$(document).ready(function() { // validate signup form on keyup and submit $("#submitform").validate({ rules: { Signature_Employer: "required", Date: "required", Signature_Applicant: "required", Date_: "required", Signature_Employer_: "required", _Date_: "required", _Signature_Applicant_: "required", _Date__: "required", secode: "required" }, messages: { Signature_Employer: "Required", Date: "Required", Signature_Applicant: "Required", Date_: "Required", Signature_Employer_: "Required", _Date_: "Required", _Signature_Applicant_: "Required", _Date__: "Enter a valid Email", secode: "" } }); $("#submitform").submit(function(){ if($(this).valid()){ self.parent.$('html, body').animate( { scrollTop: self.parent.$('#myframe').offset().top }, 500 ); } }); $("#submitform").submit(function(e){ if($(this).valid() && grecaptcha.getResponse() != ""){ $(".loader").css('visibility', 'visible'); self.parent.$('html, body').animate( { scrollTop: self.parent.$('#myframe').offset().top }, 500 ); } else { if(grecaptcha.getResponse() == "") { var $recaptcha = document.querySelector('#g-recaptcha-response'); if($recaptcha) { $recaptcha.setAttribute("required", "required"); } $('.g-recaptcha').addClass('errors').attr('id','recaptcha'); var $test = $('#recaptcha div:first').css('width','304px'); if($test){ $test.addClass('rec'); } } else { /* alert("Thank you"); */ } e.preventDefault(); } }); $('#DATE,#DATE2,#Date_to_Start').datepick({ yearRange: "2000:2014", showTrigger: 'Select date' }); $('.illnessOther').hide(); $('.illness').change(function(){ if($(this).val()=="Other"){ if($(this).is(':checked')){ $('.illnessOther').show(); }else{ $('.illnessOther').hide(); } } }); /* $("#Other").click(function() { $("#Other").show(); $("#Other").hide(); }); */ });
* = Required Information
Texas Department of Aging and Disability Services
Form 1728
October 2013-E
Consumer Directed Services
Liability Acknowledgement
Liability Acknowledgement Between the Employer and the Applicant for Employment

The individual receiving services or the individual's legally authorized representative (LAR) is the employer in the consumer Direct Services (CDS) option

The employer employs (hires, manages and terminates) employees. The employer is solely responsible and liable for any negligent acts or omissions by the employer; the employee; other employee(s) or services provider(s); the individual receiving services; or, if application, the employer's designated representative.

Employees or services providers are not employed or retained by the Texas Department of Aging and Disability Services (DADS); any other state or federal governmental agency; or by the Financial Management Services Agency (FMSA).

As an applicant for employment through the CDS option, I acknowledge that I have read and that I understand the above information regarding the employer and employee liability


Liability Notice to Applicants for Employment
Section 1:
The employer:
is a subscriber of Texas Workers Compensation through the Texas Department of Insurance, Division of Workers Compensation.
is not a subscriber of Texas Workers Compensation through Department of Insurance, Division of Workers Compensation.

Section 2:
Employer indicates the correct option in this section if the employer is not a subscriber to Texas Workers' Compensation.
I have made the following arrangement(s) for the employee work-related injuries/illnesses:
self-insurance;
homeowners personal liability insurance;
renters persona liability insurance;
medical coverage insurance;
risk pool insurance;
Other
I have no insurance or other protection against employee work-related injuried/illness for my employee(s)

Acknowledgement by Employer and Applicant for Employment

I acknowledge that I have read the above information in Section I and Section II