sunicks-agora.digitaljobler.com Open in urlscan Pro
52.20.144.10  Public Scan

Form analysis
1 forms found in the DOM

Name: application_frm — POST

<form class="kt-form" method="post" action="" name="application_frm" novalidate="novalidate" id="kt_login_form">
  <input type="hidden" name="_token" value="TXzhQmXXQGTBIBDHP8xiWRE24CExJvWIKffUz4R1">
  <div class="row">
    <div class="col-lg-4 form-group">
      <label>First Name: *</label>
      <input class="form-control" type="text" value="" placeholder="First name" name="first_name" required="">
    </div>
    <div class="col-lg-4 form-group">
      <label>Last Name: *</label>
      <input class="form-control" type="text" value="" placeholder="Last Name" name="last_name" required="">
    </div>
    <div class="col-lg-4 form-group">
      <label>Age: </label>
      <input class="form-control" type="number" min="1" value="" placeholder="Age" name="age">
    </div>
  </div>
  <div class="row">
    <div class="col-lg-4 form-group">
      <label>Email: *</label>
      <input class="form-control" type="email" value="" placeholder="Email" name="email" required="">
    </div>
    <div class="col-lg-4 form-group">
      <label>Mobile Number: *</label>
      <input type="text" class="form-control" id="phone_number" name="phone_number" value="" placeholder="Enter phone number (xxx-xxx-xxxx)">
    </div>
    <div class="col-lg-4 form-group">
      <label>Investable Assets:</label>
      <select name="assets" class="form-control">
        <option value="">Please select</option>
        <option value="0-99000">$0 - $99,000</option>
        <option value="100000-249000">$100,000 - $249,000</option>
        <option value="250000-499000">$250,000 - $499,000</option>
        <option value="500000-0">$500,000 + </option>
      </select>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-4 form-group">
      <label>Timezone: *</label>
      <select name="timezone" class="form-control timezone" id="kt_select2_2">
        <option value="">Please select</option>
        <option value="America/New_York">(GMT-05:00) (Eastern Standard Time)</option>
        <option value="America/Chicago">(GMT-06:00) Central Time</option>
        <option value="America/Denver">(GMT-07:00) Mountain Time</option>
        <option value="America/Phoenix">(GMT-07:00) Mountain Time - Arizona</option>
        <option value="America/Los_Angeles">(GMT-08:00) Pacific Time Los Angeles</option>
        <option value="America/Anchorage">(GMT-09:00) Alaska Time</option>
        <option value="America/Adak">(GMT-10:00) America/Adak (Hawaii-Aleutian Standard Time)</option>
        <option value="Pacific/Honolulu">(GMT-10:00) Hawaii Time</option>
      </select>
    </div>
    <div class="col-lg-4 form-group">
      <label>State: *</label>
      <select class="form-control" name="state" id="state" required="">
        <option value="">Please select</option>
        <option value="AK">Alaska</option>
        <option value="AL">Alabama</option>
        <option value="AR">Arkansas</option>
        <option value="AZ">Arizona</option>
        <option value="CA">California</option>
        <option value="CO">Colorado</option>
        <option value="CT">Connecticut</option>
        <option value="DC">District of Columbia</option>
        <option value="DE">Delaware</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="HI">Hawaii</option>
        <option value="IA">Iowa</option>
        <option value="ID">Idaho</option>
        <option value="IL">Illinois</option>
        <option value="IN">Indiana</option>
        <option value="KS">Kansas</option>
        <option value="KY">Kentucky</option>
        <option value="LA">Louisiana</option>
        <option value="MA">Massachusetts</option>
        <option value="MD">Maryland</option>
        <option value="ME">Maine</option>
        <option value="MI">Michigan</option>
        <option value="MN">Minnesota</option>
        <option value="MO">Missouri</option>
        <option value="MS">Mississippi</option>
        <option value="MT">Montana</option>
        <option value="NC">North Carolina</option>
        <option value="ND">North Dakota</option>
        <option value="NE">Nebraska</option>
        <option value="NH">New Hampshire</option>
        <option value="NJ">New Jersey</option>
        <option value="NM">New Mexico</option>
