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- <!DOCTYPE html>
- <html lang="en">
- <head>
- <meta charset="utf-8">
- <meta http-equiv="X-UA-Compatible" content="IE=edge">
- <meta name="viewport" content="width=device-width, initial-scale=1">
- <!-- The above 3 meta tags *must* come first in the head; any other head content must come *after* these tags -->
- <title>Registration Form</title>
- <script type="text/javascript" src="//code.jquery.com/jquery-1.8.3.js"></script>
- <style type="text/css">
- .test{ display:none; }
- input[type="submit"]{ border: thin solid #333; }
- </style>
- <script type="text/javascript">
- $(window).load(function(){
- $(':input').bind('keypress keydown keyup change',function(){
- var ssc_gp = parseFloat($(':input[name="ssc_gp"]').val(),10);
- var ssc=75;
- if(ssc_gp >= ssc){
- $("input[name=submit]").removeClass("test");
- }else if(ssc_gp < ssc){
- $("input[name=submit]").addClass("test");
- }
- console.log(ssc,ssc_gp);
- });
- });
- </script>
- <!-- Bootstrap -->
- <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css">
- <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
- <script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
- <link href="css/bootstrap.min.css" rel="stylesheet">
- <link href="css/dcalendar.picker.css" rel="stylesheet">
- <style type="text/css">
- #deceased {
- background-color: #FFF3F5;
- padding-top: 10px;
- margin-bottom: 10px;
- }
- .remove_field {
- float: right;
- cursor: pointer;
- position: absolute;
- }
- .remove_field:hover {
- text-decoration: none;
- }
- /*css start */
- /*!Don't remove this!
- * jQuery DCalendar and DCalendar Picker plugin styles
- *
- * Author: Dionlee Uy
- * Email: dionleeuy@gmail.com
- *
- * Date: Mon Mar 2 2013
- */
- .calendar {
- position: relative;
- font-family: 'Century Gothic','Segoe UI', Calibri, Arial;
- font-size: 12px;
- border-collapse: collapse;
- margin: 0;
- padding: 0;
- z-index: 4;
- border: 1px solid rgba(0,0,0,0.08);
- width: 250px;
- color: #000;
- text-align: center;
- background-color: #FFF;
- }
- .calendar th,
- .calendar td {
- text-align: center;
- -webki-ttransition: all 0.3s ease;
- -moz-transition: all 0.3s ease;
- transition: all 0.3s ease;
- }
- .calendar th:first-child,
- .calendar td:first-child {
- margin-left: 5px;
- }
- .calendar span {
- padding: 6px 4px;
- display: block;
- }
- .calendar .month {
- padding: 15px;
- }
- .calendar .pMDate, .calendar .nMDate {
- color: #AAA;
- }
- .calendar .date, .calendar .pMDate, .calendar .nMDate, .calendar .month {
- cursor: pointer;
- }
- .calendar .date:hover, .calendar .pMDate:hover, .calendar .nMDate:hover, .calendar .month:hover {
- background-color: #E2E2E2;
- }
- .calendar .date:active, .calendar .pMDate:active, .calendar .nMDate:active, .calendar .month:active {
- background-color: #22A7F0;
- color: #FFF;
- }
- .calendar .selected {
- background-color: #22A7F0 !important;
- color: #FFF !important;
- }
- .calendar tr:first-child th {
- background-color: #FFF;
- padding: 4px;
- padding-top: 8px;
- font-size: 14px;
- }
- .calendar tr:first-child th {
- cursor: pointer;
- color: #000;
- }
- .calendar tr:first-child th:hover {
- color: #22A7F0;
- }
- .calendar tr:first-child th:active {
- color: #22A7F0;
- }
- .calendar thead tr:nth-child(2) th {
- color: #555;
- padding: 8px 3px;
- }
- .calendar #prev, .calendar #next {
- font-family: 'Times New Roman';
- font-size: 20px;
- padding: 0;
- }
- .calendar #today {
- text-align: center;
- cursor: pointer;
- color: #22A7F0;
- padding: 10px 6px;
- }
- .calendar #today:hover {
- color: #80A7DD;
- }
- .calendar #today:active {
- color: #000;
- }
- .calendar #currDay {
- color: #22A7F0;
- }
- .datepicker {
- background: #ffffff url('https://cdn4.iconfinder.com/data/icons/small-n-flat/24/calendar-128.png') no-repeat right top;
- background-size: 30px 30px;
- ;
- }
- .panel-primary {
- border-color: #33b7b7;
- }
- .panel-primary > .panel-heading {
- color: #fff;
- background-color: #33b7b7;
