{"id":2197,"date":"2026-01-28T14:26:25","date_gmt":"2026-01-28T13:26:25","guid":{"rendered":"http:\/\/wordpress.p12300.webspaceconfig.de\/?page_id=2197"},"modified":"2026-07-10T12:05:13","modified_gmt":"2026-07-10T10:05:13","slug":"application-form","status":"publish","type":"page","link":"https:\/\/www.peter-brehm.de\/en\/contacts\/application-form\/","title":{"rendered":"Application form"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:60px;--awb-padding-bottom:60px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1456px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"--awb-text-color:var(--awb-color4);\"><h1 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;text-transform:uppercase;--fontSize:40;line-height:1.5;\">Contact<\/h1><\/div><div class=\"fusion-text fusion-text-1\" style=\"--awb-content-alignment:center;\"><p>PETER BREHM GmbH<br \/>\nAm M\u00fchlberg 30, 91085 Weisendorf, Germany<\/p>\n<p>Phone: +49 9135 7103 0<br \/>\nFax: +49 9135 7103 16<br \/>\nEmail: <a href=\"mailto:info@peter-brehm.de\">info@peter-brehm.de<\/a><\/p>\n<\/div><div class=\"fusion-social-links fusion-social-links-1\" style=\"--awb-margin-top:0px;--awb-margin-right:0px;--awb-margin-bottom:0px;--awb-margin-left:0px;--awb-alignment:center;--awb-box-border-top:0px;--awb-box-border-right:0px;--awb-box-border-bottom:0px;--awb-box-border-left:0px;--awb-icon-colors-hover:var(--awb-color4);--awb-box-colors-hover:var(--awb-color1);--awb-box-border-color:var(--awb-color3);--awb-box-border-color-hover:var(--awb-color4);\"><div class=\"fusion-social-networks color-type-custom\"><div class=\"fusion-social-networks-wrapper\"><a class=\"fusion-social-network-icon fusion-tooltip fusion-facebook awb-icon-facebook\" style=\"color:var(--awb-color4);font-size:16px;\" data-placement=\"top\" data-title=\"Facebook\" data-toggle=\"tooltip\" title=\"Facebook\" aria-label=\"facebook\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"#\"><\/a><a class=\"fusion-social-network-icon fusion-tooltip fusion-twitter awb-icon-twitter\" style=\"color:var(--awb-color4);font-size:16px;\" data-placement=\"top\" data-title=\"X\" data-toggle=\"tooltip\" title=\"X\" aria-label=\"twitter\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"#\"><\/a><a class=\"fusion-social-network-icon fusion-tooltip fusion-tiktok awb-icon-tiktok\" style=\"color:var(--awb-color4);font-size:16px;\" data-placement=\"top\" data-title=\"Tiktok\" data-toggle=\"tooltip\" title=\"Tiktok\" aria-label=\"tiktok\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"#\"><\/a><a class=\"fusion-social-network-icon fusion-tooltip fusion-youtube awb-icon-youtube\" style=\"color:var(--awb-color4);font-size:16px;\" data-placement=\"top\" data-title=\"YouTube\" data-toggle=\"tooltip\" title=\"YouTube\" aria-label=\"youtube\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"#\"><\/a><a class=\"fusion-social-network-icon fusion-tooltip fusion-linkedin awb-icon-linkedin\" style=\"color:var(--awb-color4);font-size:16px;\" data-placement=\"top\" data-title=\"LinkedIn\" data-toggle=\"tooltip\" title=\"LinkedIn\" aria-label=\"linkedin\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"#\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-bottom:60px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1456px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-two\" style=\"--awb-text-color:var(--awb-color4);--awb-font-size:1.6em;\"><h2 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;font-size:1em;text-transform:uppercase;--fontSize:25.6;line-height:1.5;\">Application form<\/h2><\/div><style id=\"wpforms-css-vars-694\">\n\t\t\t\t#wpforms-694 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-694\"><form id=\"wpforms-form-694\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"694\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/2197\" data-token=\"8dcb563f4ccc26e0aa135c94a4fda651\" data-token-time=\"1786874268\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\">\t\t<div id=\"wpforms-694-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-694-field_1\" >Layout \/ Your<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-694-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-694-field_5-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"5\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-694-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_6\">Title:<\/label><input type=\"text\" id=\"wpforms-694-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-694-field_6-error\" 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type=\"text\" id=\"wpforms-694-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-694-field_9-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-694-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_10\">Last name: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-694-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-694-field_10-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-694-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_11\">Clinic \/ Institution \/ Company:<\/label><input type=\"text\" id=\"wpforms-694-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-694-field_11-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-694-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_12\">Position \/ Department:<\/label><input type=\"text\" id=\"wpforms-694-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-694-field_12-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-694-field_13-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_13\">Email address: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-694-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" spellcheck=\"false\" aria-errormessage=\"wpforms-694-field_13-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-694-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_14\">Phone: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-694-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-694-field_14-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-694-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_15\">Street, No.:<\/label><input type=\"text\" id=\"wpforms-694-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-694-field_15-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-694-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_16\">Postal code, City<\/label><input type=\"text\" id=\"wpforms-694-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-694-field_16-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-694-field_3-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-694-field_3\">Your message:<\/label><textarea id=\"wpforms-694-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-694-field_3-error\" ><\/textarea><\/div><div id=\"wpforms-694-field_17-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">Data protection <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-694-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-694-field_17_1\" name=\"wpforms[fields][17][]\" value=\"I hereby confirm that i have read the privacy policy\" aria-errormessage=\"wpforms-694-field_17_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-694-field_17_1\">I hereby confirm that i have read the privacy policy<\/label><\/li><\/ul><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( 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--><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":3030,"parent":2438,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"seitenlink":[],"class_list":["post-2197","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/pages\/2197","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/comments?post=2197"}],"version-history":[{"count":14,"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/pages\/2197\/revisions"}],"predecessor-version":[{"id":2603,"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/pages\/2197\/revisions\/2603"}],"up":[{"embeddable":true,"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/pages\/2438"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/media\/3030"}],"wp:attachment":[{"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/media?parent=2197"}],"wp:term":[{"taxonomy":"seitenlink","embeddable":true,"href":"https:\/\/www.peter-brehm.de\/en\/wp-json\/wp\/v2\/seitenlink?post=2197"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}