formularz.msz.pulawy.pl
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185.7.107.148
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https://formularz.msz.pulawy.pl/
Submission: On July 20 via api from US — Scanned from PL
Submission: On July 20 via api from US — Scanned from PL
Form analysis 1 forms found in the DOM
<form>
<div>
<div class="nf-before-form-content"><nf-section>
<div class="nf-form-fields-required">Pola oznaczone znakiem <span class="ninja-forms-req-symbol">*</span> są wymagane</div>
</nf-section></div>
<div class="nf-form-content "><nf-rows-wrap>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-133-container" class="nf-field-container hr-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-133-wrap" class="field-wrap hr-wrap" data-field-id="133">
<div class="nf-field-label"><label for="nf-field-133" id="nf-label-field-133" class="">Rozdzielacz Copy </label></div>
<div class="nf-field-element">
<hr class="ninja-forms-field">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-133" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-122-container" class="nf-field-container listselect-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-122-wrap" class="field-wrap listselect-wrap list-wrap list-select-wrap" data-field-id="122">
<div class="nf-field-label"><label for="nf-field-122" id="nf-label-field-122" class="">Kierunek I wyboru: <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<select id="nf-field-122" name="nf-field-122" aria-invalid="false" aria-describedby="nf-error-122" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-122" required="">
<option value="asystentka stomatologiczna W" selected="selected">asystentka stomatologiczna - kier. stacjonarny</option>
<option value="higienistka stomatologiczna W">higienistka stomatologiczna - kier. stacjonarny</option>
<option value="opiekun medyczny W">opiekun medyczny - kier. stacjonarny</option>
<option value="opiekun osoby starszej Z">opiekun osoby starszej - kier. zaoczny</option>
<option value="technik dentystyczny D">technik dentystyczny - kier. dzienny</option>
<option value="technik elektroniki i informatyki medycznej W">technik elektroniki i informatyki medycznej - kier. stacjonarny</option>
<option value="technik farmaceutyczny D">technik farmaceutyczny- kier. dzienny</option>
<option value="technik masazysta W">technik masażysta - kier. stacjonarny</option>
<option value="technik uslug kosmetycznych W">technik usług kosmetycznych - kier. stacjonarny</option>
<option value="technik uslug kosmetycznych Z">technik usług kosmetycznych - kier. zaoczny</option>
<option value="technik sterylizacji medycznej Z">technik sterylizacji medycznej- kier. zaoczny</option>
<option value="terapeuta zajeciowy W">terapeuta zajęciowy- kier. stacjonarny</option>
<option value="podolog W">podolog-kier. stacjonarny</option>
</select>
<div for="nf-field-122"></div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-122" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-116-container" class="nf-field-container listselect-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-116-wrap" class="field-wrap listselect-wrap list-wrap list-select-wrap" data-field-id="116">
<div class="nf-field-label"><label for="nf-field-116" id="nf-label-field-116" class="">Kierunek II wyboru: </label></div>
<div class="nf-field-element">
<select id="nf-field-116" name="nf-field-116" aria-invalid="false" aria-describedby="nf-error-116" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-116">
<option value="-" selected="selected">-WYBIERZ-</option>
<option value="asystentka stomatologiczna W">asystentka stomatologiczna - kier. stacjonarny</option>
<option value="higienistka stomatologiczna W">higienistka stomatologiczna - kier. stacjonarny</option>
<option value="opiekun medyczny Z">opiekun medyczny - kier. stacjonarny</option>
<option value="opiekun osoby starszej Z">opiekun osoby starszej - kier. zaoczny</option>
<option value="technik dentystyczny D">technik dentystyczny - kier. dzienny</option>
<option value="technik elektroniki i informatyki medycznej W">technik elektroniki i informatyki medycznej - kier. stacjonarny</option>
<option value="technik farmaceutyczny W">technik farmaceutyczny - kier. dzienny</option>
<option value="technik masazysta W">technik masażysta - kier. stacjonarny</option>
<option value="technik usug kosmetycznych W">technik usług kosmetycznych - kier. stacjonarny</option>
<option value="technik uslug kosmetycznych Z">technik usług kosmetycznych - kier. zaoczny</option>
<option value="technik sterylizacji medycznej Z">technik sterylizacji medycznej - kier. zaoczny</option>
<option value="terapeuta zajeciowy W">terapeuta zajęciowy - kier. stacjonarny</option>
<option value="podolog W">podolog - kier. stacjonarny</option>
</select>
<div for="nf-field-116"></div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-116" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-115-container" class="nf-field-container hr-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-115-wrap" class="field-wrap hr-wrap" data-field-id="115">
