forms.schoolsourcetech.com
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52.73.134.83
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https://forms.schoolsourcetech.com/res/workflowContinue?EParam=jFMIig1ZP56GBl8ST-B2SjiYlmtatDLbxIlXrYVWlIq1wUJh8A1oEgNcZ_NsBFjwtOFu...
Submission: On January 05 via manual from US — Scanned from DE
Submission: On January 05 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://forms.schoolsourcetech.com/res/submit
<form method="post" id="FSForm" action="https://forms.schoolsourcetech.com/res/submit" enctype="application/x-www-form-urlencoded" onsubmit="return Vromansys.Form.processSubmit(this);">
<div style="display:none">
<input type="hidden" name="GenId" value="W5N2c0OPh6iBWtuU">
<input type="hidden" name="LocId" value="comsewogue/pggtagjhph">
<input type="hidden" name="EParam" value="AT1kKIiyxDydZQTpLdwf3KeLTfEDMMCuYMFtsf8TukK1U1x6l9ralRzWwJR6wNT0vZP9dpQKLgC9Q4edV-QvqBc6VAmcJw56">
<input type="hidden" name="ElapsedTime" id="ElapsedTime" value="0">
<input type="hidden" name="Referrer" id="Referrer" value="">
<input type="text" name="subject_line" id="subject_line" autocomplete="off"><label for="subject_line">subject_line</label>
</div>
<!-- BEGIN_ITEMS -->
<div class="form_table">
<div class="clear"></div>
<div id="q19" class="q full_width">
<a class="item_anchor" name="ItemAnchor0"></a>
<div class="full_width_space">
<div style="text-align: center;"> </div>
<div style="text-align: center;"><img src="https://www.comsewogue.k12.ny.us/UserFiles/Servers/Server_60149/Image/Logos/footer-logo-300.png" alt="Comsewogue Logo" width="150" height="150"></div>
</div>
</div>
<div class="clear"></div>
<div id="q1" class="q full_width">
<a class="item_anchor" name="ItemAnchor1"></a>
<div class="segment_header" style="background:#CC0000;width:auto;text-align:Center;">
<h1 style="font-weight:bold;font-size:24px;padding:20px 1em ;">Sick Day Confirmation</h1>
</div>
</div>
<div class="clear"></div>
<div id="q20" class="q read_only">
<a class="item_anchor" name="ItemAnchor2"></a>
<label class="question top_question" for="RESULT_TextField-2">Reference Number</label>
<input type="text" name="RESULT_TextField-2" class="text_field read_only" id="RESULT_TextField-2" size="25" disabled="" value="SD-1163363">
</div>
<div class="clear"></div>
<div id="q12" class="q required read_only">
<a class="item_anchor" name="ItemAnchor3"></a>
<label class="question top_question" for="RESULT_TextField-3">Today's Date <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-3" disabled="" class="text_field calendar_field read_only" id="RESULT_TextField-3" size="10" maxlength="10" date="mm/dd/yy" datemax="" datemin="" value="01/05/2023">
</div>
<div id="q17" class="q required read_only">
<a class="item_anchor" name="ItemAnchor4"></a>
<label class="question top_question" for="RESULT_RadioButton-4">Requester <b class="icon_required" style="color:#F00">*</b></label>
<select id="RESULT_RadioButton-4" name="RESULT_RadioButton-4" class="drop_down read_only" disabled="">
<option></option>
<option value="Radio-0">Briana Gaudino (District Office)</option>
<option value="Radio-1">Christine Marchese (CHS)</option>
<option value="Radio-2">Jennifer Moran (JFK)</option>
<option value="Radio-3">Mary Lund (Boyle)</option>
<option value="Radio-4" selected="">Wendy Rosario (Terryville)</option>
<option value="Radio-5">Carmela Werner (Clinton)</option>
<option value="Radio-6">Giovanna DiGiovanna (Norwood)</option>
<option value="Radio-7">Toni Petrone (Norwood)</option>
<option value="Radio-8">Doreen Burke (Food Services)</option>
<option value="Radio-9">Iris Heller (Buildings & Grounds)</option>
</select>
