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Hecton
Jan 13th, 2015
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  1. <html>
  2. <head>
  3. <title>Student Registration Form</title>
  4. <style type="text/css">
  5. h3{font-family: Calibri; font-size: 22pt; font-style: italic; font-weight: bold; color:#D18800;
  6. text-align: center; text-decoration: underline }
  7. table{font-family: Calibri; color:white; font-size: 11pt; font-style: normal;
  8. text-align:; background-color: #D18800; border-collapse: collapse; border: 0px solid navy}
  9. table.inner{border: 0px}
  10. button.calendarStyle
  11. {
  12. background-color: transparent;
  13. border: 0;
  14. height:22px;
  15. width:22px;
  16. background-image:url(imgs/calendar.png);
  17. cursor: pointer;
  18. cursor: hand;
  19. }
  20. </style>
  21. <script type="text/javascript">
  22. function CheckSchoolName(val){
  23. var element=document.getElementById('schoolid');
  24. if(val=='otherschool')
  25. element.style.display='block';
  26. else
  27. element.style.display='none';
  28. }
  29.  
  30. </script>
  31. <link rel="stylesheet" type="text/css" href="calendar/calendar-blue2.css" />
  32. <script type="text/javascript" src="calendar/calendar.js"></script>
  33. <script type="text/javascript" src="calendar/calendar-en.js"></script>
  34. <script type="text/javascript" src="calendar/calendar-setup.js"></script>
  35. </head>
  36.  
  37. <body>
  38.  
  39. <h3>STUDENT REGISTRATION FORM</h3>
  40. <form action="formprocessbeta.php" method="POST">
  41.  
  42. <table align="center" cellpadding = "10" border="0">
  43. <input type="hidden" name="resumeid" id="resumeid" />
  44. <!----- First Name ---------------------------------------------------------->
  45. <th colspan="4" align="center">
  46. Personal info
  47.  
  48. </th>
  49. <tr>
  50. <td><align="center">FIRST NAME</align></td>
  51. <td><input type="text" name="First_Name" maxlength="30"/>
  52.  
  53.  
  54. &nbsp; &nbsp; &nbsp; LAST NAME &nbsp; &nbsp; &nbsp;
  55. <input type="text" name="Last_Name" maxlength="30"/>
  56.  
  57. </td>
  58. </tr>
  59.  
  60. <tr>
  61. <td>GENDER</td>
  62. <td>
  63. Male <input type="radio" name="Gender" value="Male" />
  64. Female <input type="radio" name="Gender" value="Female" />
  65. &nbsp; &nbsp; &nbsp; NATIONALITY &nbsp; &nbsp; &nbsp; <select name="nationality">
  66. <option value="">-- select one --</option>
  67. <option value="afghan">Afghan</option>
  68. <option value="albanian">Albanian</option>
  69. <option value="algerian">Algerian</option>
  70. <option value="american">American</option>
  71. <option value="andorran">Andorran</option>
  72. <option value="angolan">Angolan</option>
  73. <option value="antiguans">Antiguans</option>
  74. <option value="argentinean">Argentinean</option>
  75. <option value="armenian">Armenian</option>
  76. <option value="australian">Australian</option>
  77. <option value="austrian">Austrian</option>
  78. <option value="azerbaijani">Azerbaijani</option>
  79. <option value="bahamian">Bahamian</option>
  80. <option value="bahraini">Bahraini</option>
  81. <option value="bangladeshi">Bangladeshi</option>
  82. <option value="barbadian">Barbadian</option>
  83. <option value="barbudans">Barbudans</option>
  84. <option value="batswana">Batswana</option>
  85. <option value="belarusian">Belarusian</option>
  86. <option value="belgian">Belgian</option>
  87. <option value="belizean">Belizean</option>
  88. <option value="beninese">Beninese</option>
  89. <option value="bhutanese">Bhutanese</option>
  90. <option value="bolivian">Bolivian</option>
  91. <option value="bosnian">Bosnian</option>
  92. <option value="brazilian">Brazilian</option>
  93. <option value="british">British</option>
  94. <option value="bruneian">Bruneian</option>
  95. <option value="bulgarian">Bulgarian</option>
  96. <option value="burkinabe">Burkinabe</option>
  97. <option value="burmese">Burmese</option>
  98. <option value="burundian">Burundian</option>
  99. <option value="cambodian">Cambodian</option>
  100. <option value="cameroonian">Cameroonian</option>
  101. <option value="canadian">Canadian</option>
  102. <option value="cape verdean">Cape Verdean</option>
  103. <option value="central african">Central African</option>
  104. <option value="chadian">Chadian</option>
  105. <option value="chilean">Chilean</option>
  106. <option value="chinese">Chinese</option>
  107. <option value="colombian">Colombian</option>
  108. <option value="comoran">Comoran</option>
  109. <option value="congolese">Congolese</option>
  110. <option value="costa rican">Costa Rican</option>
  111. <option value="croatian">Croatian</option>
  112. <option value="cuban">Cuban</option>
  113. <option value="cypriot">Cypriot</option>
