_124.5' id='input_1_124_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_124_5' id='input_1_124_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_124.6' id='input_1_124_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_1_124'>Please input the business\/organization other place of business.<\/div><\/fieldset><fieldset id=\"field_1_125\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_125\"><legend class='gfield_label gform-field-label'  >Other Location for GWI Certification? (3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_125'>\n\t\t\t<div class='gchoice gchoice_1_125_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='Yes'  id='choice_1_125_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_125\"   \/>\n\t\t\t\t\t<label for='choice_1_125_0' id='label_1_125_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_125_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='No'  id='choice_1_125_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_125_1' id='label_1_125_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_125'>Is there another business address in Marion County, IN that seeks certification?  Please select yes or no.<\/div><\/fieldset><fieldset id=\"field_1_126\"  class=\"gfield gfield--type-address gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_126\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Other Business Address (3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_126' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_126_1_container' >\n                                        <input type='text' name='input_126.1' id='input_1_126_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_126_1' id='input_1_126_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_126_2_container' >\n                                        <input type='text' name='input_126.2' id='input_1_126_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_126_2' id='input_1_126_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_126_3_container' >\n                                    <input type='text' name='input_126.3' id='input_1_126_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_126_3' id='input_1_126_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_126_4_container' >\n                                        <select name='input_126.4' id='input_1_126_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_1_126_4' id='input_1_126_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_126_5_container' >\n                                    <input type='text' name='input_126.5' id='input_1_126_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_126_5' id='input_1_126_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_126.6' id='input_1_126_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_1_126'>Please input the business\/organization other place of business.<\/div><\/fieldset><fieldset id=\"field_1_127\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_127\"><legend class='gfield_label gform-field-label'  >Other Location for GWI Certification? (4)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_127'>\n\t\t\t<div class='gchoice gchoice_1_127_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='Yes'  id='choice_1_127_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_127\"   \/>\n\t\t\t\t\t<label for='choice_1_127_0' id='label_1_127_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_127_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='No'  id='choice_1_127_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_127_1' id='label_1_127_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_127'>Is there another business address in Marion County, IN that seeks certification? Please select yes or no.<\/div><\/fieldset><fieldset id=\"field_1_128\"  class=\"gfield gfield--type-address gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_128\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Other Business Address (4)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_128' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_128_1_container' >\n                                        <input type='text' name='input_128.1' id='input_1_128_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_128_1' id='input_1_128_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_128_2_container' >\n                                        <input type='text' name='input_128.2' id='input_1_128_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_128_2' id='input_1_128_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_128_3_container' >\n                                    <input type='text' name='input_128.3' id='input_1_128_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_128_3' id='input_1_128_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_128_4_container' >\n                                        <select name='input_128.4' id='input_1_128_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_1_128_4' id='input_1_128_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_128_5_container' >\n                                    <input type='text' name='input_128.5' id='input_1_128_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_128_5' id='input_1_128_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_128.6' id='input_1_128_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_1_128'>Please input the business\/organization other place of business.<\/div><\/fieldset><fieldset id=\"field_1_129\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_129\"><legend class='gfield_label gform-field-label'  >Other location for GWI Certification? (5)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_129'>\n\t\t\t<div class='gchoice gchoice_1_129_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='Yes'  id='choice_1_129_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_129\"   \/>\n\t\t\t\t\t<label for='choice_1_129_0' id='label_1_129_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_129_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='No'  id='choice_1_129_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_129_1' id='label_1_129_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_129'>Is there another business address in Marion County, IN that seeks certification? Please select yes or no.<\/div><\/fieldset><fieldset id=\"field_1_130\"  class=\"gfield gfield--type-address gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_130\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Other Business Address (5)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_130' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_130_1_container' >\n                                        <input type='text' name='input_130.1' id='input_1_130_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_130_1' id='input_1_130_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_130_2_container' >\n                                        <input type='text' name='input_130.2' id='input_1_130_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_130_2' id='input_1_130_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_130_3_container' >\n                                    <input type='text' name='input_130.3' id='input_1_130_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_130_3' id='input_1_130_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_130_4_container' >\n                                        <select name='input_130.4' id='input_1_130_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_1_130_4' id='input_1_130_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_130_5_container' >\n                                    <input type='text' name='input_130.5' id='input_1_130_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_130_5' id='input_1_130_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_130.6' id='input_1_130_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_1_130'>Please input the business\/organization other place of business.