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div:nth-of-type(1) > select:nth-of-type(2), FormField_108, FormField_244, FormField_109, (___) ___-____, FormField_111, FormField_249, FormField_248, FormField_250, mm/dd/yyyy, selector:#P1503734602_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1), selector:#P1503734602_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2), mm/dd/yyyy, selector:#P1151803973_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1), selector:#P1151803973_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2), FormField_115, FormField_251, FormField_116, (___) ___-____, FormField_118, FormField_255","validity":"unknown","availability":"unknown","representation":"structured"},"basis":"directly_observed","first_observed_at":"2026-11-06T10:35:33.818336+00:00","last_confirmed_at":"2026-11-06T10:35:33.818336+00:00","field_sources":{"value":{"via":["https://www.uppercut605.com/employment-form","form headed \"Job Application\"","submits to https://www.uppercut605.com/Forms/SubmitForm","purpose: hiring (its page names it)"],"basis":"directly_observed"}},"via":["https://www.uppercut605.com/employment-form","form headed \"Job Application\"","submits to https://www.uppercut605.com/Forms/SubmitForm","purpose: hiring (its page names it)"]},{"label":"Published form asks 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select:nth-of-type(1)","type":"select","options":["2021","2022","2023","2024","2025","2026","2027","2028","2029","2030","2031"],"disabled":true,"selector":"#P207867711_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)"},{"name":"selector:#P207867711_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","type":"select","options":["0","1","2","3","4","5","6","7","8","9","10","11"],"disabled":true,"selector":"#P207867711_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > 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opacity:0"},{"name":"FormField_62","type":"text","required":true,"selector":"input[name=\"FormField_62\"]","max_length":5},{"name":"FormField_190","type":"text","label":"mm/dd/yyyy","required":true,"selector":"#P1951469242","max_length":10,"autocomplete":"off"},{"name":"selector:#P1951469242_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)","type":"select","options":["2021","2022","2023","2024","2025","2026","2027","2028","2029","2030","2031"],"disabled":true,"selector":"#P1951469242_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)"},{"name":"selector:#P1951469242_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","type":"select","options":["0","1","2","3","4","5","6","7","8","9","10","11"],"disabled":true,"selector":"#P1951469242_root 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> div:nth-of-type(1) > div > label > input","option_values":["on","on","on"]},{"name":"FormField_231","type":"radio","options":["Yes","No"],"selector":"div > form > div:nth-of-type(10) > div:nth-of-type(1) > div > div:nth-of-type(2) > div:nth-of-type(1) > div > div:nth-of-type(1) > div > label > input","option_values":["on","on"]},{"name":"FormField_235","type":"text","selector":"input[name=\"FormField_235\"]","max_length":100},{"name":"FormField_236","type":"radio","options":["Yes","No"],"selector":"div > form > div:nth-of-type(11) > div:nth-of-type(1) > div > div:nth-of-type(2) > div:nth-of-type(1) > div > div:nth-of-type(1) > div > label > input","option_values":["on","on"]},{"name":"FormField_240","type":"text","selector":"input[name=\"FormField_240\"]","max_length":100},{"name":"FormField_102","type":"text","selector":"input[name=\"FormField_102\"]","max_length":100},{"name":"FormField_103","type":"text","label":"(___) 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div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)"},{"name":"selector:#P457120115_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","type":"select","options":["0","1","2","3","4","5","6","7","8","9","10","11"],"disabled":true,"selector":"#P457120115_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","option_labels":["January","February","March","April","May","June","July","August","September","October","November","December"]},{"name":"FormField_114","type":"text","label":"mm/dd/yyyy","selector":"#P304976024","max_length":10,"autocomplete":"off"},{"name":"selector:#P304976024_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > 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div > div > div > div:nth-of-type(1) > select:nth-of-type(1)"},{"text":"January\nFebruary\nMarch\nApril\nMay\nJune\nJuly\nAugust\nSeptember\nOctober\nNovember\nDecember","type":"select-one","hidden":true,"targets":["P207867711_table"],"disabled":true,"selector":"#P207867711_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(2)"},{"text":"Today","type":"button","hidden":true,"targets":["P207867711"],"disabled":true,"selector":"#P207867711_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(1)"},{"text":"Clear","type":"button","hidden":true,"targets":["P207867711"],"disabled":true,"selector":"#P207867711_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(2)"},{"text":"Close","type":"button","hidden":true,"targets":["P207867711"],"disabled":true,"selector":"#P207867711_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(3)"},{"text":"Select