- border-color: #33b7b7;
- }
- #input
- {
- width:120px;
- }
- /*End css */
- </style>
- <!-- HTML5 shim and Respond.js for IE8 support of HTML5 elements and media queries -->
- <!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
- <!--[if lt IE 9]>
- <script src="https://oss.maxcdn.com/html5shiv/3.7.2/html5shiv.min.js"></script>
- <script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script>
- <![endif]-->
- <!-- jQuery (necessary for Bootstrap's JavaScript plugins) -->
- <script src="js/jquery-1.12.4.js"></script>
- <script src="js/dcalendar.picker.js"></script>
- <!-- Include all compiled plugins (below), or include individual files as needed -->
- <script src="js/bootstrap.min.js"></script>
- <script type='text/javascript'>
- $(function() {
- //calendar call function
- $('.datepicker').dcalendar();
- $('.datepicker').dcalendarpicker();
- var max_fields = 10; //maximum input boxes allowed
- var x = 1; //initlal text box count
- $('#add').click(function () {
- if(x < max_fields){ //max input box allowed
- x++; //text box increment
- $("#addblock").before('<div class="col-md-12 col-sm-12" id="deceased"> <a href="#" class="remove_field" title="Remove">X</a> <div class="form-group col-md-3 col-sm-3"> <label for="name">Name*</label> <input type="text" class="form-control input-sm" id="name" placeholder=""> </div> <div class="form-group col-md-3 col-sm-3"> <label for="gender">Gender*</label> <input type="text" class="form-control input-sm" id="gender" placeholder=""> </div> <div class="form-group col-md-3 col-sm-3"> <label for="age">Age*</label> <input type="text" class="form-control input-sm" id="age" placeholder=""> </div> <div class="form-group col-md-3 col-sm-3"> <label for="DOB">Date of Birth or Exact Birth Year*</label> <input type="text" class="form-control input-sm datepicker" id="DOB'+x+'" placeholder=""> </div> <div class="form-group col-md-3 col-sm-3"> <label for="DOD">Date of Death or Exact Death Year*</label> <input type="text" class="form-control input-sm datepicker" id="DOD'+x+'" placeholder=""> </div> <div class="form-group col-md-3 col-sm-3"> <label for="mother">Deceased Person\'s Mother Name*</label> <input type="text" class="form-control input-sm" id="mother" placeholder=""> </div> <div class="form-group col-md-3 col-sm-3"> <label for="father">Deceased Person\'s Father Name*</label> <input type="text" class="form-control input-sm" id="father" placeholder=""> </div> <div class="form-group col-md-3 col-sm-3"> <label for="photo">Upload Photo*</label> <input type="file" id="photo"> <p class="help-block">Please upload individual photo. Group photo is not acceptable.</p> </div></div>');
- $('.datepicker').dcalendarpicker();
- } else{
- alert("Only 10 Names Allowed");
- }
- });
- $(document).on('click', '.remove_field', function(e){
- e.preventDefault();
- $(this).parent('div').remove();
- x--;
- });
- });
- //js start
- /* -- DO NOT REMOVE --
- * jQuery DCalendar 1.1 and DCalendar Picker 1.1 plugin
- *
- * Author: Dionlee Uy
- * Email: dionleeuy@gmail.com
- *
- * Date: Sat Mar 2 2013
- *
- * @requires jQuery
- * -- DO NOT REMOVE --
- */
- if (typeof jQuery === 'undefined') { throw new Error('DCalendar.Picker: This plugin requires jQuery'); }
- +function ($) {
- Date.prototype.getDays = function() { return new Date(this.getFullYear(), this.getMonth() + 1, 0).getDate(); };
- var months = ['January','February','March','April','May','June','July','August','September','October','November','December'],
- short_months = ['Jan','Feb','Mar','Apr','May','Jun','Jul','Aug','Sep','Oct','Nov','Dec'],
- daysofweek = ['Sunday','Monday','Tuesday','Wednesday','Thursday','Friday','Saturday'],
- DCalendar = function(elem, options) {
- this.calendar = $(elem);
- this.today = new Date(); //system date
- this.date = this.today; //current selected date, default is today
- this.viewMode = 'days';
- this.options = options;
- this.selected = (this.date.getMonth() + 1) + "/" + this.date.getDate() + "/" + this.date.getFullYear();