<\/div><\/fieldset><div id=\"field_1_21\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_21\">For all sites that you wish to certify, what is the total number of\u2026<\/div><div id=\"field_1_105\"  class=\"gfield gfield--type-number gfield--width-quarter gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_105\"><label class='gfield_label gform-field-label' for='input_1_105' >Full-time Employees<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_105' id='input_1_105' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_105\" \/><\/div><div class='gfield_description' id='gfield_description_1_105'>Please input number of full-time employees (over 30 hours weekly) your business\/organization currently employs. Please input a whole number.<\/div><\/div><div id=\"field_1_107\"  class=\"gfield gfield--type-number gfield--width-quarter gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_107\"><label class='gfield_label gform-field-label' for='input_1_107' >Part-time Employees<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_107' id='input_1_107' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_107\" \/><\/div><div class='gfield_description' id='gfield_description_1_107'>Please input number of part-time employees (under 30 hours weekly) your business\/organization currently employs. Please input a whole number.<\/div><\/div><div id=\"field_1_106\"  class=\"gfield gfield--type-number gfield--width-quarter gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_106\"><label class='gfield_label gform-field-label' for='input_1_106' >Contract Workers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_106' id='input_1_106' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_106\" \/><\/div><div class='gfield_description' id='gfield_description_1_106'>Please input number of contract workers your business\/organization currently employs. Please input a whole number.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_139' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_139' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_25\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><h3 class=\"gsection_title\">Wage &amp; Benefit Analysis<\/h3><\/div><fieldset id=\"field_1_86\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_86\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Good Wages Analysis Exclusion (Question A)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_86'><div class='gchoice gchoice_1_86_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.1' type='checkbox'  value='Apprentices'  id='choice_1_86_1'   aria-describedby=\"gfield_description_1_86\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_1' id='label_1_86_1' class='gform-field-label gform-field-label--type-inline'>Apprentices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_86_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.2' type='checkbox'  value='Interns'  id='choice_1_86_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_2' id='label_1_86_2' class='gform-field-label gform-field-label--type-inline'>Interns<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_86_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.3' type='checkbox'  value='Minors (under age 18)'  id='choice_1_86_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_3' id='label_1_86_3' class='gform-field-label gform-field-label--type-inline'>Minors (under age 18)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_86_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.4' type='checkbox'  value='New Hires'  id='choice_1_86_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_4' id='label_1_86_4' class='gform-field-label gform-field-label--type-inline'>New Hires<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_86_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.5' type='checkbox'  value='Part-time Employees'  id='choice_1_86_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_5' id='label_1_86_5' class='gform-field-label gform-field-label--type-inline'>Part-time Employees<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_86_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.6' type='checkbox'  value='Temp Employees'  id='choice_1_86_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_6' id='label_1_86_6' class='gform-field-label gform-field-label--type-inline'>Temp Employees<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_86_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_86.7' type='checkbox'  value='None'  id='choice_1_86_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_86_7' id='label_1_86_7' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_86'>Please indicate if you would like any of the following groups excluded from the good wages analysis.<\/div><\/fieldset><fieldset id=\"field_1_27\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_27\"><legend class='gfield_label gform-field-label'  >Tipped Employees (Question B)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_27'>\n\t\t\t<div class='gchoice gchoice_1_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Yes'  id='choice_1_27_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_27\"   \/>\n\t\t\t\t\t<label for='choice_1_27_0' id='label_1_27_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No'  id='choice_1_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_27_1' id='label_1_27_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_27'>Does the business\/organization employ tip-based employees? Please select yes or no.<\/div><\/fieldset><div id=\"field_1_109\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_109\"><label class='gfield_label gform-field-label' for='input_1_109' >Compensation Structure for Tipped Employees<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_109' id='input_1_109' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_109\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_109'>Please describe the compensation structure for tipped employees including base hourly wage, how tips are earned, how any tip pooling and splitting occurs, and the average hourly compensation for tipped employees once hourly wage and tips are combined.<\/div><\/div><div id=\"field_1_110\"  class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_110\"><label class='gfield_label gform-field-label' for='input_1_110' >Lowest Hourly Wage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_110' id='input_1_110' type='text' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_110\" \/><\/div><div class='gfield_description' id='gfield_description_1_110'>Excluding the employees noted in questions A and B, what is the lowest hourly wage for full-time employees?