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<?php
$pageTitle = 'Apply | US Work At Home Solutions';
// Pre-fill from quick-start form
$firstName = htmlspecialchars($_GET['first_name'] ?? '', ENT_QUOTES);
$lastName = htmlspecialchars($_GET['last_name'] ?? '', ENT_QUOTES);
$email = htmlspecialchars($_GET['email'] ?? '', ENT_QUOTES);
$phone = htmlspecialchars($_GET['phone'] ?? '', ENT_QUOTES);
$state = htmlspecialchars($_GET['state'] ?? '', ENT_QUOTES);
$states = [
'AL' => 'Alabama',
'AK' => 'Alaska',
'AZ' => 'Arizona',
'AR' => 'Arkansas',
'CA' => 'California',
'CO' => 'Colorado',
'CT' => 'Connecticut',
'DE' => 'Delaware',
'FL' => 'Florida',
'GA' => 'Georgia',
'HI' => 'Hawaii',
'ID' => 'Idaho',
'IL' => 'Illinois',
'IN' => 'Indiana',
'IA' => 'Iowa',
'KS' => 'Kansas',
'KY' => 'Kentucky',
'LA' => 'Louisiana',
'ME' => 'Maine',
'MD' => 'Maryland',
'MA' => 'Massachusetts',
'MI' => 'Michigan',
'MN' => 'Minnesota',
'MS' => 'Mississippi',
'MO' => 'Missouri',
'MT' => 'Montana',
'NE' => 'Nebraska',
'NV' => 'Nevada',
'NH' => 'New Hampshire',
'NJ' => 'New Jersey',
'NM' => 'New Mexico',
'NY' => 'New York',
'NC' => 'North Carolina',
'ND' => 'North Dakota',
'OH' => 'Ohio',
'OK' => 'Oklahoma',
'OR' => 'Oregon',
'PA' => 'Pennsylvania',
'RI' => 'Rhode Island',
'SC' => 'South Carolina',
'SD' => 'South Dakota',
'TN' => 'Tennessee',
'TX' => 'Texas',
'UT' => 'Utah',
'VT' => 'Vermont',
'VA' => 'Virginia',
'WA' => 'Washington',
'WV' => 'West Virginia',
'WI' => 'Wisconsin',
'WY' => 'Wyoming',
];
?>
<?php require __DIR__ . '/includes/header.php'; ?>
<section class="section application-shell" id="application">
<div class="container-modern">
<div class="stepper">
<span class="stepper-item active">1. Application</span>
<span class="stepper-item">2. Voice Sample</span>
<span class="stepper-item">3. Confirmation</span>
</div>
<div class="application-header">
<h2>Start your application</h2>
</div>
<div id="formError" class="error-box" style="display:none; max-width:820px; margin:0 auto 18px;"></div>
<div class="form-card" style="max-width:820px; margin:0 auto;">
<div class="form-card-top">
<h3>Sales Contractor Application</h3>
</div>
<div class="form-card-body">
<form id="applicationForm">
<!-- Honeypot: hidden from humans, bots fill it in -->
<div style="position:absolute;left:-9999px;opacity:0;height:0;overflow:hidden;" aria-hidden="true">
<label for="website">Website</label>
<input type="text" id="website" name="website" tabindex="-1" autocomplete="off">
</div>
<div class="quick-fields">
<div class="field full-width">
<label for="heard_about">How did you hear about us?</label>
<select id="heard_about" name="heard_about">
<option value="">-- Select One --</option>
<option>Craigslist</option>
<option>Facebook</option>
<option>Google</option>
<option>Indeed.com</option>
<option>Online Job Board</option>
<option>Previously Worked</option>
<option>Friend / Family</option>
<option>Social Media</option>
<option>Workforce Services</option>
<option>ZipRecruiter</option>
</select>
</div>
</div>
<div class="divider-modern"></div>
<div class="subsection-title">Personal Information</div>
<div class="quick-fields">
<div class="field">
<label for="first_name">First Name</label>
<input type="text" id="first_name" name="first_name" placeholder="First name" value="<?= $firstName ?>" required>
</div>
<div class="field">
<label for="last_name">Last Name</label>
<input type="text" id="last_name" name="last_name" placeholder="Last name" value="<?= $lastName ?>" required>
</div>
<div class="field">
<label for="email">Email Address</label>
<input type="email" id="email" name="email" placeholder="Email address" value="<?= $email ?>" required>
</div>
<div class="field">
<label for="mobile">Mobile Number</label>
<input type="tel" id="mobile" name="mobile" placeholder="(555) 555-5555" value="<?= $phone ?>" required>
</div>
<div class="field full-width">
<label for="street">Street Address</label>
<input type="text" id="street" name="street" placeholder="Street address">
</div>
</div>
