Capture and mail

[hacker1312001]

Ok guys i know there's another topic in the forum that is similar, but give this one a chance. I have an html form from which i am trying to capture the contents of the content box, and then email me the information. This is the body of the form

[code]
<form method="post" enctype="text/plain" action="applicationsubmission.php">

Name(last): <INPUT NAME="Name(last):  " TYPE="text" SIZE=30><br>
Name(first): <INPUT NAME="Name(first):  " TYPE="text" SIZE=30><br>
Middle Initial: <INPUT NAME="Name(middle initial):" TYPE="text" SIZE=1><BR><br>
Social Security Number: <INPUT NAME="Social Security Number:" TYPE="text" SIZE=12><br><br>
Address(Street): <INPUT NAME="Address(Street:):" TYPE="text" SIZE=60><BR>
Address(City): <INPUT NAME="City:" TYPE="text" SIZE=20><br>
Address(State): <INPUT NAME="State:" TYPE="text" SIZE=2><br>
Zip Code: <INPUT NAME="Zip Code:" TYPE="text" SIZE=5><BR><br>
Position Applying For: <INPUT NAME="Position Applying For:" TYPE="text" SIZE=20><br><br>
Bakery Cafe Location: <INPUT NAME="Bakery Cafe Location:" TYPE="text" SIZE=20><br>
Full Time: <INPUT NAME="Full Time" TYPE="checkbox"><br>
Part Time: <INPUT NAME="Part Time" TYPE="checkbox"><br><br>
In the past 5 years have you been convicted of a felony relating to theft or dishonesty?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox"><br>
If Yes, When? <INPUT NAME="If Yes, When?" TYPE="text" SIZE=10><br>
Where? <INPUT NAME="Where?" TYPE="text" SIZE=20><BR><br>
Nature and disposition of conviction: <INPUT NAME="Nature and disposition of conviction:" TYPE="text" SIZE=75><br><br>
Have you previously applied for employment with Saint Louis Bread Company or Panera Bread?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox"><BR>
If Yes, When? <INPUT NAME="If Yes, When?" TYPE="text"><br>
Where? <INPUT NAME="Where?" TYPE="text"><BR><br>
Are you related to associate employed by Saint Louis Bread Company or Panera Bread?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox"><br>
If Yes, indicate name, relationship, and location:: <INPUT NAME="If Yes, indicate name, relationship, and location:" TYPE="text"><br><br>
Date available for employment: <INPUT NAME="Date available for employment:" TYPE="text"><br><br>
Are you 18 years of age or older?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox">
If under 18 years of age, applicant will be required to submit a birth certificate or work certificate as required by state and federal law.<br><br>
<b>Availability:<br></b>
Monday: <INPUT NAME="Monday:" TYPE="text" SIZE=10><br>
Tuesday: <INPUT NAME="Tuesday:" TYPE="text" SIZE=10><BR>
Wednesday: <INPUT NAME="Wednesday:" TYPE="text" SIZE=10><BR>
Thursday: <INPUT NAME="Thursday:" TYPE="text" SIZE=10><BR>
Friday: <INPUT NAME="Friday:" TYPE="text" SIZE=10><BR>
Saturday: <INPUT NAME="Saturday:" TYPE="text" SIZE=10><BR>
Sunday: <INPUT NAME="Sunday:" TYPE="text" SIZE=10><BR>
Total hours per week available: <INPUT NAME="Total hours per week available:" TYPE="text" SIZE=10><br>
How far do you live from the bakery cafe? <INPUT NAME="How far do you live from the bakery cafe?" TYPE="text" SIZE=10><BR><br>
<b>School</B><br><br>
Name and address of last school attended: <INPUT NAME="Name and address of last school attended:" TYPE="text" SIZE=50><BR><br>
Dates:<br>
From: <INPUT NAME="From:" TYPE="text" SIZE=15>
To: <INPUT NAME="To:" TYPE="text" SIZE=15><BR><br>
Graduated?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox"><BR><br>
Date of degree: <INPUT NAME="Date of degree" TYPE="text" SIZE=15><BR><br>
Major: <INPUT NAME="Major" TYPE="text" SIZE=20><BR>
Minor: <INPUT NAME="Minor" TYPE="text" SIZE=20><BR><br>
Are you presently enrolled in school?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox"><BR>
If Yes, give name and address of school: <INPUT NAME="If Yes, give name and address of school:" TYPE="text" SIZE=50><BR>
Day: <INPUT NAME="Day" TYPE="checkbox">
Night: <INPUT NAME="Night" TYPE="checkbox"><BR><br>
List any other accomplishments or special interests: <INPUT NAME="List any other accomplishments or special interests:" TYPE="text" SIZE=50><BR><br>