  114. <option value="czech">Czech</option>
  115. <option value="danish">Danish</option>
  116. <option value="djibouti">Djibouti</option>
  117. <option value="dominican">Dominican</option>
  118. <option value="dutch">Dutch</option>
  119. <option value="east timorese">East Timorese</option>
  120. <option value="ecuadorean">Ecuadorean</option>
  121. <option value="egyptian">Egyptian</option>
  122. <option value="emirian">Emirian</option>
  123. <option value="equatorial guinean">Equatorial Guinean</option>
  124. <option value="eritrean">Eritrean</option>
  125. <option value="estonian">Estonian</option>
  126. <option value="ethiopian">Ethiopian</option>
  127. <option value="fijian">Fijian</option>
  128. <option value="filipino">Filipino</option>
  129. <option value="finnish">Finnish</option>
  130. <option value="french">French</option>
  131. <option value="gabonese">Gabonese</option>
  132. <option value="gambian">Gambian</option>
  133. <option value="georgian">Georgian</option>
  134. <option value="german">German</option>
  135. <option value="ghanaian">Ghanaian</option>
  136. <option value="greek">Greek</option>
  137. <option value="grenadian">Grenadian</option>
  138. <option value="guatemalan">Guatemalan</option>
  139. <option value="guinea-bissauan">Guinea-Bissauan</option>
  140. <option value="guinean">Guinean</option>
  141. <option value="guyanese">Guyanese</option>
  142. <option value="haitian">Haitian</option>
  143. <option value="herzegovinian">Herzegovinian</option>
  144. <option value="honduran">Honduran</option>
  145. <option value="hungarian">Hungarian</option>
  146. <option value="icelander">Icelander</option>
  147. <option value="indian">Indian</option>
  148. <option value="indonesian">Indonesian</option>
  149. <option value="iranian">Iranian</option>
  150. <option value="iraqi">Iraqi</option>
  151. <option value="irish">Irish</option>
  152. <option value="israeli">Israeli</option>
  153. <option value="italian">Italian</option>
  154. <option value="ivorian">Ivorian</option>
  155. <option value="jamaican">Jamaican</option>
  156. <option value="japanese">Japanese</option>
  157. <option value="jordanian">Jordanian</option>
  158. <option value="kazakhstani">Kazakhstani</option>
  159. <option value="kenyan">Kenyan</option>
  160. <option value="kittian and nevisian">Kittian and Nevisian</option>
  161. <option value="kuwaiti">Kuwaiti</option>
  162. <option value="kyrgyz">Kyrgyz</option>
  163. <option value="laotian">Laotian</option>
  164. <option value="latvian">Latvian</option>
  165. <option value="lebanese">Lebanese</option>
  166. <option value="liberian">Liberian</option>
  167. <option value="libyan">Libyan</option>
  168. <option value="liechtensteiner">Liechtensteiner</option>
  169. <option value="lithuanian">Lithuanian</option>
  170. <option value="luxembourger">Luxembourger</option>
  171. <option value="macedonian">Macedonian</option>
  172. <option value="malagasy">Malagasy</option>
  173. <option value="malawian">Malawian</option>
  174. <option value="malaysian">Malaysian</option>
  175. <option value="maldivan">Maldivan</option>
  176. <option value="malian">Malian</option>
  177. <option value="maltese">Maltese</option>
  178. <option value="marshallese">Marshallese</option>
  179. <option value="mauritanian">Mauritanian</option>
  180. <option value="mauritian">Mauritian</option>
  181. <option value="mexican">Mexican</option>
  182. <option value="micronesian">Micronesian</option>
  183. <option value="moldovan">Moldovan</option>
  184. <option value="monacan">Monacan</option>
  185. <option value="mongolian">Mongolian</option>
  186. <option value="moroccan">Moroccan</option>
  187. <option value="mosotho">Mosotho</option>
  188. <option value="motswana">Motswana</option>
  189. <option value="mozambican">Mozambican</option>
  190. <option value="namibian">Namibian</option>
  191. <option value="nauruan">Nauruan</option>
  192. <option value="nepalese">Nepalese</option>
  193. <option value="new zealander">New Zealander</option>
  194. <option value="ni-vanuatu">Ni-Vanuatu</option>
  195. <option value="nicaraguan">Nicaraguan</option>
  196. <option value="nigerien">Nigerien</option>
  197. <option value="north korean">North Korean</option>
  198. <option value="northern irish">Northern Irish</option>
  199. <option value="norwegian">Norwegian</option>
  200. <option value="omani">Omani</option>
  201. <option value="pakistani">Pakistani</option>
  202. <option value="palauan">Palauan</option>
  203. <option value="panamanian">Panamanian</option>
  204. <option value="papua new guinean">Papua New Guinean</option>
  205. <option value="paraguayan">Paraguayan</option>
  206. <option value="peruvian">Peruvian</option>