<div class="quick-fields" style="grid-template-columns: 2fr 1fr 1fr;">
<div class="field">
<label for="city">City</label>
<input type="text" id="city" name="city" placeholder="City">
</div>
<div class="field">
<label for="state">State</label>
<select id="state" name="state">
<option value="">Select</option>
<?php foreach ($states as $abbr => $name): ?>
<option value="<?= $abbr ?>" <?= $state === $abbr ? 'selected' : '' ?>><?= $abbr ?></option>
<?php endforeach; ?>
</select>
</div>
<div class="field">
<label for="zip">ZIP</label>
<input type="text" id="zip" name="zip" placeholder="ZIP">
</div>
</div>
<div class="quick-fields">
<div class="field">
<label for="birthday">Birthday</label>
<input type="date" id="birthday" name="birthday">
</div>
</div>
<div class="quick-fields" style="grid-template-columns:1fr;">
<div class="field">
<label>Have you ever been convicted of a felony?</label>
<div style="display:flex; gap:16px; margin-top:8px;">
<label><input type="radio" name="felony" value="yes" onchange="document.getElementById('felonyDetails').style.display='block'"> Yes</label>
<label><input type="radio" name="felony" value="no" onchange="document.getElementById('felonyDetails').style.display='none'"> No</label>
</div>
</div>
<div class="field full-width" id="felonyDetails" style="display:none;">
<label for="felony_details">Please describe the conviction(s):</label>
<textarea id="felony_details" name="felony_details" rows="4" placeholder="Please provide details about your conviction(s)..." style="width:100%;padding:10px;border:1px solid #ccd6e0;border-radius:8px;font-size:15px;font-family:inherit;resize:vertical;"></textarea>
</div>
</div>
<div class="divider-modern"></div>
<div class="subsection-title">Work From Home Readiness</div>
<div class="quick-fields" style="grid-template-columns:1fr;">
<div class="field">
<label>Have You Worked From Home Before?</label>
<div style="display:flex; gap:16px; margin-top:8px;">
<label><input type="radio" name="wfh" value="yes" onchange="document.getElementById('wfhDetails').style.display='block'"> Yes</label>
<label><input type="radio" name="wfh" value="no" onchange="document.getElementById('wfhDetails').style.display='none'"> No</label>
</div>
</div>
<div class="field full-width" id="wfhDetails" style="display:none;">
<label for="wfh_type">What Type of Work From Home?</label>
<input type="text" id="wfh_type" name="wfh_type" placeholder="Example: calling, customer service, chat, sales">
</div>
<div class="field">
<label>Have You Sold Over the Phone?</label>
<div style="display:flex; gap:16px; margin-top:8px;">
<label><input type="radio" name="phone_sales" value="yes" onchange="document.getElementById('salesDetails').style.display='block'"> Yes</label>
<label><input type="radio" name="phone_sales" value="no" onchange="document.getElementById('salesDetails').style.display='none'"> No</label>
</div>
</div>
<div class="field full-width" id="salesDetails" style="display:none;">
<label for="sales_type">What Have You Sold?</label>
<input type="text" id="sales_type" name="sales_type" placeholder="Products or services sold">
</div>
<div class="field full-width">
<label>Do you have access to a (1) desktop computer, (2) high-speed internet (at least 50 Mbps up and 50 Mbps down), (3) Google Chrome browser, and a (4) headset that you can use to make calls from home?</label>
<div style="display:flex; gap:16px; margin-top:8px;">
<label><input type="radio" name="has_equipment" value="yes" onchange="document.getElementById('equipmentNotice').style.display='none'"> Yes</label>
<label><input type="radio" name="has_equipment" value="no" onchange="document.getElementById('equipmentNotice').style.display='block'"> No</label>
</div>
<div id="equipmentNotice" style="display:none; margin-top:8px; padding:10px 14px; background:#fff8e1; border-left:4px solid #f9a825; border-radius:4px; color:#555; font-size:0.92em;">
These 4 items are required to use our system and speak with customers. If you don't currently have these, you'll just need to get set up before starting.
