<%@ Language="vb" AutoEventWireup="false" CodeBehind="SPHSubmittalForm.aspx.vb" Inherits="Web.SPHSubmittalForm" %>
<%@ Register TagPrefix="ctrl" Namespace="Web" Assembly="Web" %>
<%@ Register Src="~/_include/controls/YesNoPicker.ascx" TagPrefix="ctrl" TagName="YesNoPicker" %>

<!DOCTYPE html>

<html xmlns="http://www.w3.org/1999/xhtml">
    <head runat="server">
            <title>TCS Online Portal</title>

            <link rel="stylesheet" href="/_assets/css/main.css?v=2020091401" />
    </head>

    <body style="align-content:center;padding-left:300px;">
        <form runat="server" >
            <div >
                <header class="text-center mb-2">
                    <img alt="TCS" src="/_assets/images/logo_150_tcs.png" />
                </header>
 
                <h1>SAFETY PERFORMANCE HISTORY INVESTIGATION</h1>
                <h2>PREVIOUS USDOT REGULATED EMPLOYERS</h2>
                <h3>In accordance with 49 CFR 40.25 and 391.23, we are hereby requesting that you supply us with the Safety Performance History of this individual. Under DOT rule 391.23(g), you must respond to this inquiry within 30 days of receipt.<br /><br /></h3>
  
                <ul class="formFields">
                    <li>
                        <asp:Label runat="server" Text="Applicant Name" Width="200px" />
                        <asp:TextBox ID="txtName" runat="server" MaxLength="250" Enabled="false" CssClass="form-control" Width="200px" />
                    </li>
                    <li>
                        <asp:Label runat="server" Text="SSN" Width="200px"  />
                        <asp:TextBox ID="txtSSN" runat="server" MaxLength="50" Enabled="false" CssClass="form-control" Width="200px"  />
                    </li>
                    <li>
                        <asp:Label runat="server" Text="Employment Dates" Width="200px"  />
                        <asp:TextBox ID="txtEmploymentDates" runat="server" MaxLength="150" Enabled="false" CssClass="form-control" Width="200px"  />
                    </li>
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="yn1" Text="required" Display="Dynamic" CssClass="required"  ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="1. Are the dates of employment correct as stated above?" />
                        <ctrl:YesNoPicker ID="yn1" runat="server" UndefinedValue="true" />
                    </li>    
                    <li>
                        <asp:Label runat="server" Text="If no, please provide the correct dates of employment:" />
                        <asp:TextBox ID="txtEmploymentDatesCorrected" runat="server" MaxLength="150" CssClass="form-control" />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="yn2" Text="required" Display="Dynamic" CssClass="required"  ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="2. Did the applicant drive commercial vehicles for your company?" />
                        <ctrl:YesNoPicker ID="yn2" runat="server" UndefinedValue="true" />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="yn3" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="3. Was the applicant a safe and efficient driver?" />
                        <ctrl:YesNoPicker ID="yn3" runat="server" UndefinedValue="true" />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="yn4" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="4. Was the applicant involved in any vehicle accidents while employed with your company? If yes, please provide details in comment section below." />
                        <ctrl:YesNoPicker ID="yn4" runat="server" UndefinedValue="true" />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlReasonLeft" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="5. Reason for leaving your employment:" />
                        <asp:DropDownList ID="ddlReasonLeft" CssClass="form-control" runat="server">
                            <asp:ListItem Text="" />
                            <asp:ListItem Text="Lay Off" />
                            <asp:ListItem Text="Resignation" />
                            <asp:ListItem Text="Termination" />
                            <asp:ListItem Text="Other" />
                        </asp:DropDownList>
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="yn6" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="6. Has the applicant tested positive for a controlled substance in the last three (3) years?" />
                        <ctrl:YesNoPicker ID="yn6" runat="server" UndefinedValue="true" />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="yn7" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="7. Has the applicant had an alcohol test with a B.A.C. of 0.04 or greater in the last three (3) years?" />
                        <ctrl:YesNoPicker ID="yn7" runat="server" UndefinedValue="true" />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="yn8" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="8. Has the applicant refused a required test for drugs or alcohol in the last three (3) years?" />
                        <ctrl:YesNoPicker ID="yn8" runat="server" UndefinedValue="true" />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="ddl9" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="9. Did the applicant complete a substance abuse rehabilitation program, if required? If yes, please provide documentation of the employee's successful completion of DOT return to duty requirements." />
                        <asp:DropDownList ID="ddl9" CssClass="form-control" runat="server">
                            <asp:ListItem Text="" />
                            <asp:ListItem Text="N/A" />
                            <asp:ListItem Text="No" />
                            <asp:ListItem Text="Yes" />
                        </asp:DropDownList>
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="yn10" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="10. Has this person ever violated any other DOT agency drug and alcohol testing regulations?" />
                        <ctrl:YesNoPicker ID="yn10" runat="server" UndefinedValue="true" />
                    </li>    
                    <li>
                        <asp:Label runat="server" Text="Comments:"  Width="100px" />
                        <asp:TextBox ID="txtComments" runat="server" MaxLength="1000" CssClass="form-control" Height="100px" TextMode="MultiLine" Width="400px" />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="txtByName" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="Name:" Width="100px" />
                        <asp:TextBox ID="txtByName" runat="server" MaxLength="250" CssClass="form-control" Width="400px"  />
                    </li>    
                    <li>
                        <asp:RequiredFieldValidator runat="server" ControlToValidate="txtByTitle" Text="required" Display="Dynamic" CssClass="required" ValidationGroup="AccountInfo" />
                        <asp:Label runat="server" Text="Title:" Width="100px" />
                        <asp:TextBox ID="txtByTitle" runat="server" MaxLength="250" CssClass="form-control" Width="400px"  />
                    </li>    
                    <li>
                        <asp:Button ID="btnSave" runat="server" CssClass="btn btn-primary" ValidationGroup="AccountInfo" Text="Submit" Width="150px" />
                    </li>
                </ul>

                <footer id="mainFooter">
                    <p>Copyright <%=Now.Year%> TCS</p>
                </footer>
            </div>
        </form>
    </body>
</html>