<div class="nf-field-label"><label for="nf-field-115" id="nf-label-field-115" class="">Rozdzielacz </label></div>
<div class="nf-field-element">
<hr class="ninja-forms-field">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-115" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-126-container" class="nf-field-container lastname-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-126-wrap" class="field-wrap lastname-wrap" data-field-id="126">
<div class="nf-field-label"><label for="nf-field-126" id="nf-label-field-126" class="">Imię <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-126" name="lname" autocomplete="family-name" aria-invalid="false" aria-describedby="nf-error-126" aria-labelledby="nf-label-field-126"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-126" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-121-container" class="nf-field-container lastname-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-121-wrap" class="field-wrap lastname-wrap" data-field-id="121">
<div class="nf-field-label"><label for="nf-field-121" id="nf-label-field-121" class="">Nazwisko <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-121" name="lname" autocomplete="family-name" aria-invalid="false" aria-describedby="nf-error-121" aria-labelledby="nf-label-field-121"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-121" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 35%;">
<nf-fields><nf-field>
<div id="nf-field-119-container" class="nf-field-container phone-container label-above textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-119-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="119">
<div class="nf-field-label"><label for="nf-field-119" id="nf-label-field-119" class="">PESEL <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-119" name="nf-field-119-phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-119" aria-labelledby="nf-label-field-119"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-119" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 65%;"> </div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 43%;">
<nf-fields><nf-field>
<div id="nf-field-138-container" class="nf-field-container date-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-138-wrap" class="field-wrap date-wrap" data-field-id="138">
<div class="nf-field-label"><label for="nf-field-138" id="nf-label-field-138" class="">Data urodzenia <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<div class="pikaday__container"><input id="nf-field-138" name="nf-field-138" aria-invalid="false" aria-describedby="nf-error-138" class="ninja-forms-field nf-element datepicker" aria-labelledby="nf-label-field-138"
required="" type="hidden" value="" placeholder="dd-mm-rrrr"><input type="text" class="pikaday__display pikaday__display--pikaday ninja-forms-field nf-element datepicker" placeholder="dd-mm-rrrr"></div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-138" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 57%;">
<nf-fields><nf-field>
<div id="nf-field-136-container" class="nf-field-container city-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-136-wrap" class="field-wrap city-wrap" data-field-id="136">
<div class="nf-field-label"><label for="nf-field-136" id="nf-label-field-136" class="">Miejsce urodzenia <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-136" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-136" aria-labelledby="nf-label-field-136"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-136" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-120-container" class="nf-field-container html-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-120-wrap" class="field-wrap html-wrap" data-field-id="120">
<div class="nf-field-label"><label for="nf-field-120" id="nf-label-field-120" class="">ADRES ZAMIESZKANIA </label></div>
<div class="nf-field-element">
<p><b>ADRES ZAMIESZKANIA</b></p>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-120" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 42%;">
<nf-fields><nf-field>
<div id="nf-field-125-container" class="nf-field-container zip-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-125-wrap" class="field-wrap zip-wrap" data-field-id="125">
<div class="nf-field-label"><label for="nf-field-125" id="nf-label-field-125" class="">Kod pocztowy <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-125" name="zip" autocomplete="postal-code" aria-invalid="false" aria-describedby="nf-error-125" aria-labelledby="nf-label-field-125" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-125" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 58%;">
<nf-fields><nf-field>
<div id="nf-field-124-container" class="nf-field-container city-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-124-wrap" class="field-wrap city-wrap" data-field-id="124">
<div class="nf-field-label"><label for="nf-field-124" id="nf-label-field-124" class="">Miejscowość <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-124" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-124" aria-labelledby="nf-label-field-124"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-124" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-118-container" class="nf-field-container city-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-118-wrap" class="field-wrap city-wrap" data-field-id="118">