  207. <option value="polish">Polish</option>
  208. <option value="portuguese">Portuguese</option>
  209. <option value="qatari">Qatari</option>
  210. <option value="romanian">Romanian</option>
  211. <option value="russian">Russian</option>
  212. <option value="rwandan">Rwandan</option>
  213. <option value="saint lucian">Saint Lucian</option>
  214. <option value="salvadoran">Salvadoran</option>
  215. <option value="samoan">Samoan</option>
  216. <option value="san marinese">San Marinese</option>
  217. <option value="sao tomean">Sao Tomean</option>
  218. <option value="saudi">Saudi</option>
  219. <option value="scottish">Scottish</option>
  220. <option value="senegalese">Senegalese</option>
  221. <option value="serbian">Serbian</option>
  222. <option value="seychellois">Seychellois</option>
  223. <option value="sierra leonean">Sierra Leonean</option>
  224. <option value="singaporean">Singaporean</option>
  225. <option value="slovakian">Slovakian</option>
  226. <option value="slovenian">Slovenian</option>
  227. <option value="solomon islander">Solomon Islander</option>
  228. <option value="somali">Somali</option>
  229. <option value="south african">South African</option>
  230. <option value="south korean">South Korean</option>
  231. <option value="spanish">Spanish</option>
  232. <option value="sri lankan">Sri Lankan</option>
  233. <option value="sudanese">Sudanese</option>
  234. <option value="surinamer">Surinamer</option>
  235. <option value="swazi">Swazi</option>
  236. <option value="swedish">Swedish</option>
  237. <option value="swiss">Swiss</option>
  238. <option value="syrian">Syrian</option>
  239. <option value="taiwanese">Taiwanese</option>
  240. <option value="tajik">Tajik</option>
  241. <option value="tanzanian">Tanzanian</option>
  242. <option value="thai">Thai</option>
  243. <option value="togolese">Togolese</option>
  244. <option value="tongan">Tongan</option>
  245. <option value="trinidadian or tobagonian">Trinidadian or Tobagonian</option>
  246. <option value="tunisian">Tunisian</option>
  247. <option value="turkish">Turkish</option>
  248. <option value="tuvaluan">Tuvaluan</option>
  249. <option value="ugandan">Ugandan</option>
  250. <option value="ukrainian">Ukrainian</option>
  251. <option value="uruguayan">Uruguayan</option>
  252. <option value="uzbekistani">Uzbekistani</option>
  253. <option value="venezuelan">Venezuelan</option>
  254. <option value="vietnamese">Vietnamese</option>
  255. <option value="welsh">Welsh</option>
  256. <option value="yemenite">Yemenite</option>
  257. <option value="zambian">Zambian</option>
  258. <option value="zimbabwean">Zimbabwean</option>
  259. </select>
  260.  
  261. </td>
  262. </tr>
  263.  
  264. <tr>
  265. <td>DATE OF BIRTH</td>
  266.  
  267. <td>
  268. <select name="bday" id="Birthday_Day">
  269. <option value="-1">Day:</option>
  270. <option value="1">1</option>
  271. <option value="2">2</option>
  272. <option value="3">3</option>
  273.  
  274. <option value="4">4</option>
  275. <option value="5">5</option>
  276. <option value="6">6</option>
  277. <option value="7">7</option>
  278. <option value="8">8</option>
  279. <option value="9">9</option>
  280. <option value="10">10</option>
  281. <option value="11">11</option>
  282. <option value="12">12</option>
  283.  
  284. <option value="13">13</option>
  285. <option value="14">14</option>
  286. <option value="15">15</option>
  287. <option value="16">16</option>
  288. <option value="17">17</option>
  289. <option value="18">18</option>
  290. <option value="19">19</option>
  291. <option value="20">20</option>
  292. <option value="21">21</option>
  293.  
  294. <option value="22">22</option>
  295. <option value="23">23</option>
  296. <option value="24">24</option>
  297. <option value="25">25</option>
  298. <option value="26">26</option>
  299. <option value="27">27</option>
  300. <option value="28">28</option>
  301. <option value="29">29</option>
  302. <option value="30">30</option>
  303.  
  304. <option value="31">31</option>
  305. </select>
  306.  
  307. <select id="Birthday_Month" name="Bmonth">
  308. <option value="">Month:</option>
  309. <option value="January">Jan</option>
  310. <option value="February">Feb</option>
  311. <option value="March">Mar</option>
  312. <option value="April">Apr</option>
  313. <option value="May">May</option>
  314. <option value="June">Jun</option>
  315. <option value="July">Jul</option>
  316. <option value="August">Aug</option>
  317. <option value="September">Sep</option>
  318. <option value="October">Oct</option>
  319. <option value="November">Nov</option>
  320. <option value="December">Dec</option>
  321. </select>
  322.  
  323. <select name="Birthday_Year" id="Byear">
  324.  
