<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<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;
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.style4 {color: #FFFFFF}
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</style>
</head>
<body>
<p> </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"> </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> </p>
<p> </p>
</form>
</body>
</html>