<\/div><\/div><div id=\"field_1_111\"  class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_111\"><label class='gfield_label gform-field-label' for='input_1_111' >Lowest Salary Exempt Employee (Annual)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_111' id='input_1_111' type='text' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_111\" \/><\/div><div class='gfield_description' id='gfield_description_1_111'>Please input the lowest annual salary for an exempt employee at the business\/organization.<\/div><\/div><fieldset id=\"field_1_32\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_32\"><legend class='gfield_label gform-field-label'  >Employees $18\/hour Threshold?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_32'>\n\t\t\t<div class='gchoice gchoice_1_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Yes'  id='choice_1_32_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_32\"   \/>\n\t\t\t\t\t<label for='choice_1_32_0' id='label_1_32_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='No'  id='choice_1_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_1' id='label_1_32_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_32'>Are there any employees who only meet the $18\/hour threshold after bonuses or commissions are added?<\/div><\/fieldset><fieldset id=\"field_1_33\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_33\"><legend class='gfield_label gform-field-label'  >Employee Opt-out?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_33'>\n\t\t\t<div class='gchoice gchoice_1_33_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Yes'  id='choice_1_33_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_33\"   \/>\n\t\t\t\t\t<label for='choice_1_33_0' id='label_1_33_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_33_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='No'  id='choice_1_33_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_33_1' id='label_1_33_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_33'>Do you have full-time employees who have opted for a wage lower than $18\/hour based on concerns about qualifying for support programs?<\/div><\/fieldset><fieldset id=\"field_1_120\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_120\"><legend class='gfield_label gform-field-label'  >Second Chance Employer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_120'>\n\t\t\t<div class='gchoice gchoice_1_120_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='Yes'  id='choice_1_120_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_120\"   \/>\n\t\t\t\t\t<label for='choice_1_120_0' id='label_1_120_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_120_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='No'  id='choice_1_120_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_120_1' id='label_1_120_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_120_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='Other'  id='choice_1_120_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_120_2' id='label_1_120_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_120'>Is the organization a re-entry friendly employer?<\/div><\/fieldset><div id=\"field_1_121\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_121\"><label class='gfield_label gform-field-label' for='input_1_121' >Second Chance Explanation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_121' id='input_1_121' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_121\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_121'>Please explain why other was selected for the second chance employer question.<\/div><\/div><div id=\"field_1_34\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_34\"><label class='gfield_label gform-field-label' for='input_1_34' >Who is eligible for health insurance?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_1_34' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_34\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_34'>Please indicate which employees are eligible for health insurance at your business\/organization.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_140' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_140' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_35\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_35\"><h3 class=\"gsection_title\">Business Status<\/h3><\/div><fieldset id=\"field_1_36\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_36\"><legend class='gfield_label gform-field-label'  >Positions Eliminated Last 12 Months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_36'>\n\t\t\t<div class='gchoice gchoice_1_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Yes'  id='choice_1_36_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_36\"   \/>\n\t\t\t\t\t<label for='choice_1_36_0' id='label_1_36_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='No'  id='choice_1_36_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_36_1' id='label_1_36_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_36'>Have any full-time positions been eliminated in the past 12 months?<\/div><\/fieldset><fieldset id=\"field_1_37\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_37\"><legend class='gfield_label gform-field-label'  >Labor Union<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_37'>\n\t\t\t<div class='gchoice gchoice_1_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Yes'  id='choice_1_37_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_37\"   \/>\n\t\t\t\t\t<label for='choice_1_37_0' id='label_1_37_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='No'  id='choice_1_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_37_1' id='label_1_37_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_37'>Are employees' part of any labor union?<\/div><\/fieldset><div id=\"field_1_113\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_113\"><label class='gfield_label gform-field-label' for='input_1_113' >Current CBA Start Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_113' id='input_1_113' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_113_date_format gfield_description_1_113\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_113_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_113' class='gform_hidden' value='https:\/\/employindy.org\/goodwagesinitiative\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_1_113'>When does the current collective bargaining contract begin?<\/div><\/div><div id=\"field_1_112\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_112\"><label class='gfield_label gform-field-label' for='input_1_112' >Current CBA Expiration Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_112' id='input_1_112' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_112_date_format gfield_description_1_112\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_112_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_112' class='gform_hidden' value='https:\/\/employindy.org\/goodwagesinitiative\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_1_112'>When did the current collective bargaining contract expire?<\/div><\/div><fieldset id=\"field_1_40\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_40\"><legend class='gfield_label gform-field-label'  >Other Attempts to Unionize?