  325. <option value="">Year:</option>
  326. <option value="2012">2012</option>
  327. <option value="2011">2011</option>
  328. <option value="2010">2010</option>
  329. <option value="2009">2009</option>
  330. <option value="2008">2008</option>
  331. <option value="2007">2007</option>
  332. <option value="2006">2006</option>
  333. <option value="2005">2005</option>
  334. <option value="2004">2004</option>
  335. <option value="2003">2003</option>
  336. <option value="2002">2002</option>
  337. <option value="2001">2001</option>
  338. <option value="2000">2000</option>
  339.  
  340. <option value="1999">1999</option>
  341. <option value="1998">1998</option>
  342. <option value="1997">1997</option>
  343. <option value="1996">1996</option>
  344. <option value="1995">1995</option>
  345. <option value="1994">1994</option>
  346. <option value="1993">1993</option>
  347. <option value="1992">1992</option>
  348. <option value="1991">1991</option>
  349. <option value="1990">1990</option>
  350.  
  351. <option value="1989">1989</option>
  352. <option value="1988">1988</option>
  353. <option value="1987">1987</option>
  354. <option value="1986">1986</option>
  355. <option value="1985">1985</option>
  356. <option value="1984">1984</option>
  357. <option value="1983">1983</option>
  358. <option value="1982">1982</option>
  359. <option value="1981">1981</option>
  360. <option value="1980">1980</option>
  361. <option value="1979">1979</option>
  362. <option value="1978">1978</option>
  363. <option value="1977">1977</option>
  364. <option value="1976">1976</option>
  365. <option value="1975">1975</option>
  366. <option value="1974">1974</option>
  367. <option value="1973">1973</option>
  368. <option value="1972">1972</option>
  369. <option value="1971">1971</option>
  370. <option value="1970">1970</option>
  371.  
  372. <option value="1969">1969</option>
  373. <option value="1968">1968</option>
  374. <option value="1967">1967</option>
  375. <option value="1966">1966</option>
  376. <option value="1965">1965</option>
  377. <option value="1964">1964</option>
  378. <option value="1963">1963</option>
  379. <option value="1962">1962</option>
  380. <option value="1961">1961</option>
  381. <option value="1960">1960</option>
  382. <option value="1959">1959</option>
  383. <option value="1958">1958</option>
  384. <option value="1957">1957</option>
  385. <option value="1956">1956</option>
  386. <option value="1955">1955</option>
  387. <option value="1954">1954</option>
  388. <option value="1953">1953</option>
  389. <option value="1952">1952</option>
  390. <option value="1951">1951</option>
  391. <option value="1950">1950</option>
  392. <option value="1949">1949</option>
  393. <option value="1948">1948</option>
  394.  
  395. <option value="1947">1947</option>
  396. <option value="1946">1946</option>
  397. <option value="1945">1945</option>
  398. <option value="1944">1944</option>
  399. <option value="1943">1943</option>
  400. <option value="1942">1942</option>
  401. <option value="1941">1941</option>
  402. <option value="1940">1940</option>
  403. <option value="1939">1939</option>
  404. <option value="1938">1938</option>
  405. </select>
  406.  
  407. &nbsp; &nbsp; &nbsp; H.K. ID NO. &nbsp; &nbsp; &nbsp;
  408. <input type="text" name="hkidno" maxlength="15"/>
  409. (OPTIONAL)
  410. </td>
  411. </tr>
  412.  
  413. <!----- Email Id ---------------------------------------------------------->
  414. <tr>
  415. <td>EMAIL ID</td>
  416. <td><input type="text" name="email" maxlength="100" />
  417. &nbsp; &nbsp; &nbsp; FAX NO. &nbsp; &nbsp; &nbsp;
  418. <input type="text" name="faxno" maxlength="15"/>
  419. (OPTIONAL)
  420.  
  421. </td>
  422. </tr>
  423.  
  424. <!----- Mobile Number ---------------------------------------------------------->
  425. <tr>
  426. <td>HOME NUMBER</td>
  427. <td>
  428. <input type="text" name="homepinno" size="1" /> -
  429. <input type="text" name="homeno" size="7" />
  430. (10 digit number)
  431.  
  432. &nbsp; &nbsp; &nbsp; MOBILE NUMBER &nbsp; &nbsp;
  433. <input type="text" name="mobilepinno" size="1" /> -
  434. <input type="text" name="mobileno" size="7" />
  435. </td>
  436. </tr>
  437.  
  438.  
  439.  
  440.  
