diff --git a/templates/cms/page.tpl b/templates/cms/page.tpl
index 4839ab7..7dbbced 100644
--- a/templates/cms/page.tpl
+++ b/templates/cms/page.tpl
@@ -33,6 +33,11 @@
 
     {block name='cms_content'}
       {$cms.content nofilter}
+      {block name='careers-page-form'}
+        {if $page.meta.title == 'Careers' || $page.meta.title == 'careers'}
+          {include file="../misc/careers-page-form.tpl"}
+        {/if}
+      {/block}
     {/block}
 
     {block name='hook_cms_dispute_information'}
diff --git a/templates/misc/careers-page-form.tpl b/templates/misc/careers-page-form.tpl
new file mode 100644
index 0000000..bef57d9
--- /dev/null
+++ b/templates/misc/careers-page-form.tpl
@@ -0,0 +1,16 @@
+<div class="flex flex-col items-center my-24 gap-8">
+  <img src="https://brooksbingham.com/img/logo-1715173509.jpg" alt="brooksbingham-company-logo" width="64" height="64" />
+  <form action="" method="post" autocomplete="off" class="flex flex-col gap-4 max-w-4xl mx-auto w-full">
+      <input name="careersPageForm" value="careers-page-form" class="hidden" />
+      <div class="w-full flex flex-col md:flex-row gap-3">
+        <input name="firstName" type="text" placeholder="First name*" class="flex-grow" required />
+        <input name="lastName" type="text" placeholder="Last name*" class="flex-grow" required />
+      </div>
+      <input name="email" type="email" placeholder="Email*" class="" required />
+      <input name="subject" type="text" placeholder="Subject*" class="hidden" />
+      <textarea name="message" type="text" placeholder="Tell us about your experience in sales and why you're interested in brooksbingham" class="" rows="4"></textarea>
+      <button class="uppercase py-2 flex-1 text-center border border-blue-950 hover:text-blue-900 hover:border-blue-900 hover:underline text-blue-950 font-medium max-h-[40px]" type="submit">
+        Send
+      </button>
+  </form>
+</div>