- if(options.mode === 'calendar')
- this.tHead = $('<thead><tr><th id="prev">‹</th><th colspan="5" id="currM"></th><th id="next">›</th></tr><tr><th>Su</th><th>Mo</th><th>Tu</th><th>We</th><th>Th</th><th>Fr</th><th>Sa</th></tr></thead>');
- else if (options.mode === 'datepicker')
- this.tHead = $('<thead><tr><th id="prev">‹</th><th colspan="5" id="currM"></th><th id="next">›</th></tr><tr><th>S</th><th>M</th><th>T</th><th>W</th><th>T</th><th>F</th><th>S</th></tr></thead>');
- this.tHead.find('#currM').text(months[this.today.getMonth()] +" " + this.today.getFullYear());
- this.calendar.prepend(this.tHead);
- var that = this;
- this.calendar.on('click', '#next', function() { initCreate('next'); })
- .on('click', '#prev', function() { initCreate('prev'); })
- .on('click', '#today', function() {
- that.viewMode = 'days';
- var curr = new Date(that.date),
- sys = new Date(that.today);
- if(curr.toString() != sys.toString()) { that.date = sys; }
- that.create('days');
- }).on('click', '.date, .pMDate, .nMDate', function() {
- var tClass = $(this).attr('class'),
- sdate = $(this).text(),
- cmonth = that.date.getMonth(),
- cyear = that.date.getFullYear();
- /* Calculate year */
- if(tClass === 'pMDate') { cyear = (cmonth === 0 ? cyear - 1 : cyear); }
- else if(tClass === 'nMDate') { cyear = (cmonth + 2 === 13 ? cyear + 1 : cyear); }
- /* Calculate month */
- if(tClass === 'pMDate'){ cmonth = (cmonth === 0 ? '12' : cmonth); }
- else if (tClass === 'nMDate') { cmonth = (cmonth + 2 === 13 ? '1' : cmonth + 2); }
- else { cmonth = cmonth + 1; }
- // Selected date
- that.selected = cmonth + '/' + sdate + '/' + cyear;
- if(that.options.mode === 'datepicker') {
- that.calendar.find('td').removeClass('selected');
- $(this).addClass('selected');
- }
- selectDate();
- return true;
- }).on('click', '#currM', function(){
- that.viewMode = 'months';
- that.create(that.viewMode);
- }).on('click', '.month', function(e){
- that.viewMode = 'days';
- var curr = new Date(that.date), y = that.calendar.find('#currM').text();
- curr.setMonth($(e.currentTarget).attr('num'));
- that.date = curr;
- that.create(that.viewMode);
- });
- function selectDate () {
- var newDate = formatDate(that.options.format);
- var e = $.Event('selectdate', {date: newDate});
- that.calendar.trigger(e);
- }
- function formatDate (format) {
- var d = new Date(that.selected), day = d.getDate(), m = d.getMonth(), y = d.getFullYear();
- return format.replace(/(yyyy|yy|mmmm|mmm|mm|m|dd|d)/gi, function (e) {
- switch(e.toLowerCase()){
- case 'd': return day;
- case 'dd': return (day < 10 ? "0"+day: day);
- case 'm': return m+1;
- case 'mm': return (m+1 < 10 ? "0"+(m+1): (m+1));
- case 'mmm': return short_months[m];
- case 'mmmm': return months[m];
- case 'yy': return y.toString().substr(2,2);
- case 'yyyy': return y;
- }
- });
- }
- function initCreate(o){
- var curr = new Date(that.date),
- currMonth = curr.getMonth(),
- currYear = curr.getFullYear();
- curr.setDate(1);
- if(that.viewMode === 'days') {
- curr.setMonth(currMonth + (o === 'next' ? 1 : -1));
- } else {
- curr.setFullYear(currYear + (o === 'next' ? 1 : - 1));
- }
- that.date = curr;
- that.create(that.viewMode);
- }
- this.create(this.viewMode);
- }
- DCalendar.prototype = {
- constructor : DCalendar,
- //setDate : function(){},
- create : function(mode){
- var that = this, cal = [], tBody = $('<tbody></tbody>'), d = new Date(that.date), days = that.date.getDays(), day = 1, nStartDate = 1, selDate = that.selected.split('/');
- that.calendar.empty();
- if(mode === "days") {
- if(that.options.mode === 'calendar') {
- that.tHead = $('<thead><tr><th id="prev">‹</th><th colspan="5" id="currM"></th><th id="next">›</th></tr><tr><th>Su</th><th>Mo</th><th>Tu</th><th>We</th><th>Th</th><th>Fr</th><th>Sa</th></tr></thead>');
- } else if (that.options.mode === 'datepicker') {
- that.tHead = $('<thead><tr><th id="prev">‹</th><th colspan="5" id="currM"></th><th id="next">›</th></tr><tr><th>S</th><th>M</th><th>T</th><th>W</th><th>T</th><th>F</th><th>S</th></tr></thead>');
