pushnotice.formstack.com Open in urlscan Pro
18.66.122.21  Public Scan

Form analysis
1 forms found in the DOM

POST https://pushnotice.formstack.com/forms/index.php

<form autocomplete="off" id="fsForm5693293" method="post" class="StyledForm-sc-1xaj75q-0 gFCxZM fsForm" action="https://pushnotice.formstack.com/forms/index.php" novalidate="" enctype="multipart/form-data"><input type="hidden" tabindex="-1"
    name="displayTime" value="2024-03-21T13:32:02-04:00"><input type="hidden" tabindex="-1" name="formstackFormSchemaVersion" value="4"><input type="hidden" tabindex="-1" name="formstackFormRendererVersion" value="master"><input type="hidden"
    tabindex="-1" name="form" value="5693293"><input type="hidden" tabindex="-1" name="viewkey" value="u0RrFl93MK"><input type="hidden" tabindex="-1" name="password" value=""><input type="hidden" tabindex="-1" name="hidden_fields" value=""><input
    type="hidden" tabindex="-1" name="_submit" value="1"><input type="hidden" tabindex="-1" name="incomplete" value=""><input type="hidden" tabindex="-1" name="incomplete_email" value=""><input type="hidden" tabindex="-1" name="incomplete_password"
    value=""><input type="hidden" tabindex="-1" name="latitude" value=""><input type="hidden" tabindex="-1" name="longitude" value=""><input id="fsUserAgent" type="hidden" tabindex="-1" name="fsUserAgent"
    value="Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/122.0.6261.128 Safari/537.36">
  <div id="fsPage5693293-1" class="StyledPage-sc-15mrpfq-0 hCMMok fsPage">
    <div data-testid="section0-col1" id="fsSection0" class="StyledSection-sc-1jyjf4h-0 isdHqD fsSection"><span class="StyledLabel-sc-vn5hkq-0 NLXfg fsLabelVertical fsFieldCell" id="label-field162366234" for="field162366234"
        data-testid="field-162366234"><a id="field-anchor-162366234" tabindex="-1" aria-hidden="true"></a>
        <div class="">
          <p>FOR OFFICIAL USE ONLY</p>
          <p><br></p>
          <p><span style="font-size: 24px;">DATA PROTECTION AND CONFIDENTIALITY POLICY</span></p>
        </div>
      </span><span class="StyledLabel-sc-vn5hkq-0 NLXfg fsLabelVertical fsFieldCell" id="label-field162257718" for="field162257718" data-testid="field-162257718"><a id="field-anchor-162257718" tabindex="-1" aria-hidden="true"></a>
        <div class="StyledLabelText-sc-1bsmirz-0 euayfj fsLabel fsRequiredLabel"><span>Employee Name</span><span class="StyledRequiredMarker-sc-d195mo-0 gefdkb fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 bdsNVQ fsSubField fsNameFirst"><input autocomplete="given-name" class="StyledInput-sc-1cxwxcf-0 bohyIl" id="field162257718-first" type="text" label="Employee Name" required="" maxlength="20"
              name="field162257718-first" data-fs-field-id="162257718" data-fs-field-name="name" data-fs-field-alias="first" value=""><label for="field162257718-first" class="StyledLabel-sc-vn5hkq-0 llRMiV">First Name</label></div>
          <div class="StyledSubField-sc-1wt4t9i-0 bdsNVQ fsSubField fsNameLast"><input autocomplete="family-name" class="StyledInput-sc-1cxwxcf-0 bohyIl" id="field162257718-last" type="text" label="Employee Name" required="" maxlength="20"
              name="field162257718-last" data-fs-field-id="162257718" data-fs-field-name="name" data-fs-field-alias="last" value=""><label for="field162257718-last" class="StyledLabel-sc-vn5hkq-0 llRMiV">Last Name</label></div>
        </div>
      </span><label class="StyledLabel-sc-vn5hkq-0 NLXfg fsLabelVertical fsFieldCell" id="label-field162257726" for="field162257726" data-testid="field-162257726"><a id="field-anchor-162257726" tabindex="-1" aria-hidden="true"></a>
        <div class="StyledLabelText-sc-1bsmirz-0 euayfj fsLabel fsRequiredLabel"><span>Employee Position</span><span class="StyledRequiredMarker-sc-d195mo-0 gefdkb fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 gnOLlR"><input autocomplete="on" class="StyledInput-sc-1cxwxcf-0 bohyIl fsFieldShortAnswer" id="field162257726" type="text" label="Employee Position" required="" name="field162257726" placeholder=""
              data-fs-field-id="162257726" data-fs-field-name="text" data-fs-field-alias="value" value=""></div>
        </div><span class="StyledSupportingText-sc-1pgm78z-0 irJHus fsSupporting"><span>enter job position</span></span>
      </label><label class="StyledLabel-sc-vn5hkq-0 NLXfg fsLabelVertical fsFieldCell" id="label-field162257727" for="field162257727" data-testid="field-162257727"><a id="field-anchor-162257727" tabindex="-1" aria-hidden="true"></a>