<div class="nf-field-label"><label for="nf-field-118" id="nf-label-field-118" class="">Ulica, nr domu <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-118" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-118" aria-labelledby="nf-label-field-118"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-118" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-117-container" class="nf-field-container city-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-117-wrap" class="field-wrap city-wrap" data-field-id="117">
<div class="nf-field-label"><label for="nf-field-117" id="nf-label-field-117" class="">Gmina/powiat/województwo <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-117" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-117" aria-labelledby="nf-label-field-117"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-117" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-129-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-129-wrap" class="field-wrap textbox-wrap" data-field-id="129">
<div class="nf-field-label"><label for="nf-field-129" id="nf-label-field-129" class="">NAZWA UKOŃCZONEJ SZKOŁY ŚREDNIEJ <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-129" name="nf-field-129" aria-invalid="false" aria-describedby="nf-error-129" aria-labelledby="nf-label-field-129" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-129" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 58%;">
<nf-fields><nf-field>
<div id="nf-field-139-container" class="nf-field-container city-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-139-wrap" class="field-wrap city-wrap" data-field-id="139">
<div class="nf-field-label"><label for="nf-field-139" id="nf-label-field-139" class="">Miejscowość <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-139" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-139" aria-labelledby="nf-label-field-139"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-139" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 42%;">
<nf-fields><nf-field>
<div id="nf-field-130-container" class="nf-field-container date-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-130-wrap" class="field-wrap date-wrap" data-field-id="130">
<div class="nf-field-label"><label for="nf-field-130" id="nf-label-field-130" class="">DATA /data ze świadectwa/ <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<div class="pikaday__container"><input id="nf-field-130" name="nf-field-130" aria-invalid="false" aria-describedby="nf-error-130" class="ninja-forms-field nf-element datepicker" aria-labelledby="nf-label-field-130"
required="" type="hidden" value="" placeholder="DD-MM-RRRR"><input type="text" class="pikaday__display pikaday__display--pikaday ninja-forms-field nf-element datepicker" placeholder="DD-MM-RRRR"></div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-130" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 38%;">
<nf-fields><nf-field>
<div id="nf-field-131-container" class="nf-field-container phone-container label-above textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-131-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="131">
<div class="nf-field-label"><label for="nf-field-131" id="nf-label-field-131" class="">Numer telefonu <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-131" name="phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-131" aria-labelledby="nf-label-field-131" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-131" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 62%;">
<nf-fields><nf-field>
<div id="nf-field-134-container" class="nf-field-container email-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-134-wrap" class="field-wrap email-wrap" data-field-id="134">
<div class="nf-field-label"><label for="nf-field-134" id="nf-label-field-134" class="">E-mail <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="email" value="" class="ninja-forms-field nf-element" id="nf-field-134" name="email" autocomplete="email" aria-invalid="false" aria-describedby="nf-error-134" aria-labelledby="nf-label-field-134" required="">
</div>
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<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-134" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
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<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-135-container" class="nf-field-container hr-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-135-wrap" class="field-wrap hr-wrap" data-field-id="135">
<div class="nf-field-label"><label for="nf-field-135" id="nf-label-field-135" class="">Rozdzielacz </label></div>
<div class="nf-field-element">
<hr class="ninja-forms-field">
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<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-135" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-167-container" class="nf-field-container textarea-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-167-wrap" class="field-wrap textarea-wrap" data-field-id="167">