        <option value="NV">Nevada</option>
        <option value="NY">New York</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="OR">Oregon</option>
        <option value="PA">Pennsylvania</option>
        <option value="RI">Rhode Island</option>
        <option value="SC">South Carolina</option>
        <option value="SD">South Dakota</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="VA">Virginia</option>
        <option value="VT">Vermont</option>
        <option value="WA">Washington</option>
        <option value="WI">Wisconsin</option>
        <option value="WV">West Virginia</option>
        <option value="WY">Wyoming</option>
      </select>
    </div>
    <div class="col-lg-4 form-group">
      <input type="hidden" class="form-control" name="district" id="state_district" value="OPEN">
    </div>
  </div>
  <div class="row">
    <div class="col-lg-4 form-group">
      <label>Appointment Date: *</label>
      <input type="text" name="appointment_date" class="form-control" id="kt_datepicker" value="" readonly="" placeholder="Select date">
      <span class="form-text text-muted" style="font-size: 10px; font-weight: 600; font-style: italic;">*You can only schedule 21 days in the future</span>
    </div>
    <div class="col-lg-4 form-group">
      <label>Appointment Start Time: *</label>
      <div id="time-slots">
        <select name="appointment_start_time" class="form-control" id="appointment_start_time">
          <option value="" selected="">Choose...</option>
        </select>
      </div>
    </div>
    <div class="col-lg-4 form-group">
      <label>Appointment End Time: *</label>
      <input class="form-control" name="appointment_end_time" id="appointment_end_time" value="" readonly="" placeholder="Select time" type="text" style="background-color: #d2d8db">
      <span class="form-text text-muted" style="font-size: 10px; font-weight: 600; font-style: italic;">*Appointments last 30 minutes</span>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-4 form-group">
      <label>Employer:</label>
      <input type="text" class="form-control" id="employer" name="employer" value="" placeholder="Enter employer name">
    </div>
  </div>
  <div class="row">
    <div class="col-lg-12 form-group text-center">
      <div class="alert alert-outline-danger alert-dismissible fade show application-heading" role="alert">
        <label class="kt-checkbox kt-checkbox--tick kt-checkbox--success">
          <input type="checkbox" name="sms_opt_in" value="1">You are consenting to receive text messages about this appointment. You may opt out at any time with a STOP reply. <span></span>
        </label>
      </div>
    </div>
  </div>
  <!--begin::Action-->
  <div class="kt-login__actions text-center">
    <input type="hidden" name="campaignID" id="campaignID" value="57">
    <input type="hidden" name="noAgent" value="">
    <button id="kt_login_signin_submit" class="btn btn-elevate kt-login__btn-primary btn-green">Schedule Appointment</button>
  </div>
  <!--end::Action-->
</form>

Text Content

Please allow up to 2 minutes for your application to be submitted.


APPOINTMENT SETUP

First Name: *
Last Name: *
Age:
Email: *
Mobile Number: *
Investable Assets: Please select $0 - $99,000 $100,000 - $249,000 $250,000 -
$499,000 $500,000 +
Timezone: * Please select (GMT-05:00) (Eastern Standard Time) (GMT-06:00)
Central Time (GMT-07:00) Mountain Time (GMT-07:00) Mountain Time - Arizona
(GMT-08:00) Pacific Time Los Angeles (GMT-09:00) Alaska Time (GMT-10:00)
America/Adak (Hawaii-Aleutian Standard Time) (GMT-10:00) Hawaii Time
State: * Please select Alaska Alabama Arkansas Arizona California Colorado
Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho
Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan
Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New
Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon
Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah
Virginia Vermont Washington Wisconsin West Virginia Wyoming

Appointment Date: * *You can only schedule 21 days in the future
Appointment Start Time: *
Choose...
Appointment End Time: * *Appointments last 30 minutes
Employer:
You are consenting to receive text messages about this appointment. You may opt
out at any time with a STOP reply.
Schedule Appointment