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_40'>\n\t\t\t<div class='gchoice gchoice_1_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Yes'  id='choice_1_40_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_40\"   \/>\n\t\t\t\t\t<label for='choice_1_40_0' id='label_1_40_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='No'  id='choice_1_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_40_1' id='label_1_40_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_40'>Are you or other members of management aware of any effort to unionize or otherwise organize collective bargaining?<\/div><\/fieldset><div id=\"field_1_41\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_41\">The next four questions do not impact your application. However, the information is very important for GWI's work measuring the impact of certifications in the community.<\/div><fieldset id=\"field_1_42\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_42\"><legend class='gfield_label gform-field-label'  >Wage Floor Increase Last 6 Months?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_42'>\n\t\t\t<div class='gchoice gchoice_1_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Yes'  id='choice_1_42_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_42\"   \/>\n\t\t\t\t\t<label for='choice_1_42_0' id='label_1_42_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='No'  id='choice_1_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_42_1' id='label_1_42_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_42'>Did the wage floor for full-time employees at your company rise to $18\/hour or above in the past six months? Please select yes or no.<\/div><\/fieldset><div id=\"field_1_145\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_145\"><label class='gfield_label gform-field-label' for='input_1_145' >Position Title<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_145' id='input_1_145' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_145\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_145'>Please input position in which the wage increase was applied to.<\/div><\/div><div id=\"field_1_115\"  class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_115\"><label class='gfield_label gform-field-label' for='input_1_115' >Original Wage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_115' id='input_1_115' type='text' step='any' min='0' max='99' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_115 gfield_description_1_115\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_115'>Please enter a number from <strong>0<\/strong> to <strong>99<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_1_115'>Please input the hourly wage before the increase.<\/div><\/div><div id=\"field_1_116\"  class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_116\"><label class='gfield_label gform-field-label' for='input_1_116' >New Wage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_116' id='input_1_116' type='text' step='any' min='0' max='99' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_116 gfield_description_1_116\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_116'>Please enter a number from <strong>0<\/strong> to <strong>99<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_1_116'>Please input the new hourly wage after increase.<\/div><\/div><fieldset id=\"field_1_146\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_146\"><legend class='gfield_label gform-field-label'  >Wage Increase for Other Positions? (2)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_146'>\n\t\t\t<div class='gchoice gchoice_1_146_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='Yes'  id='choice_1_146_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_146\"   \/>\n\t\t\t\t\t<label for='choice_1_146_0' id='label_1_146_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_146_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='No'  id='choice_1_146_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_146_1' id='label_1_146_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_146'>Were there any other positions that received a wage increase in the last 6 months? Please select yes or no.<\/div><\/fieldset><div id=\"field_1_147\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_147\"><label class='gfield_label gform-field-label' for='input_1_147' >Position Title (2)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_1_147' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_147\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_147'>Please input position in which the wage increase was applied to.<\/div><\/div><div id=\"field_1_148\"  class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_148\"><label class='gfield_label gform-field-label' for='input_1_148' >Original Wage (2)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_148' id='input_1_148' type='text' step='any' min='0' max='99' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_148 gfield_description_1_148\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_148'>Please enter a number from <strong>0<\/strong> to <strong>99<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_1_148'>Please input the hourly wage before the increase.<\/div><\/div><div id=\"field_1_149\"  class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_149\"><label class='gfield_label gform-field-label' for='input_1_149' >New Wage (2)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_149' id='input_1_149' type='text' step='any' min='0' max='99' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_149 gfield_description_1_149\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_149'>Please enter a number from <strong>0<\/strong> to <strong>99<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_1_149'>Please input the new hourly wage after increase.<\/div><\/div><fieldset id=\"field_1_151\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_151\"><legend class='gfield_label gform-field-label'  >Wage Increase for Other Positions? (3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_151'>\n\t\t\t<div class='gchoice gchoice_1_151_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_151' type='radio' value='Yes'  id='choice_1_151_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_151\"   \/>\n\t\t\t\t\t<label for='choice_1_151_0' id='label_1_151_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_151_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_151' type='radio' value='No'  id='choice_1_151_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_151_1' id='label_1_151_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_151'>Were there any other positions that received a wage increase in the last 6 months? Please select yes or no.<\/div><\/fieldset><div id=\"field_1_152\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_152\"><label class='gfield_label gform-field-label' for='input_1_152' >Position Title (3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_152' id='input_1_152' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_152\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_152'>Please input position in which the wage increase was applied to.