- }
- that.tHead.find('#currM').text(months[that.date.getMonth()] +" " + that.date.getFullYear());
- that.calendar.append(that.tHead);
- for(var i = 1; i <= 6; i++){
- var temp = [$('<td></td>'),$('<td></td>'),$('<td></td>'),$('<td></td>'),$('<td></td>'),$('<td></td>'),$('<td></td>')];
- while(day <= days){
- d.setDate(day);
- var dayOfWeek = d.getDay();
- if(day === that.today.getDate()
- && d.getMonth() === that.today.getMonth()
- && d.getFullYear() === that.today.getFullYear()) {
- temp[dayOfWeek].attr('id', 'currDay');
- }
- if(that.options.mode === 'datepicker'
- && (((d.getMonth() + 1) + "/" + day + "/" + d.getFullYear()) === (selDate[0] + "/" + selDate[1] + "/" + selDate[2]))) {
- temp[dayOfWeek].addClass('selected');
- }
- if(i === 1 && dayOfWeek === 0){
- break;
- } else if(dayOfWeek < 6){
- temp[dayOfWeek].html('<span>'+(day++)+'</span>').addClass('date');
- } else {
- temp[dayOfWeek].html('<span>'+(day++)+'</span>').addClass('date');
- break;
- }
- }
- /* For days of previous and next month */
- if (i === 1 || i > 4) {
- var p = new Date(that.date);
- // First week
- if (i === 1) {
- var pMonth = p.getMonth(), pDays = 0;
- p.setDate(1);
- p.setMonth(pMonth - 1);
- pDays = p.getDays();
- for (var a = 6; a >= 0; a--) {
- if (temp[a].text() === ''){
- temp[a].html('<span>' + (pDays--) + '</span>').addClass('pMDate');
- if (that.options.mode === 'datepicker'
- && (((d.getMonth()) + "/" + (pDays + 1) + "/" + d.getFullYear()) === (selDate[0] + "/" + selDate[1] + "/" + selDate[2]))) {
- temp[a].addClass('selected');
- }
- }
- }
- }
- // Last week
- else if (i > 4) {
- for (var a = 0; a <= 6; a++) {
- if (temp[a].text() === ''){
- temp[a].html('<span>' + (nStartDate++) + '</span>').addClass('nMDate');
- if (that.options.mode === 'datepicker'
- && (((d.getMonth()+2) + "/" + (nStartDate - 1) + "/" + d.getFullYear()) === (selDate[0] + "/" + selDate[1] + "/" + selDate[2]))) {
- temp[a].addClass('selected');
- }
- }
- }
- }
- }
- cal.push(temp);
- }
- $.each(cal, function(i, v){
- var row = $('<tr></tr>'), l = v.length;
- for(var i = 0; i < l; i++) { row.append(v[i]); }
- tBody.append(row);
- });
- var sysDate = "Today: " + daysofweek[that.today.getDay()] + ", " + months[that.today.getMonth()] + " " + that.today.getDate() + ", " + that.today.getFullYear();
- tBody.append('<tr><td colspan="7" id="today">' + sysDate + '</td></tr>').appendTo(that.calendar);
- } else {
- this.tHead = $('<thead><tr><th id="prev">‹</th><th colspan="2" id="currM"></th><th id="next">›</th></tr>');
- that.tHead.find('#currM').text(that.date.getFullYear());
- that.tHead.appendTo(that.calendar);
- var currI = 0;
- for (var i = 0; i < 3; i++) {
- var row = $('<tr></tr>');
- for (var x = 0; x < 4; x++) {
- var col = $('<td align="center"></td>');
- var m = $('<span class="month" num="' + currI + '">' + short_months[currI] + '</span>');
- col.append(m).appendTo(row);
- currI++;
- }
- tBody.append(row);
- }
- var sysDate = "Today: " + daysofweek[that.today.getDay()] + ", "+ months[that.today.getMonth()] + " " + that.today.getDate() + ", " + that.today.getFullYear();
- tBody.append('<tr><td colspan="4" id="today">' + sysDate + '</td></tr>').appendTo(that.calendar);
- }
- }
- }
- /* DEFINITION FOR DCALENDAR */
- $.fn.dcalendar = function(opts){
- return $(this).each(function(index, elem){
- var that = this;
- var $this = $(that),
- data = $(that).data('dcalendar'),
- options = $.extend({}, $.fn.dcalendar.defaults, $this.data(), typeof opts === 'object' && opts);
- if(!data){
- $this.data('dcalendar', (data = new DCalendar(this, options)));
- }
- if(typeof opts === 'string') data[opts]();
- });
- }
- $.fn.dcalendar.defaults = {
- mode : 'calendar',
- format: 'dd/mm/yyyy',
- };
- $.fn.dcalendar.Constructor = DCalendar;
- /* DEFINITION FOR DCALENDAR PICKER */
- $.fn.dcalendarpicker = function(opts){
- return $(this).each(function(){
- var that = $(this);