  441. <tr>
  442. <td>PLACE OF BIRTH</td>
  443. <td>
  444. <select name="pob" id="pob"><option value=''>Select your place of birth </option><option value="Abkhazia">Abkhazia</option><option value="Afghanistan">Afghanistan</option><option value="Aland">Aland</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antarctica">Antarctica</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Ascension">Ascension</option><option value="Ashmore and Cartier Islands">Ashmore and Cartier Islands</option><option value="Australia">Australia</option><option value="Australian Antarctic Territory">Australian Antarctic Territory</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="Bahamas, The">Bahamas, The</option><option value="Bahrain">Bahrain</option><option value="Baker Island">Baker Island</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Bouvet Island">Bouvet Island</option><option value="Brazil">Brazil</option><option value="British Antarctic Territory">British Antarctic Territory</option><option value="British Indian Ocean Territory">British Indian Ocean Territory</option><option value="British Sovereign Base Areas">British Sovereign Base Areas</option><option value="British Virgin Islands">British Virgin Islands</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="China, People's Republic of">China, People's Republic of</option><option value="China, Republic of (Taiwan)">China, Republic of (Taiwan)</option><option value="Christmas Island">Christmas Island</option><option value="Clipperton Island">Clipperton Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo, Democratic Republic of the (Congo Kinshasa)">Congo, Democratic Republic of the (Congo Kinshasa)</option><option value="Congo, Republic of the (Congo Brazzaville)">Congo, Republic of the (Congo Brazzaville)</option><option value="Cook Islands">Cook Islands</option><option value="Coral Sea Islands">Coral Sea Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire (Ivory Coast)">Cote d'Ivoire (Ivory Coast)</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands (Islas Malvinas)">Falkland Islands (Islas Malvinas)</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Guiana">French Guiana</option><option value="French Polynesia">French Polynesia</option><option value="French Scattered Islands in the Indian Ocean">French Scattered Islands in the Indian Ocean</option><option value="French Southern and Antarctic Lands">French Southern and Antarctic Lands</option><option value="Gabon">Gabon</option><option value="Gambia, The">Gambia, The</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Howland Island">Howland Island</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Isle of Man">Isle of Man</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jarvis Island">Jarvis Island</option><option value="Jersey">Jersey</option><option value="Johnston Atoll">Johnston Atoll</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kingman Reef">Kingman Reef</option><option value="Kiribati">Kiribati</option><option value="Korea, Democratic People's Republic of (North Korea)">Korea, Democratic People's Republic of (North Korea)</option><option value="Korea, Republic of (South Korea)">Korea, Republic of (South Korea)</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Midway Islands">Midway Islands</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar (Burma)">Myanmar (Burma)</option><option value="Nagorno-Karabakh">Nagorno-Karabakh</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Navassa Island">Navassa Island</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="Netherlands Antilles">Netherlands Antilles</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Cyprus">Northern Cyprus</option><option value="Northern Mariana Islands">Northern Mariana Islands</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Palestine">Palestine</option><option value="Palmyra Atoll">Palmyra Atoll</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Peter I Island">Peter I Island</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Pridnestrovie (Transnistria)">Pridnestrovie (Transnistria)</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Queen Maud Land">Queen Maud Land</option><option value="Reunion">Reunion</option><option value="Romania">Romania</option><option value="Ross Dependency">Ross Dependency</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Swaziland">Swaziland</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste (East Timor)">Timor-Leste (East Timor)</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="U.S. Virgin Islands">U.S. Virgin Islands</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="United States">United States</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Viet Nam">Viet Nam</option><option value="Wake Island">Wake Island</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option></SELECT>
  445. </td>
  446. </tr>
  447. <!----- Gender ----------------------------------------------------------->
  448.  
  449.  
  450. <!----- Address ---------------------------------------------------------->
  451. <tr>
  452. <td>ADDRESS <br /><br /><br /></td>
  453. <td><textarea name="Address" rows="4" cols="30"></textarea></td>
  454. </tr>
  455.  
  456. <!----- City ---------------------------------------------------------->
  457. <tr>
  458. <td>CITY</td>
  459. <td><input type="text" name="city" maxlength="30" />
  460. (max 30 characters a-z and A-Z)
  461. </td>
  462. </tr>
  463.  
  464. <!----- Pin Code ---------------------------------------------------------->
  465. <tr>
  466. <td>ZIP CODE</td>
  467. <td><input type="text" name="zipcode" maxlength="6" />
  468. (6 digit number)
  469. </td>
  470. </tr>
  471.  
  472. <!----- State ---------------------------------------------------------->
  473. <tr>
  474. <td>Province</td>
  475. <td><input type="text" name="province" maxlength="30" />
  476. (max 30 characters a-z and A-Z)
  477. </td>
  478. </tr>
  479.  