</div>
<div class="clear"></div>
<div id="q2" class="q required read_only">
<a class="item_anchor" name="ItemAnchor5"></a>
<label class="question top_question" for="RESULT_TextField-5">Name of Employee Who Was Sick <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-5" class="text_field read_only" id="RESULT_TextField-5" size="30" disabled="" value="Stacey McCumiskey">
</div>
<div id="q10" class="q required read_only">
<a class="item_anchor" name="ItemAnchor6"></a>
<label class="question top_question" for="RESULT_TextField-6">Email Address of Employee Who Was Sick <b class="icon_required" style="color:#F00">*</b></label>
<input type="email" name="RESULT_TextField-6" class="text_field read_only" id="RESULT_TextField-6" size="30" disabled="" value="smccumiskey@comsewogue.k12.ny.us">
</div>
<div class="clear"></div>
<div id="q21" class="q read_only">
<a class="item_anchor" name="ItemAnchor7"></a>
<span class="question top_question">Select One:</span>
<table class="inline_grid choices">
<tbody>
<tr>
<td><input type="radio" name="RESULT_RadioButton-7" class="multiple_choice read_only" id="RESULT_RadioButton-7_0" value="Radio-0" disabled=""><label for="RESULT_RadioButton-7_0">Date Range</label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-7" class="multiple_choice read_only" id="RESULT_RadioButton-7_1" value="Radio-1" checked="" disabled=""><label for="RESULT_RadioButton-7_1">Individual Dates</label></td>
</tr>
</tbody>
</table>
</div>
<div class="clear"></div>
<div id="q13" class="q required read_only">
<a class="item_anchor" name="ItemAnchor8"></a>
<label class="question top_question" for="RESULT_TextField-8">Number of Days Charged <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-8" class="text_field read_only" id="RESULT_TextField-8" size="10" disabled="" value="2">
</div>
<div id="q6" class="q required read_only display_hidden">
<a class="item_anchor" name="ItemAnchor9"></a>
<label class="question top_question" for="RESULT_TextField-9">Starting On <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-9" disabled="" class="text_field calendar_field read_only" id="RESULT_TextField-9" size="10" maxlength="10" date="mm/dd/yy" datemax="" datemin="" disabledays="0,6" value="">
</div>
<div id="q7" class="q required read_only display_hidden">
<a class="item_anchor" name="ItemAnchor10"></a>
<label class="question top_question" for="RESULT_TextField-10">Ending On <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-10" disabled="" class="text_field calendar_field read_only" id="RESULT_TextField-10" size="10" maxlength="10" date="mm/dd/yy" datemax="" datemin="" disabledays="0,6" value="">
</div>
<div class="clear"></div>
<div id="q22" class="q required read_only">
<a class="item_anchor" name="ItemAnchor11"></a>
<label class="question top_question" for="RESULT_TextField-11">Date #1 <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-11" disabled="" class="text_field calendar_field read_only" id="RESULT_TextField-11" size="10" maxlength="10" date="mm/dd/yy" datemax="" datemin="" disabledays="0,6" value="12/12/2022">
</div>
<div id="q23" class="q read_only">
<a class="item_anchor" name="ItemAnchor12"></a>
<label class="question top_question" for="RESULT_TextField-12">Date #2</label>
<input type="text" name="RESULT_TextField-12" disabled="" class="text_field calendar_field read_only" id="RESULT_TextField-12" size="10" maxlength="10" date="mm/dd/yy" datemax="" datemin="" disabledays="0,6" value="12/16/2022">
</div>
<div id="q24" class="q read_only">
<a class="item_anchor" name="ItemAnchor13"></a>
<label class="question top_question" for="RESULT_TextField-13">Date #3</label>
