document.write('<form method="GET" action="http://www.mlrehabjobs.com/index.htm"><table border="0" cellpadding="0" style="border-collapse: collapse" id="table5"><tr><td>Job Type:</td></tr><tr><td><select size="1" name="Fld_Type"><option value="x">Select One</option><option  value="Administrative">Administrative</option><option  value="Physical Therapist (PT)">Physical Therapist (PT)</option><option  value="Physical Therapist Assistant (PTA)">Physical Therapist Assistant (PTA)</option><option  value="Occupational Therapist (OTR)">Occupational Therapist (OTR)</option><option  value="Certified Occupational Therapist Assistant (COTA)">Certified Occupational Therapist Assistant (COTA)</option><option  value="Speech Language Pathologist (SLP)">Speech Language Pathologist (SLP)</option><option  value="Speech Language Pathologist (CFY)">Speech Language Pathologist (CFY)</option><option  value="Other">Other</option></select></td></tr><tr><td height="3"></td></tr><tr><td>State:</td></tr><tr><td><select size="1" name="Fld_State"><option value="x">Any State</option><option  value="AZ">ARIZONA</option><option  value="CA">CALIFORNIA</option><option  value="HI">HAWAII</option><option  value="ID">IDAHO</option><option  value="NV">NEVADA</option><option  value="UT">UTAH</option><option  value="WA">WASHINGTON</option></select></td></tr><tr><td height="5"></td></tr><tr><td align="left"><input type="submit" value="Search" name="B3"></td></tr></table><input type="hidden" name="cnx_tpage" value="info"><input type="hidden" name="info" value="jobs"><input type="hidden" name="jobs" value="find"></form>')