- var cal = $('<table class="calendar"></table>'), hovered = false, selectedDate = false;
- that.wrap($('<div class="datepicker" style="position:relative;"></div>'));
- cal.css({
- position:'absolute',
- left:0, display:'none',
- 'box-shadow':'0 4px 6px 1px rgba(0, 0, 0, 0.14)',
- width:'230px',
- }).appendTo(that.parent());
- if(opts){
- opts.mode = 'datepicker';
- cal.dcalendar(opts);
- } else{
- cal.dcalendar({mode: 'datepicker'});
- }
- cal.hover(function(){
- hovered = true;
- }, function(){
- hovered = false;
- }).on('click', function(){
- if(!selectedDate)
- that.focus();
- else {
- selectedDate = false;
- $(this).hide();
- }
- }).on('selectdate', function(e){
- that.val(e.date).trigger('onchange');
- that.trigger($.Event('dateselected', {date: e.date, elem: that}));
- selectedDate = true;
- });
- that.on('keydown', function(e){ if(e.which) return false; })
- .on('focus', function(){
- $('.datepicker').find('.calendar').not(cal).hide();
- cal.show();
- })
- .on('blur', function(){ if(!hovered) cal.hide(); });
- });
- }
- }(jQuery);
- //js end
- </script>
- </head>
- <body style="background-color:#fffeea;">
- <div class="panel panel-primary" style="margin:20px;background-color:#fffeea;">
- <div class="panel-heading">
- <h3 class="panel-title">ADMISSION FORM</h3>
- </div>
- <div class="panel-body">
- <form action="admissionreg.php" method="post">
- <div class="col-sm-12">
- <!--<div class="form-group col-md-4 col-sm-4">
- <label for="referenceno">Reference No* </label>
- <input type="text" name="referenceno" class="form-control input-sm" id="referenceno" placeholder="">
- </div>-->
- <div class="form-group col-md-3 col-sm-3">
- <label for="admissiontype">admission Type. *</label>
- <select class="form-control input-sm" id="category" name="category" >
- <option >-- Select Admission Type --</option>
- <option value="management" >management</option>
- <option value="counselling" >counselling</option>
- <option value="spotadmission" >spotadmission</option>
- <option value="pio" >pio</option>
- </select>
- </div>
- <div class="form-group col-md-2 col-sm-2" style="float:right;">
- <label for="DOD" align="right">Date *</label>
- <input type="text" name="date" id="DOD" value='07-07-2017' align="right" readonly>
- </div>
- </div>
- </div>
- <h4>Choose Course</h4>
- <div class="col-md-12 col-sm-12">
- <div class="form-group col-md-4 col-sm-4">
- <label for="btech">B.Tech/Diploma </label>
- <span class="help-block"></span>
- <select class="form-control input-sm" id="btechdiploma" name="btech" onchange="btechFields();">
- <option>-- Select Branch --</option>
- <option value="civil">civil</option>
- <option value="CSE">CSE</option>
- <option value="ECE">ECE</option>
- <option value="EEE">EEE</option>
- <option value="Mechanical">Mechanical</option>
- <option value="Automobile">Automobile</option>
- <option value="Mining">Mining</option>
- </select>
- </div>
- <div class="form-group col-md-4 col-sm-4">
- <label for="mtech">M.Tech</label>
- <span class="help-block"></span>
- <select class="form-control input-sm" id="mtech" name="mtech" onchange="mtechFields();">
- <option>-- Select Branch --</option>
- <option value="CSE">CSE</option>
- <option value="CN & IS">CN & IS</option>
- <option value="IT">IT</option>
- <option value="DigistalSystems & Comp.Applications">DigistalSystems & Comp.Applications</option>
- <option value="Embedded Systems">Embedded Systems</option>
- <option value="VLSI Design">VLSI Design</option>
- <option value="Electrical Power Systems">Electrical Power Systems</option>
- <option value="CAD-CAM">CAD-CAM</option>
- <option value="Machine Design">Machine Design</option>
- <option value="Production Engineering">Production Engineering</option>
- <option value="Thermal Engineering">Thermal Engineering</option>
- <option value="Structural Engineering">Structural Engineering </option>
- <option value="VLSI&Embedded Systems">VLSI&Embedded Systems</option>
- <option value="Highway Engineering">Highway Engineering</option>