  480. <!----- Country ---------------------------------------------------------->
  481. <tr>
  482. <td>COUNTRY</td>
  483. <td>
  484. <select name="country" id="country"><option value=''>Select your Country </option><option value="Abkhazia">Abkhazia</option><option value="Afghanistan">Afghanistan</option><option value="Aland">Aland</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antarctica">Antarctica</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Ascension">Ascension</option><option value="Ashmore and Cartier Islands">Ashmore and Cartier Islands</option><option value="Australia">Australia</option><option value="Australian Antarctic Territory">Australian Antarctic Territory</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="Bahamas, The">Bahamas, The</option><option value="Bahrain">Bahrain</option><option value="Baker Island">Baker Island</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Bouvet Island">Bouvet Island</option><option value="Brazil">Brazil</option><option value="British Antarctic Territory">British Antarctic Territory</option><option value="British Indian Ocean Territory">British Indian Ocean Territory</option><option value="British Sovereign Base Areas">British Sovereign Base Areas</option><option value="British Virgin Islands">British Virgin Islands</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="China, People's Republic of">China, People's Republic of</option><option value="China, Republic of (Taiwan)">China, Republic of (Taiwan)</option><option value="Christmas Island">Christmas Island</option><option value="Clipperton Island">Clipperton Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo, Democratic Republic of the (Congo Kinshasa)">Congo, Democratic Republic of the (Congo Kinshasa)</option><option value="Congo, Republic of the (Congo Brazzaville)">Congo, Republic of the (Congo Brazzaville)</option><option value="Cook Islands">Cook Islands</option><option value="Coral Sea Islands">Coral Sea Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire (Ivory Coast)">Cote d'Ivoire (Ivory Coast)</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands (Islas Malvinas)">Falkland Islands (Islas Malvinas)</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Guiana">French Guiana</option><option value="French Polynesia">French Polynesia</option><option value="French Scattered Islands in the Indian Ocean">French Scattered Islands in the Indian Ocean</option><option value="French Southern and Antarctic Lands">French Southern and Antarctic Lands</option><option value="Gabon">Gabon</option><option value="Gambia, The">Gambia, The</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Howland Island">Howland Island</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Isle of Man">Isle of Man</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jarvis Island">Jarvis Island</option><option value="Jersey">Jersey</option><option value="Johnston Atoll">Johnston Atoll</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kingman Reef">Kingman Reef</option><option value="Kiribati">Kiribati</option><option value="Korea, Democratic People's Republic of (North Korea)">Korea, Democratic People's Republic of (North Korea)</option><option value="Korea, Republic of (South Korea)">Korea, Republic of (South Korea)</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Midway Islands">Midway Islands</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar (Burma)">Myanmar (Burma)</option><option value="Nagorno-Karabakh">Nagorno-Karabakh</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Navassa Island">Navassa Island</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="Netherlands Antilles">Netherlands Antilles</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Cyprus">Northern Cyprus</option><option value="Northern Mariana Islands">Northern Mariana Islands</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Palestine">Palestine</option><option value="Palmyra Atoll">Palmyra Atoll</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Peter I Island">Peter I Island</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Pridnestrovie (Transnistria)">Pridnestrovie (Transnistria)</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Queen Maud Land">Queen Maud Land</option><option value="Reunion">Reunion</option><option value="Romania">Romania</option><option value="Ross Dependency">Ross Dependency</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Swaziland">Swaziland</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste (East Timor)">Timor-Leste (East Timor)</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="U.S. Virgin Islands">U.S. Virgin Islands</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="United States">United States</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Viet Nam">Viet Nam</option><option value="Wake Island">Wake Island</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option></SELECT>
  485. </td>
  486. </tr>
  487. <!----- Country ---------------------------------------------------------->
  488.  
  489.  
  490. <tr>
  491. <th colspan="4" align="center"><b>
  492. <hr/></b>
  493.  
  494. </th></tr>
  495. <!----- Qualification---------------------------------------------------------->
  496. <tr>
  497. <td>NAME OF SCHOOL</td>
  498. <td>
  499. <select name="schoolname" onchange='CheckSchoolName(this.value);'>
  500. <option value="">Select your Instituition/School name</option>
  501. <option value="Caritas Bianchi College of Careers">Caritas Bianchi College of Careers</option>
  502. <option value="Caritas Francis Hsu College">Caritas Francis Hsu College</option>
  503. <option value="City University of Hong Kong">City University of Hong Kong</option>
  504. <option value="College of International Education, HKBU">College of International Education, HKBU</option>
  505. <option value="Community College of City University, City U">Community College of City University, City U</option>
  506. <option value="CUHK-Tung Wah Group of Hospitals Community College">CUHK-Tung Wah Group of Hospitals Community College</option>
