{"id":171,"date":"2020-12-13T16:47:09","date_gmt":"2020-12-13T16:47:09","guid":{"rendered":"http:\/\/hpj-stiftelse.dk\/?page_id=171"},"modified":"2021-06-13T08:52:52","modified_gmt":"2021-06-13T08:52:52","slug":"ansoegningsskema","status":"publish","type":"page","link":"http:\/\/hpj-stiftelse.dk\/index.php\/ansoegningsskema\/","title":{"rendered":"ANS\u00d8GNINGSSKEMA"},"content":{"rendered":"<div class=\"ufb-form-wrapper ufb-template-2\" style=\"width:150%;\">\r\n    <form method=\"post\" action=\"\" class=\"ufb-front-form\">\r\n        <div class=\"ufb-inner-form-wrap\">\r\n                        <input type=\"hidden\" name=\"form_id\" value=\"7\" class=\"form-id\"\/>\r\n                        <div class=\"ufb-each-step-wrap\" data-step-ref='1' >\r\n                                            <div class=\"ufb-step-title\">Ans\u00f8gningsskema<\/div>\r\n                            <div data-field-id=\"ufb_field_8\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Fornavn(e)\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_8\" class=\"ufb-form-textfield \" placeholder=\"Angiv dit\/dine fornavn(e)\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_8\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_9\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Efternavn(e)\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_9\" class=\"ufb-form-textfield \" placeholder=\"Angiv dit\/dine efternavn(e)\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_9\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_24\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   F\u00f8dselsdag (anf\u00f8r KUN dato DDMM\u00c5\u00c5 - og IKKE cpr-nr.)\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_24\" class=\"ufb-form-textfield \" placeholder=\"Angiv din f\u00f8dselsdato i formatet DDMM\u00c5\u00c5\u00c5\u00c5\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_24\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_11\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Adresse (gadenavn og nummer)\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_11\" class=\"ufb-form-textfield \" placeholder=\"Angiv din nuv\u00e6rende adresse\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_11\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_23\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Postnummer\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_23\" class=\"ufb-form-textfield \" placeholder=\"Angiv dit nuv\u00e6rende postnummer\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_23\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_16\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   By\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_16\" class=\"ufb-form-textfield \" placeholder=\"Angiv dit nuv\u00e6rende bynavn\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_16\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_37\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Telefonnummer\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_37\" class=\"ufb-form-textfield \" placeholder=\"Angiv dit telefonnummer med 8 cifre\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_37\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_17\" class=\"ufb-form-field-wrap  ufb-email-wrap ufb-column-1 email\"  >\n        <label class=\"ufb-control-label\" >\n                   Email\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"email\" name=\"ufb_field_17\" class=\"ufb-email-field \" placeholder=\"Angiv en gyldig mail-adresse\" value=\"\" \/>\n                                <div class=\"ufb-error\"  data-error-key=\"ufb_field_17\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_43\" class=\"ufb-form-field-wrap  ufb-radio-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Nuv\u00e6rende boligforhold\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                                        <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Permanent bolig\" name=\"ufb_field_43\" class=\"ufb-form-radio \" id=\"7-ufb_field_43-0\"  \/>\n                            <label for=\"7-ufb_field_43-0\">Permanent bolig<\/label>\n                        <\/div>\n                                                <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Midlertidig bolig\" name=\"ufb_field_43\" class=\"ufb-form-radio \" id=\"7-ufb_field_43-1\"  \/>\n                            <label for=\"7-ufb_field_43-1\">Midlertidig bolig<\/label>\n                        <\/div>\n                                                <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Andet\" name=\"ufb_field_43\" class=\"ufb-form-radio \" id=\"7-ufb_field_43-2\"  \/>\n                            <label for=\"7-ufb_field_43-2\">Andet<\/label>\n                        <\/div>\n                                                        <div class=\"ufb-error\"  data-error-key=\"ufb_field_43\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_42\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Beskriv dine nuv\u00e6rende boligforhold i fritekst<span class=\"ufb-relative\"><span class=\"ufb-info-icon\">i<\/span>\n                        <span class=\"ufb-notes ufb-info-icon-notes\">Beskriv, hvordan din boligsituation ser ud nu, og hvordan den (eventuelt) vil \u00e6ndre sig over det n\u00e6ste \u00e5r (eller l\u00e6ngere).