English: <p>Please complete the following form as part of the <acronym title="Canada Revenue Agency">CRA</acronym> survey.</p>  <form action="#" method="post"> <div>  <strong>Name:</strong><br /><br />  First<br />  <input type="text" id="fname" name="fname" size="20" maxlength="20" />  <br /><br />  Last<br /> <input type="text" id="lname" name="lname" size="20" maxlength="20" /> <br /><br /><br />  <strong>Phone numbers:</strong><br /> Home<br /> <input type="text" id="hphone" name="hphone" size="12" maxlength="12" /> <br /><br />  Work<br /> <input type="text" id="wphone" name="wphone" size="12" maxlength="12" />&nbsp;&nbsp;Ext&nbsp;<input type="text" id="wphonex" name="wphonex" size="5" maxlength="5" /> <br /><br /><br />  Gender<br /> <input type="radio" name="gender" value="m" />Male<br /> <input type="radio" name="gender" value="f" />Female<br /> <br /><br /><br />  How long have you worked for the <acronym title="Canada Revenue Agency">CRA</acronym>?<br /> <input type="radio" name="years" value="0" />0 to 5 years<br /> <input type="radio" name="years" value="1" />6 to 10 years<br /> <input type="radio" name="years" value="2" />11 to 20 years<br /> <input type="radio" name="years" value="3" />20+ years <br /><br /><br />  Are you a member of a visible minority?<br /> <input type="radio" name="vismin" value="y" />Yes<br /> <input type="radio" name="vismin" value="n" />No <br /><br /><br />  Do you require one or more adaptive technologies to perform your day to day work?<br /> <input type="radio" name="dis" value="y" />Yes<br /> <input type="radio" name="dis" value="n" />No <br /><br /><br />  <input type="submit" value="Submit" />  </div> </form>
French: 5.3 Code XHTML <p>Veuillez remplir le formulaire ci-dessous dans le cadre de l'enqu&ecirc;te de l'<acronym title="Agence du revenu du Canada">ARC</acronym>.</p>  <form action="#" method="post"> <div>  <strong>Nom :</strong><br /><br />  Pr&eacute;nom<br />  <input type="text" id="fname" name="fname" size="20" maxlength="20" />  <br /><br />  Nom<br /> <input type="text" id="lname" name="lname" size="20" maxlength="20" /> <br /><br /><br />  <strong>Num&eacute;ros de t&eacute;l&eacute;phone :</strong><br /> Domicile<br /> <input type="text" id="hphone" name="hphone" size="12" maxlength="12" /> <br /><br />  Travail<br /> <input type="text" id="wphone" name="wphone" size="12" maxlength="12" />&nbsp;&nbsp;poste&nbsp;<input type="text" id="wphonex" name="wphonex" size="5" maxlength="5" /> <br /><br /><br />  Sexe<br /> <input type="radio" name="gender" value="m" />Masculin<br /> <input type="radio" name="gender" value="f" />F&eacute;minin<br /> <br /><br /><br />  Depuis compbien de temps travaillez-vous pour l'<acronym title="Agence du revenu du Canada">ARC</acronym>?<br /> <input type="radio" name="years" value="0" />de 0 &agrave; 5 ans<br /> <input type="radio" name="years" value="1" />de 6 &agrave; 10 ans<br /> <input type="radio" name="years" value="2" />de 11 &agrave; 20 ans<br /> <input type="radio" name="years" value="3" />20 ans ou plus <br /><br /><br />  Appartenez-vous &agrave; une minorit&eacute; visible?<br /> <input type="radio" name="vismin" value="y" />Oui<br /> <input type="radio" name="vismin" value="n" />Non <br /><br /><br />  Avez-vous besoin d'une ou de plusieurs technologies adapt&eacute;es pour effectuer vos t&acirc;ches courantes?<br /> <input type="radio" name="dis" value="y" />Oui<br /> <input type="radio" name="dis" value="n" />Non <br /><br /><br />  <input type="submit" value="Envoyer" />  </div> </form>