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register.php
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register.php
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<section id="content">
<div class="container content">
<p> <?php check_message();?></p>
<form class="row form-horizontal span6 wow fadeInDown" action="process.php?action=register" method="POST">
<h2 class=" ">Personal Info</h2>
<div class="row">
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"FNAME">Firstname:</label>
<div class="col-md-8">
<input name="JOBID" type="hidden" value="<?php echo $_GET['job'];?>">
<input class="form-control input-sm" id="FNAME" name="FNAME" placeholder=
"Firstname" type="text" value="" onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off">
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"LNAME">Lastname:</label>
<div class="col-md-8">
<input name="deptid" type="hidden" value="">
<input class="form-control input-sm" id="LNAME" name="LNAME" placeholder=
"Lastname" onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off">
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"MNAME">Middle Name:</label>
<div class="col-md-8">
<input name="deptid" type="hidden" value="">
<input class="form-control input-sm" id="MNAME" name="MNAME" placeholder=
"Middle Name" onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off">
<!-- <input class="form-control input-sm" id="DEPARTMENT_DESC" name="DEPARTMENT_DESC" placeholder=
"Description" type="text" value=""> -->
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"ADDRESS">Address:</label>
<div class="col-md-8">
<textarea class="form-control input-sm" id="ADDRESS" name="ADDRESS" placeholder=
"Address" type="text" value="" required onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off"></textarea>
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"Gender">Sex:</label>
<div class="col-md-8">
<div class="col-lg-5">
<div class="radio">
<label><input checked id="optionsRadios1" checked="True" name="optionsRadios" type="radio" value="Female">Female</label>
</div>
</div>
<div class="col-lg-4">
<div class="radio">
<label><input id="optionsRadios2" name="optionsRadios" type="radio" value="Male"> Male</label>
</div>
</div>
</div>
</div>
</div>
<div class="form-group">
<div class="rows">
<div class="col-md-8">
<div class="col-md-4">
<label class="col-lg-12 control-label">Date of Birth :</label>
</div>
<div class="col-lg-3">
<select class="form-control input-sm" name="month">
<option>Month</option>
<?php
$mon = array('Jan' => 1 ,'Feb'=> 2,'Mar' => 3 ,'Apr'=> 4,'May' => 5 ,'Jun'=> 6,'Jul' => 7 ,'Aug'=> 8,'Sep' => 9 ,'Oct'=> 10,'Nov' => 11 ,'Dec'=> 8 );
foreach ($mon as $month => $value ) {
# code...
echo '<option value='.$value.'>'.$month.'</option>';
}
?>
</select>
</div>
<div class="col-lg-2">
<select class="form-control input-sm" name="day">
<option>Day</option>
<?php
$d = range(31, 1);
foreach ($d as $day) {
echo '<option value='.$day.'>'.$day.'</option>';
}
?>
</select>
</div>
<div class="col-lg-3">
<select class="form-control input-sm" name="year">
<option>Year</option>
<?php
$years = range(2010, 1900);
foreach ($years as $yr) {
echo '<option value='.$yr.'>'.$yr.'</option>';
}
?>
</select>
</div>
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"BIRTHPLACE">Place of Birth:</label>
<div class="col-md-8">
<textarea class="form-control input-sm" id="BIRTHPLACE" name="BIRTHPLACE" placeholder=
"Place of Birth" type="text" value="" required onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off"></textarea>
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"TELNO">Contact No.:</label>
<div class="col-md-8">
<input class="form-control input-sm" id="TELNO" name="TELNO" placeholder=
"Contact No." type="text" any value="" required onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off">
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"CIVILSTATUS">Civil Status:</label>
<div class="col-md-8">
<select class="form-control input-sm" name="CIVILSTATUS" id="CIVILSTATUS">
<option value="none" >Select</option>
<option value="Single">Single</option>
<option value="Married">Married</option>
<option value="Widow" >Widow</option>
<!-- <option value="Fourth" >Fourth</option> -->
</select>
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"EMAILADDRESS">Email Address:</label>
<div class="col-md-8">
<input type="Email" class="form-control input-sm" id="EMAILADDRESS" name="EMAILADDRESS" placeholder="Email Address" autocomplete="false"/>
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"USERNAME">Username:</label>
<div class="col-md-8">
<input name="deptid" type="hidden" value="">
<input class="form-control input-sm" id="USERNAME" name="USERNAME" placeholder=
"Username" onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off">
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"PASS">Password:</label>
<div class="col-md-8">
<input name="deptid" type="hidden" value="">
<input class="form-control input-sm" id="PASS" name="PASS" placeholder=
"Password" type="password" onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off">
<!-- <input class="form-control input-sm" id="DEPARTMENT_DESC" name="DEPARTMENT_DESC" placeholder=
"Description" type="text" value=""> -->
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"DEGREE">Educational Attainment:</label>
<div class="col-md-8">
<input name="deptid" type="hidden" value="">
<input class="form-control input-sm" id="DEGREE" name="DEGREE" placeholder=
"Educational Attainment" onkeyup="javascript:capitalize(this.id, this.value);" autocomplete="off">
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
""></label>
<div class="col-md-8">
<label><input type="checkbox"> By Sign up you are agree with our <a href="#">terms and condition</a></label>
</div>
</div>
</div>
<div class="form-group">
<div class="col-md-8">
<label class="col-md-4 control-label" for=
"idno"></label>
<div class="col-md-8">
<button class="btn btn-primary btn-sm" name="btnRegister" type="submit" ><span class="fa fa-save fw-fa"></span> Save</button>
</div>
</div>
</div>
</form>
</div>
</section>