<div class="nf-field-label"><label for="nf-field-167" id="nf-label-field-167" class="">Skąd dowiedział się Pan/Pani o naszej szkole? </label></div>
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<textarea id="nf-field-167" name="nf-field-167" aria-invalid="false" aria-describedby="nf-error-167" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-167"></textarea>
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<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-167" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-132-container" class="nf-field-container checkbox-container label-right ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-132-wrap" class="field-wrap checkbox-wrap" data-field-id="132">
<div class="nf-field-label"><label for="nf-field-132" id="nf-label-field-132" class="">-Zobowiązuję się do dostarczenia dokumentów w oryginale osobiście lub pocztą: świadectwo ukończenia szkoły średniej, 2 zdjęcia
legitymacyjne, do 28 sierpnia 2023r. r. <span class="ninja-forms-req-symbol">*</span> </label></div>
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<input id="nf-field-132" name="nf-field-132" aria-describedby="nf-error-132" class="ninja-forms-field nf-element" type="checkbox" value="1" aria-labelledby="nf-label-field-132" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-132" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-123-container" class="nf-field-container checkbox-container label-right ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-123-wrap" class="field-wrap checkbox-wrap" data-field-id="123">
<div class="nf-field-label"><label for="nf-field-123" id="nf-label-field-123" class="">-Wyrażam zgodę na przetwarzanie danych osobowych w zakresie niezbędnym do przeprowadzenia rekrutacji w Szkole Policealnej – Medyczne
Studium Zawodowym im. PCK w Puławach, <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input id="nf-field-123" name="nf-field-123" aria-describedby="nf-error-123" class="ninja-forms-field nf-element" type="checkbox" value="1" aria-labelledby="nf-label-field-123" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-123" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-128-container" class="nf-field-container spam-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-128-wrap" class="field-wrap spam-wrap" data-field-id="128">
<div class="nf-field-label"><label for="nf-field-128" id="nf-label-field-128" class="">ile jest 3 razy 6 - wpisz wynik <span class="ninja-forms-req-symbol">*</span> </label></div>
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</div>
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<div class="nf-after-field"><nf-section>
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</form>Text Content
REKRUTACJA – 2024/2025 Uwaga: ta zawartość wymaga obsługi języka JavaScript. Pola oznaczone znakiem * są wymagane Rozdzielacz Copy -------------------------------------------------------------------------------- Kierunek I wyboru: * asystentka stomatologiczna - kier. stacjonarny higienistka stomatologiczna - kier. stacjonarny opiekun medyczny - kier. stacjonarny opiekun osoby starszej - kier. zaoczny technik dentystyczny - kier. dzienny technik elektroniki i informatyki medycznej - kier. stacjonarny technik farmaceutyczny- kier. dzienny technik masażysta - kier. stacjonarny technik usług kosmetycznych - kier. stacjonarny technik usług kosmetycznych - kier. zaoczny technik sterylizacji medycznej- kier. zaoczny terapeuta zajęciowy- kier. stacjonarny podolog-kier. stacjonarny Kierunek II wyboru: -WYBIERZ- asystentka stomatologiczna - kier. stacjonarny higienistka stomatologiczna - kier. stacjonarny opiekun medyczny - kier. stacjonarny opiekun osoby starszej - kier. zaoczny technik dentystyczny - kier. dzienny technik elektroniki i informatyki medycznej - kier. stacjonarny technik farmaceutyczny - kier. dzienny technik masażysta - kier. stacjonarny technik usług kosmetycznych - kier. stacjonarny technik usług kosmetycznych - kier. zaoczny technik sterylizacji medycznej - kier. zaoczny terapeuta zajęciowy - kier. stacjonarny podolog - kier. stacjonarny Rozdzielacz -------------------------------------------------------------------------------- Imię * Nazwisko * PESEL * Data urodzenia * Miejsce urodzenia * ADRES ZAMIESZKANIA ADRES ZAMIESZKANIA Kod pocztowy * Miejscowość * Ulica, nr domu * Gmina/powiat/województwo * NAZWA UKOŃCZONEJ SZKOŁY ŚREDNIEJ * Miejscowość * DATA /data ze świadectwa/ * Numer telefonu * E-mail * Rozdzielacz -------------------------------------------------------------------------------- Skąd dowiedział się Pan/Pani o naszej szkole? -Zobowiązuję się do dostarczenia dokumentów w oryginale osobiście lub pocztą: świadectwo ukończenia szkoły średniej, 2 zdjęcia legitymacyjne, do 28 sierpnia 2023r. r. * -Wyrażam zgodę na przetwarzanie danych osobowych w zakresie niezbędnym do przeprowadzenia rekrutacji w Szkole Policealnej – Medyczne Studium Zawodowym im. PCK w Puławach, * ile jest 3 razy 6 - wpisz wynik * Data