// JScript source code
function verify() {


    var themessage = "You are required to complete the following fields: ";
    var correctMessage = themessage;

    if (document.verifyform.NameField.value=="") {
        themessage = themessage + " - Name";
    }

    if (document.verifyform.disabled.checked == false) {
        themessage = themessage + " -  Who is disabled";
    }


    if (document.verifyform.Phone.value=="") {
        themessage = themessage + " - Phone";
    }

    if(document.verifyform.Phone.value.search(/\d{3}\-\d{3}\-\d{4}/)==-1)
    {
        alert("The phone number you entered is not valid.\r\nPlease enter a phone number with the format xxx-xxx-xxxx.");
        return false;
    }
 


    if (document.verifyform.Email.value=="") {
        themessage = themessage + " -  E-mail";
    }

    if (document.verifyform.CurrentBenefits.value=="") {
        themessage = themessage + " -  Already receiving Social Security benefits";
    }

    if (document.verifyform.BirthDate.value=="") {
        themessage = themessage + " -  Date of birth";
    }

    if (document.verifyform.Condition.value=="") {
        themessage = themessage + " -  What health/medical condition that prevents applicant from working";
    }

    if (document.verifyform.applied.checked == false) {
        themessage = themessage + " -  Have you ever applied for Social Security Benefits";
    }

    if (document.verifyform.lawyer.checked == false) {
        themessage = themessage + " -  Do you HAVE an attorney assisting you with this matter";
    }

    if (document.verifyform.condition.value=="") {
        themessage = themessage + " -  Please describe the medical condition that prevents you from working";
    }


    if (VerifyFormats() !=-1) 
    {

        //If everything went well submit.
        if (themessage  == correctMessage){
        
	    document.verifyform.submit();
    }
    else {
           alert(themessage);
           return false;
    }
  }




function VerifyFormats(){

//alert if fields are empty and cancel form submit

if(document.verifyform.Phone.value.search(/\d{3}\-\d{3}\-\d{4}/)==-1)
{
	alert("The phone number you entered is not valid.\r\nPlease enter a phone number with the format xxx-xxx-xxxx.");
return false;
}

var emailRegEx = /^[A-Z0-9._%+-]+@[A-Z0-9.-]+\.[A-Z]{2,4}$/i;
if (document.verifyform.Email.value.search(emailRegEx) == -1) {
alert("Please enter a valid email address.");
return false;
}


if (check_date(document.verifyform.BirthDate) == -1)
{
	
alert("Please enter a valid date format.");
return false;
}

return true;
}
}


function check_date(field){
var checkstr = "0123456789";
var DateField = field;
var Datevalue = "";
var DateTemp = "";
var seperator = ".";
var day;
var month;
var year;
var leap = 0;
var err = 0;
var i;
   err = 0;
   DateValue = DateField.value;
   /* Delete all chars except 0..9 */
   for (i = 0; i < DateValue.length; i++) {
	  if (checkstr.indexOf(DateValue.substr(i,1)) >= 0) {
	     DateTemp = DateTemp + DateValue.substr(i,1);
	  }
   }
   DateValue = DateTemp;
   /* Always change date to 8 digits - string*/
   /* if year is entered as 2-digit / always assume 20xx */
   if (DateValue.length == 6) {
      DateValue = DateValue.substr(0,4) + '20' + DateValue.substr(4,2); }
   if (DateValue.length != 8) {
      err = 19;}
   /* year is wrong if year = 0000 */
   year = DateValue.substr(4,4);
   if (year == 0) {
      err = 20;
   }
   /* Validation of month*/
   month = DateValue.substr(2,2);
   if ((month < 1) || (month > 12)) {
      err = 21;
   }
   /* Validation of day*/
   day = DateValue.substr(0,2);
   if (day < 1) {
     err = 22;
   }
   /* Validation leap-year / february / day */
   if ((year % 4 == 0) || (year % 100 == 0) || (year % 400 == 0)) {
      leap = 1;
   }
   if ((month == 2) && (leap == 1) && (day > 29)) {
      err = 23;
   }
   if ((month == 2) && (leap != 1) && (day > 28)) {
      err = 24;
   }
   /* Validation of other months */
   if ((day > 31) && ((month == "01") || (month == "03") || (month == "05") || (month == "07") || (month == "08") || (month == "10") || (month == "12"))) {
      err = 25;
   }
   if ((day > 30) && ((month == "04") || (month == "06") || (month == "09") || (month == "11"))) {
      err = 26;
   }
   
   /* if no error, write the completed date to Input-Field (e.g. 13.12.2001) */
   if (err == 0) {
      //DateField.value = day + seperator + month + seperator + year;
	return true;
   }
   /* Error-message if err != 0 */
   else {
      alert("Date is incorrect!");
      //DateField.select();
	//  DateField.focus();
	return false;
   }
 }