<table style="width:60%">
    <tr>
        <td>
        <form action="#" method="post" name="job_application" id="job_form">
            <fieldset>
                <legend><h3>Personal Information</h3></legend>
                <label for="fullname">Full Name:</label>
                <input type="text" id="name_field" name="name"><br>

                <label for="address">Home Address:</label>
                <input type="text" id="address_field" name="address"><br>

                <label for="phone">Phone Number:</label>
                <input type="text" id="phone_field" name="phone">
                <br>
                <br>

                <b> Account Details: </b><br>
                <label for="email-address">Email Address:</label>
                <input type="text" id="email_field" name="email"><br>

                <label for="password">Password:</label>
                <input type="password" id="password_field" name="password"><br>
                <br>
                <br>

                <b> Gender: </b><br>
                <input type="radio" name="gender" value="male" checked> Male<br>
                <input type="radio" name="gender" value="female"> Female<br>
                <input type="radio" name="gender" value="other"> Not Disclose<br>
            </fieldset>
            <br>

            <fieldset>
                <legend><h3>Department Interest</h3></legend>

                <b>State</b>
                <select>
                    <option value="New Jersey" selected>New Jersey</option>
                    <option value="New York">New York</option>
                    <option value="Texas">Texas</option>
                    <option value="California">California</option>
                </select>
                <br>
                <br>

                <input type="checkbox" name="departmentAcc" value="Accounting" checked>Accounting
                <br>
                <input type="checkbox" name="departmentHR" value="HR">Human Resources
                <br>
                <input type="checkbox" name="departmentComp" value="Compliance">Compliance
                <br>
                <input type="checkbox" name="departmentIT" value="IT">Information Tech
                <br>
            </fieldset><br>

            <fieldset>
                <legend><h3>Create Account</h3></legend>
                <input type="submit" id="submit" name="submit" value="Submit">
            </fieldset>

        </form>
        </td>
        <td>
            <div>
                <textarea rows="15" id="output_value" cols="40"></textarea>
            </div>
        </td>
    <tr>
</table>