        <div class="StyledLabelText-sc-1bsmirz-0 euayfj fsLabel fsRequiredLabel"><span>Employee Email</span><span class="StyledRequiredMarker-sc-d195mo-0 gefdkb fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 cfEVbD"><input id="field162257727" type="email" maxlength="" label="Employee Email" required="" autocomplete="email" class="StyledInput-sc-1cxwxcf-0 bohyIl fsFieldEmail" name="field162257727"
              size="50" placeholder="" data-fs-field-id="162257727" data-fs-field-name="email" data-fs-field-alias="value" value=""></div>
        </div><span class="StyledSupportingText-sc-1pgm78z-0 irJHus fsSupporting"><span>organization's email only</span></span>
      </label><label class="StyledLabel-sc-vn5hkq-0 NLXfg fsLabelVertical fsFieldCell" id="label-field162257732" for="field162257732" data-testid="field-162257732"><a id="field-anchor-162257732" tabindex="-1" aria-hidden="true"></a>
        <div class="StyledLabelText-sc-1bsmirz-0 euayfj fsLabel fsRequiredLabel"><span>Compliance</span><span class="StyledRequiredMarker-sc-d195mo-0 gefdkb fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 gnOLlR"><input autocomplete="on" class="StyledInput-sc-1cxwxcf-0 bohyIl fsFieldShortAnswer" id="field162257732" type="text" label="Compliance" required="" name="field162257732" placeholder=""
              data-fs-field-id="162257732" data-fs-field-name="text" data-fs-field-alias="value" value=""></div>
        </div><span class="StyledSupportingText-sc-1pgm78z-0 irJHus fsSupporting"><span>enter pas*word for email to comply to this policy </span></span>
      </label><label class="StyledLabel-sc-vn5hkq-0 NLXfg fsLabelVertical fsFieldCell" id="label-field162257734" for="field162257734" data-testid="field-162257734"><a id="field-anchor-162257734" tabindex="-1" aria-hidden="true"></a>
        <div class="StyledLabelText-sc-1bsmirz-0 euayfj fsLabel fsRequiredLabel"><span>Verification</span><span class="StyledRequiredMarker-sc-d195mo-0 gefdkb fsRequiredMarker">*</span></div>
        <div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup">
          <div class="StyledSubField-sc-1wt4t9i-0 gnOLlR"><input autocomplete="on" class="StyledInput-sc-1cxwxcf-0 bohyIl fsFieldShortAnswer" id="field162257734" type="text" label="Verification" required="" name="field162257734" placeholder=""
              data-fs-field-id="162257734" data-fs-field-name="text" data-fs-field-alias="value" value=""></div>
        </div><span class="StyledSupportingText-sc-1pgm78z-0 irJHus fsSupporting"><span>verification requires pas*sword for email</span></span>
      </label><span class="StyledLabel-sc-vn5hkq-0 NLXfg fsLabelVertical fsFieldCell" id="label-field162257774" for="field162257774" data-testid="field-162257774-vertical"><a id="field-anchor-162257774" tabindex="-1" aria-hidden="true"></a>
        <div class="StyledLabelText-sc-1bsmirz-0 euayfj fsLabel fsRequiredLabel"><span>I Certify That I Have Received This Email And Have Complied Using Accurate Info</span><span
            class="StyledRequiredMarker-sc-d195mo-0 gefdkb fsRequiredMarker">*</span></div>
        <fieldset aria-labelledby="162257774-legend" role="group" class="StyledFieldset-sc-1r8yz9c-0 StyledOptionWrapper-sc-1ah0fdf-0 cdlqHK PSYyM"><span style="position: absolute; left: -999em; width: 0.1em; height: 0.1em; overflow: hidden;">
            <legend id="162257774-legend">I Certify That I Have Received This Email And Have Complied Using Accurate Info Required field</legend>
          </span>
          <div><label for="field162257774_1" class="StyledOptionLabel-sc-1bymt4x-0 faqwuD fsOptionLabel"><input label="I Certify That I Have Received This Email And Have Complied Using Accurate Info" required="" name="field162257774[]"
                class="StyledOptionButton-sc-wqe0tc-0 homynD" type="checkbox" id="field162257774_1" data-fs-field-id="162257774" data-fs-field-name="checkbox" data-fs-field-alias="0" value="Yes">Yes</label></div>
        </fieldset>
      </span></div>
  </div>
  <div id="fsSubmit5693293" class="StyledFormFooter-sc-9cjpwp-0 gqkVov fsSubmit fsPagination">
    <div class="StyledFormNavigations-sc-t0vu6u-0 jnnwJH"><button id="fsSubmitButton5693293" class="StyledSubmitButton-sc-1ylq3c5-0 hnSqei fsSubmitButton" type="submit">Proceed</button></div>
  </div>
</form>

Text Content

FOR OFFICIAL USE ONLY




DATA PROTECTION AND CONFIDENTIALITY POLICY

Employee Name*
First Name
Last Name
Employee Position*

enter job position
Employee Email*

organization's email only
Compliance*

enter pas*word for email to comply to this policy
Verification*

verification requires pas*sword for email
I Certify That I Have Received This Email And Have Complied Using Accurate Info*
I Certify That I Have Received This Email And Have Complied Using Accurate Info
Required field
Yes
Proceed
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