<\/span><\/span>\n                    \n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_42\" class=\"ufb-form-textfield \" placeholder=\"Beskriv din nuv\u00e6rende boligsituation i fritekst\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_42\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_44\" class=\"ufb-form-field-wrap  ufb-radio-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Nuv\u00e6rende indt\u00e6gtsgrundlag\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                                        <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Pensionist\" name=\"ufb_field_44\" class=\"ufb-form-radio \" id=\"7-ufb_field_44-0\"  \/>\n                            <label for=\"7-ufb_field_44-0\">Pensionist<\/label>\n                        <\/div>\n                                                <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Studerende\" name=\"ufb_field_44\" class=\"ufb-form-radio \" id=\"7-ufb_field_44-1\"  \/>\n                            <label for=\"7-ufb_field_44-1\">Studerende<\/label>\n                        <\/div>\n                                                <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Dagpenge\/overf\u00f8rselsindkomst\" name=\"ufb_field_44\" class=\"ufb-form-radio \" id=\"7-ufb_field_44-2\"  \/>\n                            <label for=\"7-ufb_field_44-2\">Dagpenge\/overf\u00f8rselsindkomst<\/label>\n                        <\/div>\n                                                <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"L\u00f8nmodtager eller selvst\u00e6ndig\" name=\"ufb_field_44\" class=\"ufb-form-radio \" id=\"7-ufb_field_44-3\"  \/>\n                            <label for=\"7-ufb_field_44-3\">L\u00f8nmodtager eller selvst\u00e6ndig<\/label>\n                        <\/div>\n                                                <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Andet\" name=\"ufb_field_44\" class=\"ufb-form-radio \" id=\"7-ufb_field_44-4\"  \/>\n                            <label for=\"7-ufb_field_44-4\">Andet<\/label>\n                        <\/div>\n                                                        <div class=\"ufb-error\"  data-error-key=\"ufb_field_44\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_45\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Uddyb dit indt\u00e6gtsgrundlag i fritekst<span class=\"ufb-relative\"><span class=\"ufb-info-icon\">i<\/span>\n                        <span class=\"ufb-notes ufb-info-icon-notes\">Beskriv, hvordan dit nuv\u00e6rende indt\u00e6gtsgrundlag ser ud nu, og hvordan det (eventuelt) vil \u00e6ndre sig over det n\u00e6ste \u00e5r (eller l\u00e6ngere).<\/span><\/span>\n                    \n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_45\" class=\"ufb-form-textfield \" placeholder=\"Beskriv dit indt\u00e6gtsgrundlag i fritekst\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_45\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_48\" class=\"ufb-form-field-wrap  ufb-radio-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   \u00d8nske om at bidrage som beboer i stiftelsen<span class=\"ufb-relative\"><span class=\"ufb-info-icon\">i<\/span>\n                        <span class=\"ufb-notes ufb-info-icon-notes\">Angiv om du \u00f8nsker og kan bidrage socialt, praktisk eller p\u00e5 anden vis som beboer i stiftelsen<\/span><\/span>\n                    \n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                                        <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Ja\" name=\"ufb_field_48\" class=\"ufb-form-radio \" id=\"7-ufb_field_48-0\"  \/>\n                            <label for=\"7-ufb_field_48-0\">Ja<\/label>\n                        <\/div>\n                                                <div class=\"ufb-sub-field-wrap\">\n                            <input type=\"radio\" value=\"Nej\" name=\"ufb_field_48\" class=\"ufb-form-radio \" id=\"7-ufb_field_48-1\"  \/>\n                            <label for=\"7-ufb_field_48-1\">Nej<\/label>\n                        <\/div>\n                                                        <div class=\"ufb-error\"  data-error-key=\"ufb_field_48\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_49\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   \u00d8nsker til lejlighed<span class=\"ufb-relative\"><span class=\"ufb-info-icon\">i<\/span>\n                        <span class=\"ufb-notes ufb-info-icon-notes\">Har du