Please Wait...

The following COVID-19 screening questions DO NOT disqualify you nor excuse you from jury duty.
If you answer "Yes" to any of these questions, your jury service will be rescheduled.

Yes No

</div>
                        </div>

<div class="offset-1 col-11"><label for="{{s.COVIDQuestionField}}">{{s.SecondaryCOVIDQuestion}}</label></div>
                            <div class="offset-1 col-11">
                                <input type="text" datepicker placeholder="mm/dd/yyyy" id="{{s.COVIDQuestionField}}" name="{{s.COVIDQuestionField}}"
                                       ng-model="jCovQ.frmObj[s.COVIDQuestionField]" ng-init="jCovQ.frmObj[s.COVIDQuestionField]=s.COVIDQuestionAnswer" />
                            </div>

</div>

<div class="offset-1 col-11"><label>{{s.SecondaryCOVIDQuestion}}</label></div>
                            <div class="form-inline input-group offset-1 col-11 col-md-3" style="max-width: 250px;">
                                <select class="form-control mt-1" title="" name="{{s.COVIDQuestionField}}" ng-model="jCovQ.frmObj[s.COVIDQuestionField]"
                                        ng-init="jCovQ.frmObj[s.COVIDQuestionField]=jCovQ.SetDropDownValue()" ng-options="n for n in [] | range:0:99">
                                    <option value="">Select</option>
                                </select>
                                <div class="input-group-append"><span class="input-group-text mt-1" style="padding: .275rem .475rem">days</span></div>

</div>

</div>

<div class="form-row mt-1" ng-if="q.COVIDQuestionType === 6" style="background-color: #eef; padding:12px; font-size:25px; line-height:25px">

<div class="form-check-inline col-10 col-lg-10">
                            <label>
                                {{q.COVIDQuestion}}

</label>
                        </div>

</div>

</div>

<div>
                            <button class="btn btn-primary" ng-click="jCovQ.saveCovidForm()" ng-if="COVIDForm.$valid" style="min-width:100%; height: 5rem; padding:.4rem;">
                                <span ng-if="!jCovQ.isProcessing" style=" font-size:25px; ">CONTINUE</span>
                                <span ng-if="jCovQ.isProcessing" style=" font-size:25px; ">Please wait...</span>
                            </button>
                        </div>
                    </div>
                </div>

</div>

</form>

<!--<div class="row mt-3">
        <div class="col-3" style="padding-left:0px;"><button type="button" class="navBtn btn float-left w-100" style="opacity: 0.8" ng-click="jCovQ.prevClick()"><i class="fa fa-chevron-left mr-1"></i>Prev</button></div>
        <div class="col-9" ng-show="jCovQ.frmObj['CertifiedTrue'] === true ||  !jCovQ.isDirty()" style="padding-left:0px;"><button type="button" class="navBtn btn btnNext w-100" ng-click="jCovQ.saveCovidForm()">Next<i class="fa fa-chevron-right ml-1"></i></button></div>

</div>-->
    </div>
</div>