- <option value="Power Electronics">Power Electronics</option>
- <option value="Heat Ventilation&Air Conditioning">Heat Ventilation&Air Conditioning</option>
- </select>
- </div>
- <div class="form-group col-md-4 col-sm-4">
- <label for="mpharmacy">M.Pharmacy </label>
- <span class="help-block"></span>
- <select class="form-control input-sm" id="mpharmacy" name="mpharmacy" onchange="mpharmacyFields();">
- <option>-- Select Branch --</option>
- <option value="Pharmaceutics">Pharmaceutics</option>
- <option value="Pharmaceutical Analysis">Pharmaceutical Analysis</option>
- <option value="Pharmacology">Pharmacology</option>
- <option value="Pharmaceutical Management&Regulatory Affairs">Pharmaceutical Management&Regulatory Affairs</option>
- <option value="Hospital & Clinical Pharmacy">Hospital & Clinical Pharmacy</option>
- </select>
- </div>
- <div class="form-group col-md-12 col-sm-12">
- <div class="form-group col-md-4">
- <div class="checkbox">
- <input id="bpharmacy" type="checkbox" name="bpharmacy" value="bpharmacy" onchange="bpharmacyFields();">
- B.Pharmacy
- </div>
- <div class="checkbox">
- <input id="pharmad" type="checkbox" name="pharmad" value=" Pharma.D" onchange="pharmadFields();">
- Pharma.D
- </div>
- <div class="checkbox">
- <input id="pharmad_pb" type="checkbox" name="pharmad_pb" value="Pharmad_pb" onchange="pharmad_pbFields();">
- pharma.D(pb)
- </div>
- </div>
- <div class="form-group col-md-4">
- <div class="checkbox">
- <input id="mba" type="checkbox" name="mba" value="MBA" onchange="mbaFields();">
- MBA
- </div>
- <div class="checkbox">
- <input id="mca" type="checkbox" name="mca" value="MCA" onchange="mcaFields();">
- MCA
- </div>
- <div class="checkbox">
- <input id="pgdm" type="checkbox" name="pgdm" value="PGDM" onchange="pgdmFields();">
- PGDM
- </div>
- </div>
- <div class="form-group col-md-4">
- <div class="checkbox">
- <input id="bed" type="checkbox" name="bed" value="B.ED" onchange="bedFields();">
- B.ED
- </div>
- <div class="checkbox">
- <input id="ded" type="checkbox" name="ded" value="D.ED" onchange="dedFields();">
- D.ED
- </div>
- <div class="checkbox">
- <input id="mam" type="checkbox" name="mam" value="MAM" onchange="mamFields();">
- MAM
- </div>
- <div class="checkbox">
- <input id="mtm" type="checkbox" name="mtm" value="MTM" onchange="mtmFields();">
- MTM
- </div>
- </div>
- </div>
- </div>
- <h4>Personal Information</h4>
- <div class=" col-sm-12">
- <div class="form-group col-md-12 col-sm-12">
- <div class="form-group col-md-9 col-sm-9">
- <div class="form-group col-md-4 col-sm-4" style="margin-left:-25px;">
- <label for="firstname">First Name* </label>
- <input type="text" name="stuname" class="form-control input-sm" id="stuname" placeholder="">
- </div>
- <div class="form-group col-md-4 col-sm-4">
- <label for="lastname">Last Name* </label>
- <input type="text" name="lastname" class="form-control input-sm" id="lastname" placeholder="">
- </div>
- <div class="form-group col-md-4 col-sm-4">
- <label for="surname">Surname* </label>
- <input type="text" name="surname" class="form-control input-sm" id="surname" placeholder="">
- </div>
- </div>
- <div class="form-group col-md-3 col-sm-3">
- <div class="col-sm-12">
- <label for="DOD" align="right">Date Of Birth *</label>
- <input type="text" name="dob" id=" DOD" placeholder=" DD-MM-YYYY" align="right">
- </div>
- </div>
- </div>
- <div class="form-group col-md-3 col-sm-3">
- <label for="category">category. *</label>
- <select class="form-control input-sm" id="Category" name="category">
- <option>-- Select Category --</option>
- <option value="OC">OC</option>
- <option value="BC-A">BC-A</option>
- <option value="BC-B">BC-B</option>
- <option value="BC-C">BC-C</option>
- <option value="BC-D">BC-D</option>
- <option value="BC-E">BC-E</option>
- <option value="SC">SC</option>
- <option value="ST">ST</option>
- <option value="Others">Others</option>
- </select>
- </div>
- <div class="form-group col-md-3 col-sm-3">