<b>References:</b><br><br>
Reference 1:<br>
Name and Occupation: <INPUT NAME="Name and Occupation" TYPE="text" SIZE=30><BR>
Address: <INPUT NAME="Address" TYPE="text" SIZE=30><BR>
Phone: <INPUT NAME="Phone" TYPE="text" SIZE=30><BR><br>
Reference 2:<br>
Name and Occupation: <INPUT NAME="Name and Occupation" TYPE="text" SIZE=30><BR>
Address: <INPUT NAME="Address" TYPE="text" SIZE=30><BR>
Phone: <INPUT NAME="Phone" TYPE="text" SIZE=30><BR><br>
<b>EMPLOYMENT HISTORY</b><br>
(list all present and past employment beginning with the most recent)<br><br>
<b>1: </b>Company name and address: <INPUT NAME="Company name and address:" TYPE="text" SIZE=50><BR>
Immediate Supervisor: <INPUT NAME="Immediate Supervisor" TYPE="text" SIZE=20><BR>
Phone: <INPUT NAME="Phone" TYPE="text" SIZE=20><BR>
Pay rate at time of employment: <INPUT NAME="Pay rate at time of employment:" TYPE="text" SIZE=5><BR><br>
Dates of employment:<br>
From: <INPUT NAME="From:" TYPE="text" SIZE=15>
To: <INPUT NAME="To:" TYPE="text" SIZE=15><br><br>
Reason for leaving(if applicable): <INPUT NAME="Reason for leaving:" TYPE="text" SIZE=50><BR>
Job title: <INPUT NAME="Job title:" TYPE="text" SIZE=20><BR>
May we contact this employer?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox"><BR><br>
<b>2: </b>Company name and address: <INPUT NAME="Company name and address:" TYPE="text" SIZE=50><BR>
Immediate Supervisor: <INPUT NAME="Immediate Supervisor" TYPE="text" SIZE=20><BR>
Phone: <INPUT NAME="Phone" TYPE="text" SIZE=20><BR>
Pay rate at time of employment: <INPUT NAME="Pay rate at time of employment:" TYPE="text" SIZE=5><BR><br>
Dates of employment:<br>
From: <INPUT NAME="From:" TYPE="text" SIZE=15>
To: <INPUT NAME="To:" TYPE="text" SIZE=15><br><br>
Reason for leaving(if applicable): <INPUT NAME="Reason for leaving:" TYPE="text" SIZE=50><BR>
Job title: <INPUT NAME="Job title:" TYPE="text" SIZE=20><BR>
May we contact this employer?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox"><BR><br>
<b>3: </b>Company name and address: <INPUT NAME="Company name and address:" TYPE="text" SIZE=50><BR>
Immediate Supervisor: <INPUT NAME="Immediate Supervisor" TYPE="text" SIZE=20><BR>
Phone: <INPUT NAME="Phone" TYPE="text" SIZE=20><BR>
Pay rate at time of employment: <INPUT NAME="Pay rate at time of employment:" TYPE="text" SIZE=5><BR><br>
Dates of employment:<br>
From: <INPUT NAME="From:" TYPE="text" SIZE=15>
To: <INPUT NAME="To:" TYPE="text" SIZE=15><br><br>
Reason for leaving(if applicable): <INPUT NAME="Reason for leaving:" TYPE="text" SIZE=50><BR>
Job title: <INPUT NAME="Job title:" TYPE="text" SIZE=20><BR>
May we contact this employer?
Yes: <INPUT NAME="Yes" TYPE="checkbox">
No: <INPUT NAME="No" TYPE="checkbox"><BR><br>
<b>DECLARATION</B><br>
(Carefully read and initial each section then sign at bottom.)<br><br>
I certify that the answers given herein are true and complete to the best of my knowledge,
and I authorize investigation of all statements contained in this application, with the exception
of contacting my present employer if I have requested so. I have read, understand, and agree
to the above statement<br>
Please initial here: <INPUT NAME="Please initial here" TYPE="text" SIZE=3><BR><br>
I understand that my continued employment will depend upon the successful completion of work assigned
to me during a new hire period of ninety (90) days upon my continued successful performance.
I have read, understand, and agree to the above statement<br>
Please initial here: <INPUT NAME="Please initial here" TYPE="text" SIZE=3><BR><br>
While this application will be retained on file for a period of one year. I acknowledge that this
application will be considered active for a period of sixty (60) days. At that time, I must submit
a new application to be considered for any employment openings. I have read, understand, and agree
to the above statement<br>
Please initial here: <INPUT NAME="Please initial here" TYPE="text" SIZE=3><BR><br>
I understand and acknowledge that unless otherwise defined by applicable law or written agreement
with Panera Bread, any employment relationship with the Company is considered "employment at will",
which means the Employee may resign at any time and the Employer may discharge the Employee at any
time, with or without cause. It is further understood that this "at will" employment relationship
may not be changed by any written document or by any conduct unless such a change is specifically
executed by the President/CEO of Panera Bread. I have read, understand, and agree to the above statement<br>
Please initial here: <INPUT NAME="Please initial here" TYPE="text" SIZE=3><BR><br>
If I should be employed by the Company, I understand that any false, incomplete, or misleading
information given on this application or during an interview shall result in immediate discharge.
I have read, understand, and agree to the above statement<br>
Please initial here: <INPUT NAME="Please initial here" TYPE="text" SIZE=3><BR><br>
I authorize an inquiry into my background by all persons, schools, companies, corporations,
credit bureaus, law enforcement agencies, doctors, and other consulting consumer reporting agencies
to supply information concerning my previous employment, education, credit, driving record, etc.
I have read, understand, and agree to the above statement<br>
Please initial here: <INPUT NAME="Please initial here" TYPE="text" SIZE=3><BR><br>
I authorize the references listed above to give representatives of Panera Bread any and all information
concerning my previous and current employment and any pertinent information they may have, personal
or otherwise, and release all parties from any and all liability from any damage that may result.
I have read, understand, and agree to the above statement<br>
Please initial here: <INPUT NAME="Please initial here" TYPE="text" SIZE=3><BR><br><br>
Signature: <INPUT NAME="Signiture:" TYPE="text" SIZE=25><BR>
Date: <INPUT NAME="Date" TYPE="text" SIZE=15><BR><br><br><br><br>

<input type="submit"> <br><br>
</form>
[/code]


And this is the syntax of the php file that it is calling

[code]
<?php
        $text = @extract($_POST);   // extract posted elements
        $subject = "Panera Application";
        mail('chris.galati@covelli.com',$subject,$text,"From: Application Submission");
?>
[/code]

i know this is sloppy, but is there a better way to do it, or more specifically why won't it work. the site where the application is uploaded is www.panera-tampa.com/application.html . Thank you for your help

Chris