{"id":42,"date":"2014-09-27T15:09:11","date_gmt":"2014-09-27T15:09:11","guid":{"rendered":"http:\/\/angelhealthcareinc.com\/wp\/?page_id=42"},"modified":"2014-09-29T02:36:54","modified_gmt":"2014-09-29T02:36:54","slug":"services-request","status":"publish","type":"page","link":"https:\/\/angelhealthcareinc.com\/?page_id=42","title":{"rendered":"Services Request"},"content":{"rendered":"<p><b>Are you in need of our services? Fill out our form below and someone will be in contact with you as soon as possible.<\/b><br \/>\n<!--------- Begin Freedback.com Form ---------><br \/>\n<FORM METHOD=\"POST\" ACTION=\"http:\/\/cgi44.Freedback.com\/mail.pl\"><\/p>\n<p><P><CENTER><HR SIZE=\"1\"><\/CENTER><\/p>\n<p><!-- Submissions are emailed to: --><br \/>\n<INPUT TYPE=\"hidden\" NAME=\"to\" VALUE=\"omoalako@gmail.com\"><\/p>\n<p><!-- Subject of emails: --><br \/>\n<INPUT TYPE=\"hidden\" name=\"subject\" VALUE=\"Freedback.com Form: http:\/\/angelhealthcareinc.com\"><br \/>\n<!-- URL (web address) of form: --><br \/>\n<INPUT TYPE=\"hidden\" NAME=\"form\" VALUE=\"http:\/\/angelhealthcareinc.com\"><\/p>\n<p><!-- Form administrator: --><br \/>\n<INPUT TYPE=\"hidden\" NAME=\"admin\" VALUE=\"omoalako@gmail.com\"><\/p>\n<p><!-- Website intended audience (general, kids, adults): --><br \/>\n<INPUT TYPE=\"hidden\" NAME=\"audience\" VALUE=\"67656e6572616c47\"><br \/>\n<!-- Website language: --><br \/>\n<INPUT TYPE=\"hidden\" NAME=\"language\" VALUE=\"en\"><br \/>\n<!-- Visible elements: --><\/p>\n<p><!-- Full name of user --><br \/>\n<P>Your full name:<BR><br \/>\n<INPUT TYPE=\"text\" NAME=\"name\" SIZE=\"30\"><br \/>\n<!-- Take email addresses with a grain of salt! --><br \/>\n<P>Your email address: (e.g.: <EM>you@aol.com<\/EM>)<BR><\/p>\n<p><INPUT TYPE=\"text\" NAME=\"from\" SIZE=\"30\"><\/p>\n<p><!-- INSERT ADDITIONAL FORM FIELDS HERE: --><\/p>\n<p><P>Your Home or Company Name and Address<BR><br \/>\n<!-- Text Box: address --><br \/>\n<INPUT TYPE=\"text\" NAME=\"address\" VALUE=\"\" SIZE=\"75\" MAXLENGTH=\"\"><\/p>\n<p><P>Your Contact Telephone #<BR><br \/>\n<!-- Text Box: tel # --><br \/>\n<INPUT TYPE=\"text\" NAME=\"tel #\" VALUE=\"\" SIZE=\"30\" MAXLENGTH=\"\"><br \/>\n<P>Fax #<BR><br \/>\n<!-- Text Box: fax --><br \/>\n<INPUT TYPE=\"text\" NAME=\"fax\" VALUE=\"\" SIZE=\"30\" MAXLENGTH=\"\"><\/p>\n<p><P>Your Needs<BR><\/p>\n<p><!-- Drop-Down List: needs --><br \/>\n<SELECT NAME=\"needs\" SIZE=\"1\"><br \/>\n   <OPTION VALUE=\"Consultants\" SELECTED> Consultants<br \/>\n   <OPTION VALUE=\"RN\"> RN\/LPN<br \/>\n   <OPTION VALUE=\"LPN\/LVN\"> LPN\/LVN<br \/>\n   <OPTION VALUE=\"CNA\"> CNA<br \/>\n   <OPTION VALUE=\"Home Health\/Escort Aide\"> Home Health\/Escort Aide<br \/>\n   <OPTION VALUE=\"Other Professional Staff\"> Other Professional Staff<\/p>\n<p><\/SELECT><\/p>\n<p><P>Please Indicate Other Professional Staff:<BR><br \/>\n<!-- Text Box: other --><\/p>\n<p><INPUT TYPE=\"text\" NAME=\"other\" VALUE=\"\" SIZE=\"35\" MAXLENGTH=\"\"><br \/>\n<P>Shift or Time Needed From<BR><br \/>\n<!-- Text Box: shft or time --><\/p>\n<p><INPUT TYPE=\"text\" NAME=\"shft or time\" VALUE=\"\" SIZE=\"35\" MAXLENGTH=\"\"><br \/>\n<P>Dates From<BR><br \/>\n<!-- Comment Box: dates --><br \/>\n<TEXTAREA NAME=\"dates\" ROWS=\"2\" COLS=\"30\" WRAP=\"hard\"><\/TEXTAREA><br \/>\n<P>How Many Staff Do You Need?<BR><br \/>\n<!-- Text Box: amount of staff --><br \/>\n<INPUT TYPE=\"text\" NAME=\"amount of staff\" VALUE=\"\" SIZE=\"2\" MAXLENGTH=\"\"><br \/>\n<P>Temporary?<BR><br \/>\n<!-- Checkbox: temporary --><\/p>\n<p><INPUT TYPE=\"checkbox\" NAME=\"temporary\" VALUE=\"Yes\"> Yes<br \/>\n<BR><INPUT TYPE=\"checkbox\" NAME=\"temporary\" VALUE=\"No\"> No<\/p>\n<p><P>Permanent?<BR><br \/>\n<!-- Checkbox: permanent --><br \/>\n<INPUT TYPE=\"checkbox\" NAME=\"permanent\" VALUE=\"Yes\"> Yes<br \/>\n<BR><INPUT TYPE=\"checkbox\" NAME=\"permanent\" VALUE=\"No\"> No<br \/>\n<!-- Submit Button --><br \/>\n<P><INPUT TYPE=\"submit\" NAME=\"Submit Button\" VALUE=\"Submit\"><br \/>\n<input type=hidden name=\"222\" value=\"2005-01-19\"><br \/>\n<\/FORM><\/p>\n<p><!---------- End Freedback.com Form ----------><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Are you in need of our services? Fill out our form below and someone will be in contact with you as soon as possible. Your full name: Your email address: (e.g.: you@aol.com) Your Home or Company Name and Address Your Contact Telephone # Fax # Your Needs Consultants RN\/LPN LPN\/LVN CNA Home Health\/Escort Aide Other [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":25,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-42","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=\/wp\/v2\/pages\/42","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=42"}],"version-history":[{"count":6,"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=\/wp\/v2\/pages\/42\/revisions"}],"predecessor-version":[{"id":50,"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=\/wp\/v2\/pages\/42\/revisions\/50"}],"up":[{"embeddable":true,"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=\/wp\/v2\/pages\/25"}],"wp:attachment":[{"href":"https:\/\/angelhealthcareinc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=42"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}