<\/div><\/div><div id=\"field_1_153\"  class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_153\"><label class='gfield_label gform-field-label' for='input_1_153' >Original Wage (3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_153' id='input_1_153' type='text' step='any' min='0' max='99' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_153 gfield_description_1_153\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_153'>Please enter a number from <strong>0<\/strong> to <strong>99<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_1_153'>Please input the hourly wage before the increase.<\/div><\/div><div class=\"spacer gfield\" style=\"grid-column: span 8;\"><\/div><div id=\"field_1_154\"  class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_154\"><label class='gfield_label gform-field-label' for='input_1_154' >New Wage (3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_154' id='input_1_154' type='text' step='any' min='0' max='99' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_154 gfield_description_1_154\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_154'>Please enter a number from <strong>0<\/strong> to <strong>99<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_1_154'>Please input the new hourly wage after increase.<\/div><\/div><fieldset id=\"field_1_87\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_87\"><legend class='gfield_label gform-field-label'  >Health Insurance Policy Change Last 6 Months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_87'>\n\t\t\t<div class='gchoice gchoice_1_87_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='Yes'  id='choice_1_87_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_87\"   \/>\n\t\t\t\t\t<label for='choice_1_87_0' id='label_1_87_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_87_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='No'  id='choice_1_87_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_87_1' id='label_1_87_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_87'>In the past six months, did your company change policy to provide access to employer-sponsored health insurance for all full-time employees?<\/div><\/fieldset><div id=\"field_1_117\"  class=\"gfield gfield--type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_117\"><label class='gfield_label gform-field-label' for='input_1_117' >Positions Bachelor&#039;s Degree Not Required<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_117' id='input_1_117' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_117\" \/><\/div><div class='gfield_description' id='gfield_description_1_117'>Approximately how many positions in your organization do not require a bachelor's degree? Please input a whole number.<\/div><\/div><div id=\"field_1_118\"  class=\"gfield gfield--type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_118\"><label class='gfield_label gform-field-label' for='input_1_118' >Positions Bachelor&#039;s Degree Required<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_118' id='input_1_118' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_118\" \/><\/div><div class='gfield_description' id='gfield_description_1_118'>Approximately how many positions in your organization require a bachelor's degree? Please input a whole number.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_141' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_141' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_44\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_44\"><h3 class=\"gsection_title\">Additional<\/h3><\/div><div id=\"field_1_119\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_119\"><label class='gfield_label gform-field-label' for='input_1_119' >Additional Information<\/label><div class='ginput_container ginput_container_text'><input name='input_119' id='input_1_119' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_119\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_119'>Is there any additional information you would like to share in this application?<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_142' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_142' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_46\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_46\"><h3 class=\"gsection_title\">Fees<\/h3><\/div><div id=\"field_1_60\"  class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_60\"><label class='gfield_label gform-field-label' for='input_1_60' >Organization Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_60' id='input_1_60' class='large gfield_select'  aria-describedby=\"gfield_description_1_60\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Organization Type*<\/option><option value='For Profit Employers' >For Profit Employers<\/option><option value='Government Agencies' >Government Agencies<\/option><option value='Non-Profit &amp; Faith Employers' >Non-Profit &amp; Faith Employers<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_1_60'>Select from our dropdown list of organization types to determine your Application (Certified) fee.<\/div><\/div><div id=\"field_1_61\"  class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_61\"><label class='gfield_label gform-field-label' for='input_1_61' >Organization Size<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_1_61' class='large gfield_select'  aria-describedby=\"gfield_description_1_61\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Organization Size*<\/option><option value='Small (less than 75 employees)' >Small (less than 75 employees)<\/option><option value='Medium (75-249 employees)' >Medium (75-249 employees)<\/option><option value='Large (250-999 employees)' >Large (250-999 employees)<\/option><option value='Major (1000+ employees)' >Major (1000+ employees)<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_1_61'>Select from our dropdown list of organization sizes to determine your Application (Certified) fee.<\/div><\/div><div id=\"field_1_65\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_65 gfield_product_1_65 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_65\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_65_1' >Large For Profit Employer<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_65.1' value='Large For Profit Employer' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_65' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_65' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_65.2' id='ginput_base_price_1_65' class='gform_hidden' value='$1,000.00' aria-label='Large For Profit Employer Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_65.3' value='1' class='ginput_quantity_1_65 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_66\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_66 gfield_product_1_66 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_66\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_66_1' >Medium For Profit Employer<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_66.1' value='Medium For Profit Employer' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_66' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_66' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_66.2' id='ginput_base_price_1_66' class='gform_hidden' value='$500.00' aria-label='Medium For Profit Employer Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_66.3' value='1' class='ginput_quantity_1_66 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_64\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_64 gfield_product_1_64 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_64\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_64_1' >Major