whoami7 - Manager
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<!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <title>Responsive Application Form</title> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <style> * { box-sizing: border-box; } body { font-family: Arial, sans-serif; padding: 20px; background: #f2f2f2; } form { max-width: 900px; background: white; padding: 30px; margin: auto; border-radius: 8px; box-shadow: 0 0 8px rgba(0,0,0,0.1); } h2 { text-align: center; margin-bottom: 30px; } .row { display: flex; flex-wrap: wrap; margin-bottom: 15px; } .col-50 { flex: 0 0 48%; margin-right: 4%; } .col-100 { flex: 0 0 100%; } .col-50:last-child { margin-right: 0; } label { font-size: 14px; margin-bottom: 4px; display: block; } input, select, textarea { width: 100%; padding: 6px 10px; font-size: 14px; border: 1px solid #ccc; border-radius: 4px; } .small-input { max-width: 300px; } .section-title { font-weight: bold; margin-top: 25px; border-top: 1px solid #ccc; padding-top: 15px; } .checkbox-group label { display: inline-block; margin-right: 15px; } .declaration { margin-top: 20px; font-size: 14px; } .submit { text-align: center; margin-top: 30px; } button { padding: 10px 25px; font-size: 16px; background: #007bff; color: white; border: none; border-radius: 4px; cursor: pointer; } button:hover { background: #0056b3; } @media (max-width: 768px) { .col-50 { flex: 0 0 100%; margin-right: 0; } .small-input { max-width: 100%; } } </style> </head> <body> <form action="send.php" method="post"> <h2>Application Form</h2> <div class="row col-100"> <label for="regno">REG NO:</label> <input type="text" id="regno" name="regno" class="small-input"> </div> <div class="row col-100"> <label>Circle the course you want to join:</label> <select name="course" required> <option value="">Select course</option> <option>CSCS</option> <option>NVQ</option> <option>ECS</option> <option>Electrical</option> <option>Plumbing</option> <option>SMSTS</option> <option>SSSTS</option> <option>CPCS</option> <option>NPORS</option> <option>GAS</option> <option>SIA</option> <option>Short Course</option> </select> </div> <div class="row col-100 section-title">Personal Details</div> <div class="row"> <div class="col-50"> <label>First Name*</label> <input type="text" name="first_name" required> </div> <div class="col-50"> <label>Middle Name</label> <input type="text" name="middle_name"> </div> </div> <div class="row"> <div class="col-50"> <label>Last Name*</label> <input type="text" name="last_name" required> </div> <div class="col-50"> <label>Gender*</label> <select name="gender" required> <option value="">Select</option> <option>Male</option> <option>Female</option> </select> </div> </div> <div class="row"> <div class="col-50"> <label>Date of Birth*</label> <input type="date" name="dob" required> </div> <div class="col-50"> <label>Place of Birth</label> <input type="text" name="place_of_birth"> </div> </div> <div class="row"> <div class="col-50"> <label>Nationality</label> <input type="text" name="nationality"> </div> <div class="col-50"> <label>Where did you hear about us?</label> <input type="text" name="referral_source"> </div> </div> <div class="row"> <div class="col-50"> <label>Email*</label> <input type="email" name="email" required> </div> </div> <div class="row"> <div class="col-50"> <label>Telephone No.*</label> <input type="tel" name="telephone" required> </div> <div class="col-50"> <label>Mobile No.*</label> <input type="tel" name="mobile" required> </div> </div> <div class="row col-100 section-title">Address</div> <div class="row"> <div class="col-50"> <label>House No.</label> <input type="text" name="house_no"> </div> <div class="col-50"> <label>Street*</label> <input type="text" name="street" required> </div> </div> <div class="row"> <div class="col-50"> <label>Town/City</label> <input type="text" name="town_city"> </div> <div class="col-50"> <label>Country</label> <input type="text" name="country"> </div> </div> <div class="row"> <div class="col-50"> <label>Postcode*</label> <input type="text" name="postcode" required> </div> </div> <div class="row col-100 section-title">Other Details</div> <div class="row"> <div class="col-50"> <label>NI No / UTR</label> <input type="text" name="ni_no"> </div> <div class="col-50"> <label>CSCS / CPCS No.</label> <input type="text" name="cscs_no"> </div> </div> <div class="row col-100"> <label>Site Location</label> <input type="text" name="site_location"> </div> <div class="row col-100"> <label>Qualification Level</label> <input type="text" name="qualification_level"> </div> <div class="row col-100 section-title">Checklist</div> <div class="row checkbox-group"> <label><input type="checkbox" name="checklist[]" value="Photo ID"> Photo ID</label> <label><input type="checkbox" name="checklist[]" value="Proof of Address"> Proof of Address</label> <label><input type="checkbox" name="checklist[]" value="Copy of CPCS / CSCS Card"> Copy of CPCS / CSCS Card</label> </div> <div class="row col-100 section-title">Declaration</div> <div class="declaration"> <p>Under the terms of the Data Protection Act, 1998, the personal information supplied by you will be treated in confidence but may be used intentionally for other registered purposes.</p> <p>I hereby declare that all the foregoing particulars are correct and apply for admission.</p> <label>Signature: ____________________________</label><br> <label>Date: ____________________________</label> </div> <div class="submit"> <button type="submit">Submit Application</button> </div> </form> </body> </html>
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