Location: PHPKode > projects > E-hris > test.php
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<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<title></title>
<link rel="stylesheet" type="text/css" href="css/main.css" />
<style type="text/css">
<!--
.style2 {font-size: x-small}
.style3 {
	color: #FFFFFF;
	font-weight: bold;
}
.style4 {color: #FFFFFF}
-->
</style>
</head>

<body>
<p>&nbsp;</p>
<form name="form1" method="post" action="">
  <table width="59%"  border="0">
    <tr>
      <th width="10%" scope="col"><span class="style4">Personal Details </span></th>
      <th colspan="5" scope="col">&nbsp;</th>
    </tr>
    <tr>
      <td><div align="right"><strong>Names</strong>:</div></td>
      <td width="10%"><select name="select">
      </select>  
      <td width="10%"><input type="text" name="textfield">      
      <td width="20%"><input type="text" name="textfield">      
      <td width="50" colspan="2"><input type="text" name="textfield">      
    </tr>
    <tr>
      <td nowrap><div align="right"><strong>Preferred Names: </strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Date of Birth: </strong></div>
      <td><input type="text" name="textfield">
      <td><img src="images/show-calendar.gif" width="26" height="22">           </tr>
    <tr>
      <td nowrap><div align="right"><strong>Payroll No: </strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Place of Birth:</strong> </div>
      <td colspan="2"><input type="text" name="textfield">
      </tr>
    <tr>
      <td><div align="right"><strong>Gender:</strong></div></td>
      <td colspan="2" nowrap><span class="style2">male</span>        <input name="gender" type="radio" value="m">
      <img src="images/male.gif" width="25" height="15"> <span class="style2">female</span>      <input name="gender" type="radio" value="f">
      <img src="images/female.gif" width="25" height="15">   
      <td><div align="right"><strong>Nationality:</strong> </div>
      <td colspan="2"><select name="select">
      </select>      
    </tr>
    <tr>
      <td><div align="right"><strong>ID No:/Pass No:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Marital Status: </strong></div>
      <td colspan="2"><select name="select">
      </select>    
    </tr>
    <tr>
      <td><div align="right"><strong>PIN:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>NSSF NO: </strong> </div>
      <td colspan="2"><input type="text" name="textfield">    
    </tr>
    <tr>
      <td><div align="right"><strong>NHIF NO:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Employment Date: </strong> </div>
      <td><input type="text" name="textfield">
      <td><img src="images/show-calendar.gif" width="26" height="22">           </tr>
    <tr>
      <th colspan="3" ><div align="center"><span class="style3">Current Residential Status    </span></div></th>
    <th colspan="3">   <div align="center" class="style4">Permanent Address </div></th>
    </tr>
    <tr>
      <td><div align="right"><strong>Current Res: </strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Home Res:     
      </strong></div>
      <td colspan="2"><input type="text" name="textfield">    
    </tr>
    <tr>
      <td><div align="right"><strong>Physical:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Province:    
        </strong>
      </div>
      <td colspan="2"><input type="text" name="textfield">    
    </tr>
    <tr>
      <td><div align="right"><strong>Description:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>District: </strong> </div>
      <td colspan="2"><input type="text" name="textfield">    
    </tr>
    <tr>
      <td><div align="right"><strong>Street:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Division:</strong></div>
      <td colspan="2"><input type="text" name="textfield">    
    </tr>
    <tr>
      <td><div align="right"><strong>Estate:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong> </strong> <strong>Location: </strong> </div>
      <td colspan="2"><input type="text" name="textfield">    
    </tr>
    <tr>
      <td><div align="right"><strong>Town:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>SubLocation:    
        </strong>
      </div>
      <td colspan="2"><input type="text" name="textfield">    
    </tr>
    <tr>
      <td><div align="right"><strong>Postal Address:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Phone No: </strong></div></td>
      <td colspan="2"><input type="text" name="textfield">      
    </tr>
    <tr>
      <th><span class="style3">Other Details</span></th>
      <td colspan="2">    
      <td>    
      <td colspan="2">    
    </tr>
    <tr>
      <td><div align="right"><strong>Unit:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Driving Licence No:     </strong></div>
      <td colspan="2"><input type="text" name="textfield">    
    </tr>
    <tr>
      <td nowrap><strong>Employment Status: </strong></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Date of Issue:</strong></div>
      <td><input type="text" name="textfield">
      <td><img src="images/show-calendar.gif" width="26" height="22">           </tr>
    <tr>
      <td><div align="right"><strong>Position:</strong></div></td>
      <td colspan="2"><input type="text" name="textfield">    
      <td><div align="right"><strong>Class(es)    
        </strong>
      </div>
      <td colspan="2" nowrap>A
        <input name="chka" type="checkbox" id="chka" value="a">
        B
        <input name="chkb" type="checkbox" id="chkb" value="b">
        C
        <input name="chkc" type="checkbox" id="chkc" value="c">
        D
        <input name="chkd" type="checkbox" id="chkd" value="d">
        E
        <input name="chke" type="checkbox" id="chke" value="e">
        F
        <input name="chka" type="checkbox" id="chka" value="a">    
    </tr>
    <tr>
      <td><div align="right"><strong>DeptName:</strong></div></td>
      <td colspan="2"><select name="select">
      </select>      
      <td>    
      <td colspan="2"><div align="right">
        <input type="reset" name="Reset" value="Reset">
        <input type="submit" name="Submit" value="Submit">    
      </div>
    </tr>
  </table>
  <p>&nbsp;</p>
  <p>&nbsp;</p>
</form>
</body>
</html>



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