  507. <option value="Hang Seng School of Commerce">Hang Seng School of Commerce</option>
  508. <option value="HKU SPACE Community College">HKU SPACE Community College</option>
  509. <option value="HKU SPACE Po Leung Kuk Community College">HKU SPACE Po Leung Kuk Community College</option>
  510. <option value="Hong Kong Art School">Hong Kong Art School</option>
  511. <option value="Hong Kong Baptist University">Hong Kong Baptist University</option>
  512. <option value="Hong Kong Central College">Hong Kong Central College</option>
  513. <option value="Hong Kong Community College, Poly U">Hong Kong Community College, Poly U</option>
  514. <option value="Hong Kong Institute of Technology">Hong Kong Institute of Technology</option>
  515. <option selected="selected" value="Hong Kong Institute of Vocational Education, VTC">Hong Kong Institute of Vocational Education, VTC</option>
  516. <option value="Hong Kong Shue Yan University">Hong Kong Shue Yan University</option>
  517. <option value="Lingnan Institute of Further Ed, Lingnan U">Lingnan Institute of Further Ed, Lingnan U</option>
  518. <option value="Lingnan University">Lingnan University</option>
  519. <option value="School of Business and Information Systems, VTC">School of Business and Information Systems, VTC</option>
  520. <option value="School of Continuing &amp; Professional Ed, HKIEd">School of Continuing &amp; Professional Ed, HKIEd</option>
  521. <option value="School of Continuing &amp; Professional Studies, CUHK">School of Continuing &amp; Professional Studies, CUHK</option>
  522. <option value="School of Continuing Education, HKBU">School of Continuing Education, HKBU</option>
  523. <option value="School of Professional Ed. &amp; Executive Dev, Poly U">School of Professional Ed. &amp; Executive Dev, Poly U</option>
  524. <option value="The Chinese University of Hong Kong">The Chinese University of Hong Kong</option>
  525. <option value="The Community College at Lingnan University">The Community College at Lingnan University</option>
  526. <option value="The Hong Kong Academy for Performing Arts">The Hong Kong Academy for Performing Arts</option>
  527. <option value="The Hong Kong Institute of Education">The Hong Kong Institute of Education</option>
  528. <option value="The Hong Kong Polytechnic University">The Hong Kong Polytechnic University</option>
  529. <option value="The Hong Kong University of Science and Technology">The Hong Kong University of Science and Technology</option>
  530. <option value="The Open University of Hong Kong">The Open University of Hong Kong</option>
  531. <option value="The University of Hong Kong">The University of Hong Kong</option>
  532. <option value="Yew Chung Community College">Yew Chung Community College</option>
  533. <option value="otherschool">Others (Please specify)</option>
  534.  
  535. </select>
  536. <align="right"><input type="text" name="schoolname" id="schoolid" placeholder="Please Specify" required style='display:none;'/></align>
  537.  
  538. </td>
  539. </tr>
  540. <tr><td>STUDY DURATION</td>
  541. <td>FROM &nbsp; <select name="startyear">
  542. <option value="">YYYY</option>
  543.  
  544. <option value="2015">2015</option>
  545. <option value="2014">2014</option>
  546. <option value="2013">2013</option>
  547. <option value="2012">2012</option>
  548. <option value="2011">2011</option>
  549. <option value="2010">2010</option>
  550. <option value="2009">2009</option>
  551. <option value="2008">2008</option>
  552. <option value="2007">2007</option>
  553. <option value="2006">2006</option>
  554. <option value="2005">2005</option>
  555. <option value="2004">2004</option>
  556. <option value="2003">2003</option>
  557. <option value="2002">2002</option>
  558. <option value="2001">2001</option>
  559. <option value="2000">2000</option>
  560. <option value="1999">1999</option>
  561. <option value="1998">1998</option>
  562. <option value="1997">1997</option>
  563. <option value="1996">1996</option>
  564. <option value="1995">1995</option>
  565. <option value="1994">1994</option>
  566. <option value="1993">1993</option>
  567. <option value="1992">1992</option>
  568. <option value="1991">1991</option>
  569. <option value="1990">1990</option>
  570. <option value="1989">1989</option>
  571. <option value="1988">1988</option>
  572. <option value="1987">1987</option>
  573. <option value="1986">1986</option>
  574. <option value="1985">1985</option>
  575. <option value="1984">1984</option>
  576. <option value="1983">1983</option>
  577. <option value="1982">1982</option>
  578. <option value="1981">1981</option>
  579. <option value="1980">1980</option>
  580. <option value="1979">1979</option>
  581. <option value="1978">1978</option>
  582. <option value="1977">1977</option>
  583. <option value="1976">1976</option>
  584. <option value="1975">1975</option>
  585. <option value="1974">1974</option>
  586. <option value="1973">1973</option>
  587. <option value="1972">1972</option>
  588. <option value="1971">1971</option>
  589. <option value="1970">1970</option>
  590. <option value="1969">1969</option>
  591. <option value="1968">1968</option>
  592. <option value="1967">1967</option>
  593. <option value="1966">1966</option>
  594. <option value="1965">1965</option>
  595. <option value="1964">1964</option>
  596. <option value="1963">1963</option>
  597. <option value="1962">1962</option>
  598. <option value="1961">1961</option>
  599. <option value="1960">1960</option>
  600. <option value="1959">1959</option>
  601. <option value="1958">1958</option>
  602. <option value="1957">1957</option>
  603. <option value="1956">1956</option>
  604. <option value="1955">1955</option>
  605. <option value="1954">1954</option>
  606. <option value="1953">1953</option>
  607. <option value="1952">1952</option>
  608. <option value="1951">1951</option>
  609. <option value="1950">1950</option>
  610. <option value="1949">1949</option>
  611. <option value="1948">1948</option>
  612. <option value="1947">1947</option>
  613.  