One","type":"button","selector":"#module_6fedc05c-ac64-4e5d-928c-547ace285331 > div > div > form > div:nth-of-type(4) > div:nth-of-type(4) > div > div > div > button"},{"text":"2021\n2022\n2023\n2024\n2025\n2026\n2027\n2028\n2029\n2030\n2031","type":"select-one","hidden":true,"targets":["P1951469242_table"],"disabled":true,"selector":"#P1951469242_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(1)"},{"text":"January\nFebruary\nMarch\nApril\nMay\nJune\nJuly\nAugust\nSeptember\nOctober\nNovember\nDecember","type":"select-one","hidden":true,"targets":["P1951469242_table"],"disabled":true,"selector":"#P1951469242_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(2)"},{"text":"Today","type":"button","hidden":true,"targets":["P1951469242"],"disabled":true,"selector":"#P1951469242_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(1)"},{"text":"Clear","type":"button","hidden":true,"targets":["P1951469242"],"disabled":true,"selector":"#P1951469242_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(2)"},{"text":"Close","type":"button","hidden":true,"targets":["P1951469242"],"disabled":true,"selector":"#P1951469242_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(3)"},{"text":"2021\n2022\n2023\n2024\n2025\n2026\n2027\n2028\n2029\n2030\n2031","type":"select-one","hidden":true,"targets":["P1651624822_table"],"disabled":true,"selector":"#P1651624822_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(1)"},{"text":"January\nFebruary\nMarch\nApril\nMay\nJune\nJuly\nAugust\nSeptember\nOctober\nNovember\nDecember","type":"select-one","hidden":true,"targets":["P1651624822_table"],"disabled":true,"selector":"#P1651624822_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(2)"},{"text":"Today","type":"button","hidden":true,"targets":["P1651624822"],"disabled":true,"selector":"#P1651624822_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(1)"},{"text":"Clear","type":"button","hidden":true,"targets":["P1651624822"],"disabled":true,"selector":"#P1651624822_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(2)"},{"text":"Close","type":"button","hidden":true,"targets":["P1651624822"],"disabled":true,"selector":"#P1651624822_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(3)"},{"text":"2021\n2022\n2023\n2024\n2025\n2026\n2027\n2028\n2029\n2030\n2031","type":"select-one","hidden":true,"targets":["P1877778477_table"],"disabled":true,"selector":"#P1877778477_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(1)"},{"text":"January\nFebruary\nMarch\nApril\nMay\nJune\nJuly\nAugust\nSeptember\nOctober\nNovember\nDecember","type":"select-one","hidden":true,"targets":["P1877778477_table"],"disabled":true,"selector":"#P1877778477_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(2)"},{"text":"Today","type":"button","hidden":true,"targets":["P1877778477"],"disabled":true,"selector":"#P1877778477_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(1)"},{"text":"Clear","type":"button","hidden":true,"targets":["P1877778477"],"disabled":true,"selector":"#P1877778477_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(2)"},{"text":"Close","type":"button","hidden":true,"targets":["P1877778477"],"disabled":true,"selector":"#P1877778477_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(3)"},{"text":"2021\n2022\n2023\n2024\n2025\n2026\n2027\n2028\n2029\n2030\n2031","type":"select-one","hidden":true,"targets":["P457120115_table"],"disabled":true,"selector":"#P457120115_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(1)"},{"text":"January\nFebruary\nMarch\nApril\nMay\nJune\nJuly\nAugust\nSeptember\nOctober\nNovember\nDecember","type":"select-one","hidden":true,"targets":["P457120115_table"],"disabled":true,"selector":"#P457120115_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(2)"},{"text":"Today","type":"button","hidden":true,"targets":["P457120115"],"disabled":true,"selector":"#P457120115_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(1)"},{"text":"Clear","type":"button","hidden":true,"targets":["P457120115"],"disabled":true,"selector":"#P457120115_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(2)"},{"text":"Close","type":"button","hidden":true,"targets":["P457120115"],"disabled":true,"selector":"#P457120115_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(3)"},{"text":"2021\n2022\n2023\n2024\n2025\n2026\n2027\n2028\n2029\n2030\n2031","type":"select-one","hidden":true,"targets":["P304976024_table"],"disabled":true,"selector":"#P304976024_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(1)"},{"text":"January\nFebruary\nMarch\nApril\nMay\nJune\nJuly\nAugust\nSeptember\nOctober\nNovember\nDecember","type":"select-one","hidden":true,"targets":["P304976024_table"],"disabled":true,"selector":"#P304976024_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(2)"},{"text":"Today","type":"button","hidden":true,"targets":["P304976024"],"disabled":true,"selector":"#P304976024_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(1)"},{"text":"Clear","type":"button","hidden":true,"targets":["P304976024"],"disabled":true,"selector":"#P304976024_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(2)"},{"text":"Close","type":"button","hidden":true,"targets":["P304976024"],"disabled":true,"selector":"#P304976024_root > div > div > div > div > div:nth-of-type(2) > button:nth-of-type(3)"},{"text":"2021\n2022\n2023\n2024\n2025\n2026\n2027\n2028\n2029\n2030\n2031","type":"select-one","hidden":true,"targets":["P153288255_table"],"disabled":true,"selector":"#P153288255_root > div > div > div > div > div:nth-of-type(1) > select:nth-of-type(1)"}],"unobserved":["choice_transitions","button_transitions"],"observation":"read_only"},"captcha_mode":"invisible","instructions":"Contact Info\nExperience\nEmployer 1 (Most Recent)\nEmployer 2\nEmployer 3\nEducation\nSchool 1\nSchool 2","captcha_scope":"form","form_selector":"#module_6fedc05c-ac64-4e5d-928c-547ace285331 > div > div > form","previous_source_keys":["urn:lumitra:route:uppercut605.com:d86bdee126bf1c53"]},"@type":"ContactPoint","value":"https://www.uppercut605.com/Forms/SubmitForm","channel":"form","purpose":"hiring","subject":{"kind":"organization"},"document":"FormField_1, FormField_2, FormField_3, FormField_4, (___) ___-____, mm/dd/yyyy, selector:#P207867711_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1), selector:#P207867711_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2), FormField_7, FormField_8, FormField_9, FormField_10, FormField_62, mm/dd/yyyy, selector:#P1951469242_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1), selector:#P1951469242_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2), FormField_188, FormField_187, FormField_195, FormField_191, FormField_211, FormField_207, FormField_219, FormField_215, FormField_231, FormField_235, FormField_236, FormField_240, FormField_102, (___) ___-____, FormField_104, FormField_242, FormField_241, FormField_243, mm/dd/yyyy, selector:#P1651624822_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1), selector:#P1651624822_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2), mm/dd/yyyy, selector:#P1877778477_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1), selector:#P1877778477_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2), FormField_108, FormField_244, FormField_109, (___) ___-____, FormField_111, FormField_249, FormField_248, FormField_250, mm/dd/yyyy, selector:#P457120115_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1), selector:#P457120115_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2), mm/dd/yyyy, selector:#P304976024_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1), selector:#P304976024_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2), FormField_115, FormField_251, FormField_116, (___) ___-____, FormField_118, FormField_255","validity":"unknown","availability":"unknown","representation":"structured"},"basis":"directly_observed","first_observed_at":"2026-11-06T10:35:34.828933+00:00","last_confirmed_at":"2026-11-06T10:35:34.828933+00:00","field_sources":{"value":{"via":["https://www.uppercut605.com/employment-form","form headed \"Job Application\"","submits to https://www.uppercut605.com/Forms/SubmitForm","purpose: hiring (its page names it)"],"basis":"directly_observed"}},"via":["https://www.uppercut605.com/employment-form","form headed \"Job Application\"","submits to https://www.uppercut605.com/Forms/SubmitForm","purpose: hiring (its page names it)"]},{"label":"Published form asks for","value":{"form":{"gaps":["challenge_on_page"],"fields":[{"name":"FormField_1","type":"text","required":true,"selector":"[name=\"FormField_1\"]","max_length":100},{"name":"FormField_2","type":"text","selector":"[name=\"FormField_2\"]","max_length":1},{"name":"FormField_3","type":"text","required":true,"selector":"[name=\"FormField_3\"]","max_length":100},{"kind":"email","name":"FormField_4","type":"email","required":true,"selector":"[name=\"FormField_4\"]"},{"name":"FormField_5","type":"text","label":"(___) ___-____","required":true,"selector":"[name=\"FormField_5\"]","max_length":14,"min_length":14},{"name":"FormField_186","type":"text","label":"mm/dd/yyyy","required":true,"selector":"#P826404342","max_length":10,"autocomplete":"off"},{"name":"selector:#P826404342_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)","type":"select","options":["2021","2022","2023","2024","2025","2026","2027","2028","2029","2030","2031"],"disabled":true,"selector":"#P826404342_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)"},{"name":"selector:#P826404342_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","type":"select","options":["0","1","2","3","4","5","6","7","8","9","10","11"],"disabled":true,"selector":"#P826404342_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","option_labels":["January","February","March","April","May","June","July","August","September","October","November","December"]},{"name":"FormField_7","type":"text","required":true,"selector":"[name=\"FormField_7\"]","max_length":100},{"name":"FormField_8","type":"text","selector":"[name=\"FormField_8\"]","max_length":100},{"name":"FormField_9","type":"text","required":true,"selector":"[name=\"FormField_9\"]","max_length":100},{"name":"FormField_10","type":"select","options":["AK","AL","AR","AZ","CA","CO","CT","DC","DE","FL","GA","HI","IA","ID","IL","IN","KS","KY","LA","MA","MD","ME","MI","MN","MO","MS","MT","NC","ND","NE","