For Profit Employer<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_64.1' value='Major For Profit Employer' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_64' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_64' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_64.2' id='ginput_base_price_1_64' class='gform_hidden' value='$2,000.00' aria-label='Major For Profit Employer Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_64.3' value='1' class='ginput_quantity_1_64 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_67\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_67 gfield_product_1_67 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_67\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_67_1' >Small For Profit Employer<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_67.1' value='Small For Profit Employer' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_67' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_67' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_67.2' id='ginput_base_price_1_67' class='gform_hidden' value='$250.00' aria-label='Small For Profit Employer Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_67.3' value='1' class='ginput_quantity_1_67 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_68\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_68 gfield_product_1_68 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_68\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_68_1' >Major Government Agency<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_68.1' value='Major Government Agency' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_68' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_68' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_68.2' id='ginput_base_price_1_68' class='gform_hidden' value='$1,000.00' aria-label='Major Government Agency Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_68.3' value='1' class='ginput_quantity_1_68 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_69\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_69 gfield_product_1_69 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_69\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_69_1' >Large Government Agency<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_69.1' value='Large Government Agency' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_69' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_69' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_69.2' id='ginput_base_price_1_69' class='gform_hidden' value='$500.00' aria-label='Large Government Agency Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_69.3' value='1' class='ginput_quantity_1_69 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_70\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_70 gfield_product_1_70 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_70\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_70_1' >Medium Government Agency<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_70.1' value='Medium Government Agency' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_70' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_70' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_70.2' id='ginput_base_price_1_70' class='gform_hidden' value='$250.00' aria-label='Medium Government Agency Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_70.3' value='1' class='ginput_quantity_1_70 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_71\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_71 gfield_product_1_71 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_71\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_71_1' >Small Government Agency<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_71.1' value='Small Government Agency' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_71' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_71' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_71.2' id='ginput_base_price_1_71' class='gform_hidden' value='$100.00' aria-label='Small Government Agency Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_71.3' value='1' class='ginput_quantity_1_71 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_72\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_72 gfield_product_1_72 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_72\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_72_1' >Major Non-Profit or Faith Employer<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_72.1' value='Major Non-Profit or Faith Employer' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_72' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_72' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_72.2' id='ginput_base_price_1_72' class='gform_hidden' value='$500.00' aria-label='Major Non-Profit or Faith Employer Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_72.3' value='1' class='ginput_quantity_1_72 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_73\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_73 gfield_product_1_73 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_73\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_73_1' >Large Non-Profit or Faith Employer<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_73.1' value='Large Non-Profit or Faith Employer' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_73' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_73' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_73.2' id='ginput_base_price_1_73' class='gform_hidden' value='$300.00' aria-label='Large Non-Profit or Faith Employer Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_73.3' value='1' class='ginput_quantity_1_73 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_74\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_74 gfield_product_1_74 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_74\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_74_1' >Medium Non-Profit or Faith Employer<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_74.1' value='Medium Non-Profit or Faith Employer' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_74' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_74' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_74.2' id='ginput_base_price_1_74' class='gform_hidden' value='$150.00' aria-label='Medium Non-Profit or Faith Employer Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_74.3' value='1' class='ginput_quantity_1_74 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_63\"  class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-quarter hide gfield_price gfield_price_1_63 gfield_product_1_63 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_63\"><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_63_1' >Small Non-Profit or Faith Employer<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_63.1' value='Small Non-Profit or Faith Employer' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_1_63' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_1_63' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_63.2' id='ginput_base_price_1_63' class='gform_hidden' value='$50.00' aria-label='Small Non-Profit or Faith Employer Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_63.3' value='1' class='ginput_quantity_1_63 