</div>
</div>
<div class="field full-width">
<label for="motivation">Why do you want to work from home?</label>
<textarea id="motivation" name="motivation" placeholder="Tell us a little about why you want to work from home."></textarea>
</div>
</div>
<div class="divider-modern"></div>
<div class="subsection-title">Work History and References</div>
<div class="quick-fields">
<div class="field full-width">
<label for="recent_work">Most Recent Work Experience</label>
<textarea id="recent_work" name="recent_work" placeholder="Company, role, dates, supervisor, pay, and reason for leaving."></textarea>
</div>
<div class="field full-width">
<label for="previous_work">Previous Work Experience</label>
<textarea id="previous_work" name="previous_work" placeholder="Second most recent employer details."></textarea>
</div>
<div class="field">
<label for="ref1_name">Reference #1</label>
<input type="text" id="ref1_name" name="ref1_name" placeholder="Name and relationship">
</div>
<div class="field">
<label for="ref1_phone">Reference #1 Phone</label>
<input type="tel" id="ref1_phone" name="ref1_phone" placeholder="(555) 555-5555">
</div>
<div class="field">
<label for="ref2_name">Reference #2</label>
<input type="text" id="ref2_name" name="ref2_name" placeholder="Name and relationship">
</div>
<div class="field">
<label for="ref2_phone">Reference #2 Phone</label>
<input type="tel" id="ref2_phone" name="ref2_phone" placeholder="(555) 555-5555">
</div>
</div>
<div class="divider-modern"></div>
<div class="btn-row">
<button type="submit" class="btn-primary-modern" id="submitBtn">Submit Application</button>
</div>
<div class="tiny-consent" style="margin-top:16px; text-align:center;">
<strong>Consent:</strong> By submitting this application, I consent to receive communications about this independent contractor opportunity, including text messages regarding next steps.
</div>
</form>
</div>
</div>
</div>
</section>
<script>
// Reset the submit button if the page is restored from the browser's bfcache
// (e.g. when the user hits Back from voice.php).
window.addEventListener('pageshow', function(e) {
if (e.persisted) {
var btn = document.getElementById('submitBtn');
if (btn) {
btn.disabled = false;
btn.textContent = 'Submit Application';
}
}
});
document.getElementById('applicationForm').addEventListener('submit', function(e) {
e.preventDefault();
var btn = document.getElementById('submitBtn');
var errorBox = document.getElementById('formError');
btn.disabled = true;
btn.textContent = 'Submitting...';
errorBox.style.display = 'none';
var formData = new FormData(this);
fetch(BASE_URL + '/api/submit-application.php', {
method: 'POST',
body: formData
})
.then(function(res) { return res.json(); })
.then(function(data) {
if (data.success) {
// Associate email with visitor tracking (fire and forget)
var emailVal = document.getElementById('email').value;
if (emailVal) {
fetch(BASE_URL + '/api/track-email.php', {
method: 'POST',
headers: { 'Content-Type': 'application/json' },
body: JSON.stringify({ email: emailVal })
}).catch(function() {}); // non-blocking
}
// Redirect to voice recording page with application ID
window.location.href = BASE_URL + '/voice.php?app_id=' + encodeURIComponent(data.application_id);
} else {
errorBox.textContent = data.message || 'Something went wrong. Please try again.';
errorBox.style.display = 'block';
btn.disabled = false;
btn.textContent = 'Submit Application';
window.scrollTo({ top: 0, behavior: 'smooth' });
}
})
.catch(function() {
errorBox.textContent = 'Network error. Please check your connection and try again.';
errorBox.style.display = 'block';
btn.disabled = false;
btn.textContent = 'Submit Application';
window.scrollTo({ top: 0, behavior: 'smooth' });
});
});
// Phone number formatting: (XXX) XXX-XXXX
function formatPhone(value) {
var digits = value.replace(/\D/g, '');
if (digits.length > 10) digits = digits.substring(0, 10);
if (digits.length > 6) return '(' + digits.substring(0,3) + ') ' + digits.substring(3,6) + '-' + digits.substring(6);
if (digits.length > 3) return '(' + digits.substring(0,3) + ') ' + digits.substring(3);
if (digits.length > 0) return '(' + digits;
return '';
}
document.querySelectorAll('input[type="tel"]').forEach(function(input) {
// Format any pre-filled value
if (input.value) input.value = formatPhone(input.value);
// Format as user types
input.addEventListener('input', function() {
var pos = this.selectionStart;
var before = this.value.length;
this.value = formatPhone(this.value);
var after = this.value.length;
var newPos = pos + (after - before);
this.setSelectionRange(newPos, newPos);
});
});
</script>
<?php require __DIR__ . '/includes/footer.php'; ?>