<input type="text" name="RESULT_TextField-13" disabled="" class="text_field calendar_field read_only" id="RESULT_TextField-13" size="10" maxlength="10" date="mm/dd/yy" datemax="" datemin="" disabledays="0,6" value="">
</div>
<div id="q25" class="q read_only">
<a class="item_anchor" name="ItemAnchor14"></a>
<label class="question top_question" for="RESULT_TextField-14">Date #4</label>
<input type="text" name="RESULT_TextField-14" disabled="" class="text_field calendar_field read_only" id="RESULT_TextField-14" size="10" maxlength="10" date="mm/dd/yy" datemax="" datemin="" disabledays="0,6" value="">
</div>
<div class="clear"></div>
<div id="q15" class="q full_width">
<a class="item_anchor" name="ItemAnchor15"></a>
<div class="segment_header" style="background:#CC0000;width:auto;text-align:Left;">
<h1 style="font-weight:bold;font-size:20px;padding:10px 1em ;">Employee Signature</h1>
</div>
</div>
<div class="clear"></div>
<div id="q18" class="q required read_only">
<a class="item_anchor" name="ItemAnchor16"></a>
<label class="question top_question" for="RESULT_TextField-16">Date Signed by Employee <b class="icon_required" style="color:#F00">*</b></label>
<input type="text" name="RESULT_TextField-16" disabled="" class="text_field calendar_field read_only" id="RESULT_TextField-16" size="10" maxlength="10" date="mm/dd/yy" datemax="" datemin="" value="01/05/2023">
</div>
<div class="clear"></div>
<div id="q14" class="q required">
<a class="item_anchor" name="ItemAnchor17"></a>
<span class="question top_question">I confirm that I was absent on the day(s) listed above and I will be charged 2 sick day(s). <b class="icon_required" style="color:#F00">*</b></span>
<input type="hidden" name="RESULT_TextField-17_30" id="RESULT_TextField-17_30" value="">
<input type="hidden" name="RESULT_TextField-17_SVG" id="RESULT_TextField-17_SVG" value="">
<div class="signature text_field">
<div>
<div style="padding:0 !important;margin:0 !important;width: 100% !important; height: 0 !important;margin-top:-1em !important;margin-bottom:1em !important;"></div><canvas class="jSignature" width="550"
style="margin: 0px; padding: 0px; border: none; height: 138px; width: 100%;" height="138"></canvas>
<div style="padding:0 !important;margin:0 !important;width: 100% !important; height: 0 !important;margin-top:-1.5em !important;margin-bottom:1.5em !important;"></div>
</div>
</div>
<div class="signature_clear"><span>clear</span></div>
</div>
<div class="clear"></div>
</div>
<!-- END_ITEMS -->
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<input type="hidden" name="EParam" value="x8J1JeDzqXY6pLBAue8ASz9dEeu44yq6WLqPdM6ujArzc1aUhJd5BP7IDL3pzwSjLLaLMfv87ES6qICYGRBMSJdaiFj4QDw2">
<div class="outside_container">
<div class="buttons_reverse"><input type="submit" name="Submit" value="Submit" class="submit_button" id="FSsubmit"><input type="submit" name="SavePartialWork" value="Save Progress" class="submit_button" id="FSsavePartialWork"></div>
</div>
</form>Text Content
subject_line SICK DAY CONFIRMATION Reference Number Today's Date * Requester * Briana Gaudino (District Office) Christine Marchese (CHS) Jennifer Moran (JFK) Mary Lund (Boyle) Wendy Rosario (Terryville) Carmela Werner (Clinton) Giovanna DiGiovanna (Norwood) Toni Petrone (Norwood) Doreen Burke (Food Services) Iris Heller (Buildings & Grounds) Name of Employee Who Was Sick * Email Address of Employee Who Was Sick * Select One: Date Range Individual Dates Number of Days Charged * Starting On * Ending On * Date #1 * Date #2 Date #3 Date #4 EMPLOYEE SIGNATURE Date Signed by Employee * I confirm that I was absent on the day(s) listed above and I will be charged 2 sick day(s). * clear