NH","NJ","NM","NV","NY","OH","OK","OR","PA","RI","SC","SD","TN","TX","UT","VA","VT","WA","WI","WV","WY"],"required":true,"selector":"[name=\"FormField_10\"]"},{"name":"FormField_62","type":"text","required":true,"selector":"[name=\"FormField_62\"]","max_length":5},{"name":"FormField_190","type":"text","label":"mm/dd/yyyy","required":true,"selector":"#P878222688","max_length":10,"autocomplete":"off"},{"name":"selector:#P878222688_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)","type":"select","options":["2021","2022","2023","2024","2025","2026","2027","2028","2029","2030","2031"],"disabled":true,"selector":"#P878222688_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)"},{"name":"selector:#P878222688_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","type":"select","options":["0","1","2","3","4","5","6","7","8","9","10","11"],"disabled":true,"selector":"#P878222688_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","option_labels":["January","February","March","April","May","June","July","August","September","October","November","December"]},{"name":"FormField_188","type":"text","required":true,"selector":"[name=\"FormField_188\"]","max_length":100},{"name":"FormField_187","type":"text","required":true,"selector":"[name=\"FormField_187\"]","max_length":100},{"name":"FormField_195","type":"radio","options":["Yes","No"],"selector":"div:nth-of-type(7) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on"]},{"name":"FormField_191","type":"radio","options":["Yes","No"],"selector":"div:nth-of-type(7) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on"]},{"name":"FormField_211","type":"radio","options":["Yes","No"],"selector":"div:nth-of-type(8) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on"]},{"name":"FormField_207","type":"radio","options":["Yes","No"],"selector":"div:nth-of-type(8) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on"]},{"name":"FormField_219","type":"radio","options":["Yes","No"],"selector":"div:nth-of-type(9) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on"]},{"name":"FormField_215","type":"radio","options":["Answer 1","Answer 2","Answer 3"],"selector":"div:nth-of-type(9) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on","on"]},{"name":"FormField_231","type":"radio","options":["Yes","No"],"selector":"div:nth-of-type(10) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on"]},{"name":"FormField_235","type":"text","selector":"[name=\"FormField_235\"]","max_length":100},{"name":"FormField_236","type":"radio","options":["Yes","No"],"selector":"div:nth-of-type(11) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on"]},{"name":"FormField_240","type":"text","selector":"[name=\"FormField_240\"]","max_length":100},{"name":"FormField_102","type":"text","selector":"[name=\"FormField_102\"]","max_length":100},{"name":"FormField_103","type":"text","label":"(___) ___-____","selector":"[name=\"FormField_103\"]","max_length":14,"min_length":14},{"name":"FormField_104","type":"text","selector":"[name=\"FormField_104\"]","max_length":150},{"name":"FormField_242","type":"text","required":true,"selector":"[name=\"FormField_242\"]","max_length":100},{"name":"FormField_241","type":"text","required":true,"selector":"[name=\"FormField_241\"]","max_length":100},{"kind":"message","name":"FormField_243","type":"textarea","required":true,"selector":"[name=\"FormField_243\"]","max_length":500},{"name":"FormField_106","type":"text","label":"mm/dd/yyyy","selector":"#P1520024664","max_length":10,"autocomplete":"off"},{"name":"selector:#P1520024664_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)","type":"select","options":["2021","2022","2023","2024","2025","2026","2027","2028","2029","2030","2031"],"disabled":true,"selector":"#P1520024664_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(1)"},{"name":"selector:#P1520024664_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","type":"select","options":["0","1","2","3","4","5","6","7","8","9","10","11"],"disabled":true,"selector":"#P1520024664_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > select:nth-of-type(2)","option_labels":["January","February","March","April","May","June","July","August","September","October","November","December"]},{"name":"FormField_107","type":"text","label":"mm/dd/yyyy","selector":"#P902673796","max_length":10,"autocomplete":"off"},{"name":"selector:#P902673796_root > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > 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select:nth-of-type(2)","option_labels":["January","February","March","April","May","June","July","August","September","October","November","December"]},{"name":"FormField_108","type":"text","selector":"[name=\"FormField_108\"]","max_length":200},{"name":"FormField_244","type":"radio","options":["Yes","No"],"selector":"div:nth-of-type(18) > div:nth-of-type(1) > div:nth-of-type(2) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > div:nth-of-type(1) > label:nth-of-type(1) > input:nth-of-type(1)","option_values":["on","on"]},{"name":"FormField_109","type":"text","selector":"[name=\"FormField_109\"]","max_length":100},{"name":"FormField_110","type":"text","label":"(___) 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