s\u00e6rlige \u00f8nsker om beliggenhed\/etage, s\u00e5 kan du angive dem her. Angiv samtidig din begrundelse for dit \u00f8nske (fx &quot;stueetage, d\u00e5rligt g\u00e5ende&quot;)<\/span><\/span>\n                    \n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_49\" class=\"ufb-form-textfield \" placeholder=\"Angiv eventuelle \u00f8nsker til etage eller opgang\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_49\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_50\" class=\"ufb-form-field-wrap  ufb-textfield-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Uddybning<span class=\"ufb-relative\"><span class=\"ufb-info-icon\">i<\/span>\n                        <span class=\"ufb-notes ufb-info-icon-notes\">Uddyb eventuelt din begrundelse for ans\u00f8gning om at komme p\u00e5 venteliste (fx yderligere informationer om boligforhold, civile forhold, arbejdsforhold, \u00f8konomi, etc.)<\/span><\/span>\n                    \n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"text\" name=\"ufb_field_50\" class=\"ufb-form-textfield \" placeholder=\"Uddyb eventuelt din begrundelse for ans\u00f8gning\" value=\"\" \/>\n                \n                <div class=\"ufb-error\"  data-error-key=\"ufb_field_50\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_53\" class=\"ufb-form-field-wrap  ufb-agreement-block-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   \n        <\/label>\n                    <div class=\"ufb-form-field\">\n                <label class=\"ufb-agreement-checkbox-wrap-label\">\n                    <input type=\"checkbox\" name=\"ufb_field_53\" value=\"1\" class=\"ufb-agreement-checkbox\"\/><div class=\"ufb-agreement-text\">Bekr\u00e6ft, at du har l\u00e6st stiftelsens persondatapolitik p\u00e5 siden ANS\u00d8G eller http:\/\/hpj-stiftelse.dk\/index.php\/persondatapolitik\/\r\n<\/div>\n                    <div class=\"ufb-error\"  data-error-key=\"ufb_field_53\"><\/div>\n                <\/label>\n            <\/div>\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_46\" class=\"ufb-form-field-wrap  ufb-captcha-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   Bekr\u00e6ft, at du er et menneske\n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                                    <div class=\"ufb-math-captcha-wrap\">\n                        <div class=\"ufb-captcha-num-wrap\"><span class=\"ufb-captcha-num\">7<\/span> + <span>4<\/span> = <\/div><input type=\"text\" name=\"ufb_field_46\" class=\"ufb-math-captcha-ans\" placeholder=\"Enter Sum\"\/>\n                        <input type=\"hidden\" name=\"ufb_field_46_num_1\" value=\"7\"\/>\n                        <input type=\"hidden\" name=\"ufb_field_46_num_2\" value=\"4\"\/>\n                    <\/div>\n                \n                <div class=\"ufb-error\" data-error-key=\"ufb_field_46\"><\/div>\n            <\/div>\n\n            \n    <\/div>\n        <div data-field-id=\"ufb_field_47\" class=\"ufb-form-field-wrap  ufb-submit-wrap ufb-column-1 \"  >\n        <label class=\"ufb-control-label\" >\n                   \n        <\/label>\n        \n            <div class=\"ufb-form-field\">\n                <input type=\"submit\" class=\"ufb-form-submit\" name=\"ufb_field_47\" value=\"Indsend dit ans\u00f8gningsskema\"\/>\n                                <span class=\"ufb-form-loader\" style=\"display:none\"><\/span>\n            <\/div>\n\n            \n    <\/div>\n                        <div class=\"ufb-step-actions-wrap\">\r\n                        \r\n                    <\/div>\r\n                        <div class=\"ufb-step-error\" data-step-ref=\"1\" data-step-error-message=\"\" style=\"display:none\"><\/div>\r\n                <\/div>\r\n                        <\/div>\r\n        <div class=\"ufb-form-message\" style=\"display: none;\"><\/div>\r\n        <input type=\"hidden\" name=\"user_ip\" value=\"10.9.23.227\"\/>\r\n        <input type=\"hidden\" name=\"page_url\" value=\"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/pages\/171\"\/>\r\n        <input type=\"hidden\" name=\"user_logged_in\" value=\"No\"\/>\r\n        <input type=\"hidden\" name=\"loggedin_username\" value=\"\"\/>\r\n        <input type=\"hidden\" name=\"loggedin_user_email\" value=\"\"\/>\r\n            <\/form>\r\n \r\n<\/div>\r\n\r\n\r\n\n\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-171","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/pages\/171","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/comments?post=171"}],"version-history":[{"count":5,"href":"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/pages\/171\/revisions"}],"predecessor-version":[{"id":288,"href":"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/pages\/171\/revisions\/288"}],"wp:attachment":[{"href":"http:\/\/hpj-stiftelse.dk\/index.php\/wp-json\/wp\/v2\/media?parent=171"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}