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_1_75\"  class=\"gfield gfield--type-total gfield--width-half show-label gfield_price gfield_price_1_ gfield_total gfield_total_1_ field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" data-js-reload=\"field_1_75\"><label class='gfield_label gform-field-label' for='input_1_75' >Total Amount Due<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_75' id='input_1_75' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_1' \/>\n\t\t\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_1_75'>Total Amount Due<\/div><\/div><fieldset id=\"field_1_79\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_79\"><legend class='gfield_label gform-field-label'  >Payment Option<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_79'>\n\t\t\t<div class='gchoice gchoice_1_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Credit Card via Paypal Online' checked='checked' id='choice_1_79_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_79\"   \/>\n\t\t\t\t\t<label for='choice_1_79_0' id='label_1_79_0' class='gform-field-label gform-field-label--type-inline'>Credit Card via Paypal Online<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Invoice (ACH)'  id='choice_1_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_79_1' id='label_1_79_1' class='gform-field-label gform-field-label--type-inline'>Invoice (ACH)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_79_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Invoice (check)'  id='choice_1_79_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_79_2' id='label_1_79_2' class='gform-field-label gform-field-label--type-inline'>Invoice (check)<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_79'>Choose from one of the following payment options.<\/div><\/fieldset><fieldset id=\"field_1_132\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_132\"><legend class='gfield_label gform-field-label'  >Use Primary Address for Invoice?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_132'>\n\t\t\t<div class='gchoice gchoice_1_132_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_132' type='radio' value='Yes'  id='choice_1_132_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_132\"   \/>\n\t\t\t\t\t<label for='choice_1_132_0' id='label_1_132_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_132_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_132' type='radio' value='No'  id='choice_1_132_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_132_1' id='label_1_132_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_132'>Please select yes or no.<\/div><\/fieldset><fieldset id=\"field_1_133\"  class=\"gfield gfield--type-address gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_133\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address for Invoice<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_133' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_133_1_container' >\n                                        <input type='text' name='input_133.1' id='input_1_133_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_133_1' id='input_1_133_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_133_2_container' >\n                                        <input type='text' name='input_133.2' id='input_1_133_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_133_2' id='input_1_133_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_133_3_container' >\n                                    <input type='text' name='input_133.3' id='input_1_133_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_133_3' id='input_1_133_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_133_4_container' >\n                                        <select name='input_133.4' id='input_1_133_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_1_133_4' id='input_1_133_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_133_5_container' >\n                                    <input type='text' name='input_133.5' id='input_1_133_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_133_5' id='input_1_133_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_133.6' id='input_1_133_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_1_133'>Please put in the address for the invoice to be sent to.<\/div><\/fieldset><fieldset id=\"field_1_84\"  class=\"gfield gfield--type-paypal gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gform_ppcp_custom_card_fields\"  data-field-class=\"gform_ppcp_custom_card_fields\" data-js-reload=\"field_1_84\"><legend class='gfield_label gfield_label_before_complex gform-field-label' for='input_1_84_1' >Credit Card Information<\/legend><div class='ginput_container ginput_container_select gform_ppcp_payment_method' style=\"display:none;\"><select name='input_84.6' id='input_84_6' class='medium gfield_select' ><option value='Credit Card' >Credit Card<\/option><\/select><\/div><div class='ginput_complex ginput_container ginput_container_custom_card_fields gform-grid-row' id='input_1_84' ><span class='ginput_full gform-grid-col' id='input_1_84_1_container' >\n                                    <div class='gform_card_icon_container gform_card_icon_style1'><div class='gform_card_icon gform_card_icon_amex' >American Express<\/div><div class='gform_card_icon gform_card_icon_discover' >Discover<\/div><div class='gform_card_icon gform_card_icon_mastercard' >MasterCard<\/div><div class='gform_card_icon gform_card_icon_visa' >Visa<\/div><span class='screen-reader-text' id='field_1_84_supported_creditcards'>Supported Credit Cards: American Express, Discover, MasterCard, Visa<\/span><\/div>\n                                    <span id='input_1_84_1' class='ginput_card_field ginput_card_number gform-theme-field-control'>Card Number<\/span>\n                                    <label for='input_1_84_1' id='input_1_84_1_label'  class='gform-field-label gform-field-label--type-sub'>Card Number<\/label>\n                                 <\/span><span class='ginput_full ginput_cardextras gform-grid-col gform-grid-row' id='input_1_84_2_container'>\n                                            <span class='ginput_cardinfo_left gform-grid-col' id='input_1_84_2_cardinfo_left'>\n                                                <span id='input_1_84_2' class='ginput_card_field ginput_card_expiration gform-theme-field-control'>Exp. Date<\/span>\n                                                <label for='input_1_84_2'  class='gform-field-label gform-field-label--type-sub'>Expiration Date<\/label>\n                                            <\/span><span class='ginput_cardinfo_right gform-grid-col' id='input_1_84_2_cardinfo_right'>\n                                                <span id='input_1_84_3' class='ginput_card_field ginput_card_security_code gform-theme-field-control'>Sec. Code<\/span>\n                                                <span class='ginput_card_security_code_icon'>&nbsp;<\/span>\n                                                <label for='input_1_84_3'  class='gform-field-label gform-field-label--type-sub'>Security Code<\/label>\n                                             <\/span>\n                                        <\/span> <\/div><\/fieldset><div id=\"field_1_83\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_83\"><div class=\"text large-text dk-blue bold\"><p>Please continue with application submission. Our team will follow up with an invoice for applicable fees.