{"id":6202,"date":"2022-10-25T15:06:45","date_gmt":"2022-10-25T15:06:45","guid":{"rendered":"http:\/\/34.194.241.198\/?page_id=6202"},"modified":"2022-10-25T15:06:45","modified_gmt":"2022-10-25T15:06:45","slug":"form-cares-application-for-assistance","status":"publish","type":"page","link":"https:\/\/shooterandlindsey.com\/?page_id=6202","title":{"rendered":"Form CARES Application for Assistance"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6202\" class=\"elementor elementor-6202\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-969d68a elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"969d68a\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-74e79cb\" data-id=\"74e79cb\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c1c9b34 elementor-widget elementor-widget-heading\" data-id=\"c1c9b34\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">To apply for assistance, please complete the application form below in its entirety<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2ba4c39 elementor-widget elementor-widget-text-editor\" data-id=\"2ba4c39\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Application for CARES Assistance<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-97f87c8 elementor-widget elementor-widget-shortcode\" data-id=\"97f87c8\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f29387-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F6202#wpcf7-f29387-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"29387\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f29387-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<div id=\"responsive-form\" class=\"clearfix\">\n\t<div class=\"form-row\">\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>EMPLOYEE NAME <span class=\"required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"employee-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"employee-name\" \/><\/span><br \/>\n<\/label><br \/>\n<label>EMPLOYEE # <span class=\"required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"employee-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"employee-number\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>DATE <span class=\"required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"todays-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"todays-date\" \/><\/span><br \/>\n<\/label><br \/>\n<label>DATE OF BIRTH <span class=\"required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-birth\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>HOME PHONE<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"home-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"home-phone\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>CELL PHONE<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cell-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cell-phone\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>STREET ADDRESS<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"street-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"street-address\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>APT\/UNIT<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"apt-unit\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"apt-unit\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>CITY<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>STATE<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"state\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"state\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>ZIP CODE<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"zip-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"zip-code\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>EMAIL <span class=\"required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p><label>Type of Assistance Requested (Check one)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-assistance-requested\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-assistance-requested\" value=\"Education\" \/><span class=\"wpcf7-list-item-label\">Education<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-assistance-requested\" value=\"Adoption\" \/><span class=\"wpcf7-list-item-label\">Adoption<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-assistance-requested\" value=\"Counseling\" \/><span class=\"wpcf7-list-item-label\">Counseling<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-assistance-requested\" value=\"Immediate Family Emergency\" \/><span class=\"wpcf7-list-item-label\">Immediate Family Emergency<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-assistance-requested\" value=\"Property Damage\" \/><span class=\"wpcf7-list-item-label\">Property Damage<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-assistance-requested\" value=\"Funeral Expense for Immediate Family\" \/><span class=\"wpcf7-list-item-label\">Funeral Expense for Immediate Family<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-assistance-requested\" value=\"Mission (Military -- Veteran Support, Mission Trips)\" \/><span class=\"wpcf7-list-item-label\">Mission (Military -- Veteran Support, Mission Trips)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t\t<p><label> Assistance Amount Requested<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"amount-requested\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"amount-requested\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Provide details, including relevant documentation, supporting your request for assistance<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"details\"><textarea cols=\"40\" rows=\"14\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"details\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>I hereby certify the statements above to be true and accurate. I authorize the Juniper Cares Employee Relief Fund Committee to review my application in consideration for financial assistance provided by the Juniper Cares Employee Relief Fund. I understand any assistance funded to me is in the form of a grant and is not payable back to the Employee Relief Fund or to Juniper, unless it is deemed that I falsified the information submitted in my application. I agree if any of the information contained within my application changes prior to receiving any assistance, I will immediately notify the Employee Relief Fund Committee in writing at <a href=\"mailto:caresfund@juniperlandscaping.com\">caresfund@juniperlandscaping.com<\/a>\n\t\t\t<\/p>\n\t\t\t<p>By submission of my application for consideration, I certify that the information in this application is true, complete, and correct. I understand that false answers, statements, or significant omissions made by me shall be sufficient cause for denial of assistance and corrective action. Should my request be approved, I agree to the terms set-forth in this application and related policies and procedures.\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>SIGNATURE <span class=\"required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"signature\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"signature\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>DATE <span class=\"required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-signed\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-signed\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full mt-4\">\n\t\t\t<p>If you are completing the application on behalf of another person, please provide the following:\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>NAME<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"other-name\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>EMAIL<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"other-email\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>HOME PHONE<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-home-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"other-home-phone\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>CELL PHONE<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-cell-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"other-cell-phone\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Submission Process:\n\t\t\t<\/p>\n\t\t\t<ol>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Complete the application, sign, and submit to caresfund@juniperlandscaping.com.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>The Committee will review your application in accordance with the Juniper Cares Employee Relief Fund. Based upon the initial assessment by the committee, you will be referred to a Project Manager from Helping Hands Charitable who will gather basic information about your current need.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>The Helping Hands Project Manager shall advise the Committee of the financial need maintaining your personal information in confidence.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t<\/ol>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>For Committee Use Only:\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>DATE RECEIVED<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-received\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-received\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><label>INITIAL REVIEW BY<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"initial-review-by\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"initial-review-by\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Criteria Met\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-reviewed\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-reviewed\" value=\"Yes. Application forwarded to Helping Hands Grant Committee for further review.\" \/><span class=\"wpcf7-list-item-label\">Yes. Application forwarded to Helping Hands Grant Committee for further review.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-reviewed\" value=\"No. Employee has been notified that assistance is not available at this time.\" \/><span class=\"wpcf7-list-item-label\">No. Employee has been notified that assistance is not available at this time.<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full text-center\">\n\t\t\t<p><div class=\"gglcptch gglcptch_v2\"><\/div> <input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full text-center\">\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>To apply for assistance, please complete the application form below in its entirety Application for CARES Assistance<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-6202","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.4 - 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