- <label for="Gender">Gender. *</label>
- <!-- <span class="help-block"></span> -->
- <select class="form-control input-sm" id="Gender" name="gender">
- <option>-- Select Gender --</option>
- <option value="Male">Male</option>
- <option value="Female">Female</option>
- </select>
- </div>
- <div class="form-group col-md-3 col-sm-3">
- <label for="Region">Region. *</label>
- <!-- <span class="help-block"></span> -->
- <select class="form-control input-sm" name="region" id="Region">
- <option>-- Select Region(specify the state) --</option>
- <option value="OU">OU</option>
- <option value="AU">AU</option>
- <option value="SVU">SVU</option>
- <option value="Other States">Other States</option>
- </select>
- </div>
- <div class="form-group col-md-3 col-sm-3">
- <label for="Religion">Religion*</label>
- <input type="text" name="religion" class="form-control input-sm" id="Religion" placeholder="">
- </div>
- <div class="form-group col-md-4 col-sm-4">
- <label for="Aadhaar No">Aadhaar No*</label>
- <input type="text" name="aadhaarno" class="form-control input-sm" id="aadhaarno" placeholder="">
- </div>
- <div class="form-group col-md-4 col-sm-4">
- <label for="rationcardno">Ration Card No*</label>
- <input type="text" name="rationcardno" class="form-control input-sm" id="rationcardno" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="mobileno">Mobileno*</label>
- <input type="text" name="mobileno" class="form-control input-sm" id="mobileno" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="email">Email Id*</label>
- <input type="text" name="email" class="form-control input-sm" id="email" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="fathername">Father's Name*</label>
- <input type="text" name="fathername" class="form-control input-sm" id="fathername" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="fatheroccu">Father's Occupation*</label>
- <input type="text" name="fatheroccu" class="form-control input-sm" id="fatheroccu" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="mothername">Mother's Name*</label>
- <input type="text" name="mothername" class="form-control input-sm" id="mothername" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="motheroccu">Mother's Occupation</label>
- <input type="text" name="motheroccu" class="form-control input-sm" id="motheroccu" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="fathermob">Father's/Primary ContactNo*</label>
- <input type="text" name="fathermob" class="form-control input-sm" id="fathermob" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="mothermob">Mother's/Secondary ContactNo</label>
- <input type="text" name="mothermob" class="form-control input-sm" id="mothermob" placeholder="">
- </div>
- <div class="form-group col-md-12 col-sm-12">
- <label for="Parentaddr">Parent Residential Address*</label>
- <textarea name="parent_address" class="form-control input-sm" id="Parentaddr" rows="3"></textarea>
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="CET">Name of the CET Attempted*</label>
- <span class="help-block"></span>
- <select class="form-control input-sm" id="cet" name="cet">
- <option>-- Select CET Attempted--</option>
- <option value="POLYCET">POLYCET</option>
- <option value="JEE">JEE</option>
- <option value="EAMCET">EAMCET</option>
- <option value="ECET">ECET</option>
- <option value="ICET">ICET</option>
- <option value="PGECET">PGECET</option>
- <option value="GATE">GATE</option>
- <option value="GPAT">GPAT</option>
- <option value="EDCET">EDCET</option>
- <option value="DIETCET">DIETCET</option>
- </select>
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="hallticketno">Hall Ticket No*</label>
- <input type="text" class="form-control input-sm" name="hallticketno" id="hallticketno" placeholder="">
- </div>
- <div class="form-group col-md-6 col-sm-6">
- <label for="Rank">Rank*</label>
- <input type="text" name="rank" class="form-control input-sm" id="rank" placeholder="">
- </div>
- </div>
- <h4>Education qualification:</h4>