<\/p><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_143' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_143' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_7' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_7' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_57\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_57\"><h3 class=\"gsection_title\">Submission<\/h3><\/div><div id=\"field_1_47\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_47\">To conclude your application, please review the following and add your signature.<\/div><fieldset id=\"field_1_52\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full offset show-label gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_52\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >On behalf of the organization listed above, I affirm the following:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_52.1' id='input_1_52_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_52\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_52_1' >Yes<\/label><input type='hidden' name='input_52.2' value='Yes' class='gform_hidden' \/><input type='hidden' name='input_52.3' value='1' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_52'>The information provided in this application is true and accurate; information that would impact the consideration of this application is not being withheld. <br \/>\n<br \/>\nEmployer understands that Good Wages Initiative may ask to interview a sampling of employees and will work with Good Wages Initiative on this request.<br \/>\n<br \/>\nThis can include but is not limited to full-time employees, part-time employees, interns, apprentices, and employees with special considerations (e.g., tipped, commissioned, bonused, wage increase opt-outs). <br \/>\n<br \/>\nEmployer understands that Good Wages Initiative will provide employees and job applicants a means to express anonymous concerns about employer's wage floor. <br \/>\n<br \/>\nEmployer agrees that no retaliatory action will be taken against employees or job applicants who express concerns.<br \/>\n<br \/>\nEmployer understands that Certified status is contingent upon employer maintaining $18\/hr (or salary equivalent) wage floor for full-time employees and offering employer-sponsored health insurance for all full-time employees for the entirety of the two-year certification period. <br \/>\n<br \/>\nEmployer agrees to notify the Good Wages Initiative if our wages for full-time employees fall below the $18\/hour threshold.<br \/>\n<br \/>\nEmployer agrees to notify the Good Wages Initiative if we no longer offer employer-sponsored health insurance to full-time employees.<br \/>\n<br \/>\nIf granted certification employer will complete Biannual Employer reporting process, which may include completing reporting forms and interviews and providing requested employer data. <br \/>\n<br \/>\nIf granted certification employer will share status as a Good Wages Initiative Certified Employer with our employees. <br \/>\n<br \/>\nIf granted certification employer will share status as a Good Wages Initiative Certified Employer publicly (via social media, blog post, and\/or press release). <br \/>\n<br \/>\nEmployer understands that the good wages threshold of $18\/hour may change during the Certified period, which would require adjustments to employer wage floor in order to re-certify. <br \/>\n<br \/>\nEmployer name and logo may be used by Good Wages Initiative to promote employer\u2019s status and the Good Wages Initiative program. <br \/>\n<br \/>\nEmployer understands they may use the Good Wages Initiative name, taglines, hashtags, and logo set out in the GWI Toolkit for the purpose of promoting participation in the initiative. Examples of uses by employers may include display on: (a) signage or banners at a job fair or professional networking event; (b) websites, social media, press releases, brochures, or other outreach materials; (c) hiring statements and employee communications; and (d) grant applications, reports, and other fundraising materials.<br \/>\n<br \/>\nIn order to facilitate consistent Good Wages Initiative branding and messaging across platforms and participants, Employers agree to communicate about the initiative in accordance with the style guide and instructions provided by EmployIndy. The current style guide is included in the GWI Toolkit.<br \/>\n<br \/>\nEmployer agrees to promote and share marketing assets as directed by EmployIndy. This includes circulation through digital channels (i.e. social media) and physical avenues of engagement, such as the display of certificates in the workplace. <br \/>\n<br \/>\nEmployer recognizes that participation in Good Wages Initiative is a collaborative effort. Employers are encouraged to elevate any needs, challenges, questions, and\/or concerns, marketing or otherwise, as their participation evolves.<\/div><\/fieldset><fieldset id=\"field_1_48\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_48\"><legend class='gfield_label gform-field-label'  >Authorized by Employer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_48'>\n\t\t\t<div class='gchoice gchoice_1_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='Yes'  id='choice_1_48_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_48\"   \/>\n\t\t\t\t\t<label for='choice_1_48_0' id='label_1_48_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='No'  id='choice_1_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_48_1' id='label_1_48_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1_48'>Are you authorized to complete this application on behalf of the stated employer? Please select yes or no.<\/div><\/fieldset><div id=\"field_1_51\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_51\"><label class='gfield_label gform-field-label' for='input_1_51' >Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_1_51' type='text' value='' class='large' maxlength='50' aria-describedby=\"gfield_description_1_51\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_51'>Please type your full name.<\/div><\/div><div id=\"field_1_49\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_49\"><label class='gfield_label gform-field-label' for='input_1_49' >Your Initials<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_1_49' type='text' value='' class='small' maxlength='2' aria-describedby=\"gfield_description_1_49\"  placeholder='Your Initials' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_49'>Please type your first and last initial.<\/div><\/div><div id=\"field_1_85\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_85\">NOTE: This form contains several required fields. If you submit the form and do not receive a confirmation message, please double-check the entire form for missing field entries (there will be a note indicating missing field entries in red).<\/div><div id=\"field_1_144\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_144\"><label class='gfield_label gform-field-label' for='input_1_144' >Untitled<\/label><div class='ginput_container ginput_container_text'><input name='input_144' id='input_1_144' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  jQuery(\"#gform_1\").trigger(\"submit\",[true]); 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