- <div class="container" style="margin-left:-14px;">
- <table class="table warning" width:100%;>
- <thead>
- <tr class="warning">
- <th>
- Name of the Exam
- </th>
- <th>Nmae of the board/university</th>
- <th>Rollno</th>
- <th>
- Aggregate marks<br>
- secured<br>(maths,physics,<br>chemistry)
- </th>
- <th>
- Aggregate maximum
- marks
- </th>
- <th>
- Groups Marks
- Secured
- </th>
- <th>Groups Maximum <br>Marks </th>
- <th>
- Month&<br>
- year passing
- </th>
- <th>
- Total<br>
- percentage
- </th>
- <th>
- Groups<br>
- percentage
- </th>
- </tr>
- </thead>
- <tbody>
- <tr class="warning" >
- <td>
- <label>SSc/10th</label>
- </td>
- <td><input type="text" name="ssc_board" id="input"></td>
- <td><input type="text" name="ssc_rollno" id="input"></td>
- <td><input type="text" name="ssc_ams" id="input"></td>
- <td><input type="text" name="ssc_amm" id="input"></td>
- <td><input type="text" name="ssc_gms" id="input"></td>
- <td><input type="text" name="ssc_gmm" id="input"></td>
- <td><input type="text" name="ssc_yearpassing" id="input"></td>
- <td><input type="text" name="ssc_tp" id="input"></td>
- <td><input type="text" name="ssc_gp" id="input"></td>
- </tr>
- <tr class="warning">
- <td>
- <label>inter/10+2</label>
- </td>
- <td><input type="text" name="inter_board" id="input"></td>
- <td><input type="text" name="inter_rollno" id="input"></td>
- <td><input type="text" name="inter_ams" id="input"></td>
- <td><input type="text" name="inter_amm" id="input"></td>
- <td><input type="text" name="inter_gms" id="input"></td>
- <td><input type="text" name="inter_gmm" id="input"></td>
- <td><input type="text" name="inter_yearpassing" id="input"></td>
- <td><input type="text" name="inter_tp" id="input"></td>
- <td><input type="text" name="inter_gp" id="input"></td>
- </tr>
- <tr class="warning" id="divDegree">
- <td>
- <label>Degree</label>
- </td>
- <td><input type="text" name="degree_univ" id="input"></td>
- <td><input type="text" name="degree_rollno" id="input"></td>
- <td><input type="text" name="degree_ams" id="input"></td>
- <td><input type="text" name="degree_amm" id="input"></td>
- <td><input type="text" name="degree_gms" id="input"></td>
- <td><input type="text" name="degree_gmm" id="input"></td>
- <td><input type="text" name="degree_yearpassing" id="input"></td>
- <td><input type="text" name="degree_tp" id="input"></td>
- <td><input type="text" name="degree_gp" id="input"></td>
- </tr>
- <tr class="warning" id="divPG">
- <td>
- <label>PG</label>
- </td>
- <td><input type="text" name="pg_univ" id="input"></td>
- <td><input type="text" name="pg_rollno" id="input"></td>
- <td><input type="text" name="pg_ams" id="input"></td>
- <td><input type="text" name="pg_amm" id="input"></td>
- <td><input type="text" name="pg_gms" id="input"></td>
- <td><input type="text" name="pg_gmm" id="input"></td>
- <td><input type="text" name="pg_yearpassing" id="input"></td>
- <td><input type="text" name="pg_tp" id="input"></td>
- <td><input type="text" name="pg_gp" id="input"></td>
- </tr>
- </tbody>
- </table>
- </div>
- <div class="form-group col-md-4 col-sm-4">
- <label for="referencename">Reference Name* </label>
- <input type="text" name="referencename" class="form-control input-sm" id="referencename" placeholder="">
- </div>
- <div class="form-group col-md-4 col-sm-4" style="float:right">
- <label for="contactno">Reference Contact No* </label>
- <input type="text" name="contactno" class="form-control input-sm" id="contactno" placeholder="">
- </div>
- <div class="col-md-12 col-sm-12">
- <div class="form-group col-md-3 col-sm-3 pull-middle">
- <center style="margin-left: 502px;">
- <!-- <input type="submit" name="submit" class="btn btn-default" value="SUBMIT" /> -->
- <input type="submit" name="submit" class="test" value="Save" />
- </center>
- </div>
- </div>
- </form>
- </div>
- </div>
- </div>
- <script src="javascript/checkbox.js"></script>
- </body>
- </html>
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