  614. </select>
  615. &nbsp; &nbsp; TO &nbsp;
  616. <select name="endyear">
  617. <option value="">YYYY</option>
  618. <option value="Present">Present</option>
  619. <option value="2022">2022</option>
  620. <option value="2021">2021</option>
  621. <option value="2020">2020</option>
  622. <option value="2019">2019</option>
  623. <option value="2018">2018</option>
  624. <option value="2017">2017</option>
  625. <option value="2016">2016</option>
  626. <option value="2015">2015</option>
  627. <option value="2014">2014</option>
  628. <option value="2013">2013</option>
  629. <option value="2012">2012</option>
  630. <option value="2011">2011</option>
  631. <option value="2010">2010</option>
  632. <option value="2009">2009</option>
  633. <option value="2008">2008</option>
  634. <option value="2007">2007</option>
  635. <option value="2006">2006</option>
  636. <option value="2005">2005</option>
  637. <option value="2004">2004</option>
  638. <option value="2003">2003</option>
  639. <option value="2002">2002</option>
  640. <option value="2001">2001</option>
  641. <option value="2000">2000</option>
  642. <option value="1999">1999</option>
  643. <option value="1998">1998</option>
  644. <option value="1997">1997</option>
  645. <option value="1996">1996</option>
  646. <option value="1995">1995</option>
  647. <option value="1994">1994</option>
  648. <option value="1993">1993</option>
  649. <option value="1992">1992</option>
  650. <option value="1991">1991</option>
  651. <option value="1990">1990</option>
  652. <option value="1989">1989</option>
  653. <option value="1988">1988</option>
  654. <option value="1987">1987</option>
  655. <option value="1986">1986</option>
  656. <option value="1985">1985</option>
  657. <option value="1984">1984</option>
  658. <option value="1983">1983</option>
  659. <option value="1982">1982</option>
  660. <option value="1981">1981</option>
  661. <option value="1980">1980</option>
  662. <option value="1979">1979</option>
  663. <option value="1978">1978</option>
  664. <option value="1977">1977</option>
  665. <option value="1976">1976</option>
  666. <option value="1975">1975</option>
  667. <option value="1974">1974</option>
  668. <option value="1973">1973</option>
  669. <option value="1972">1972</option>
  670. <option value="1971">1971</option>
  671. <option value="1970">1970</option>
  672. <option value="1969">1969</option>
  673. <option value="1968">1968</option>
  674. <option value="1967">1967</option>
  675. <option value="1966">1966</option>
  676. <option value="1965">1965</option>
  677. <option value="1964">1964</option>
  678. <option value="1963">1963</option>
  679. <option value="1962">1962</option>
  680. <option value="1961">1961</option>
  681. <option value="1960">1960</option>
  682. <option value="1959">1959</option>
  683. <option value="1958">1958</option>
  684. <option value="1957">1957</option>
  685. <option value="1956">1956</option>
  686. <option value="1955">1955</option>
  687. <option value="1954">1954</option>
  688. <option value="1953">1953</option>
  689. <option value="1952">1952</option>
  690. <option value="1951">1951</option>
  691. <option value="1950">1950</option>
  692. <option value="1949">1949</option>
  693. <option value="1948">1948</option>
  694. <option value="1947">1947</option>
  695.  
  696. </select>
  697. &nbsp; &nbsp; &nbsp; MODE OF STUDY &nbsp; &nbsp;
  698. <select name="modeofstudy" size="3">
  699. <option value="">--Select One--</option>
  700. <option value="Full Time">Full-time</option>
  701. <option value="Part-time">Part-time</option>
  702. </select>
  703. </td>
  704. </tr>
  705. <tr><td>MAJOR COURSE</td>
  706. <td><input type="text" name="majorcourse" size="42" maxlength="50"/>
  707. &nbsp; &nbsp; STUDY STATUS &nbsp; &nbsp;
  708. <select name="studystatus">
  709. <option value="">---Select One---</option>
  710.  
  711. <option value="Graduated">Graduated</option>
  712. <option value="Final-year">Final-year</option>
  713. <option value="Non-final year">Non-final year</option>
  714. <option value="Withdrew">Withdrew</option>
  715. <option value="Deferred">Deferred</option>
  716. <option value="Suspended">Suspended</option>
  717.  
  718. </select>
  719.  
  720. </td>
  721. </tr>
  722. <tr><td>EXPECTED/<BR>DATE OF GRADUATION</td>
  723. <td>
  724. <input type=text name=graduatedate id=graduatedate value=""/><button type=reset class=calendarStyle id=triggercalender></button><SCRIPT type='text/javascript'> Calendar.setup({
  725. inputField : "graduatedate",
  726. ifFormat : "%m/%d/%Y",
  727. showsTime : false,
  728. button : "triggercalender",
  729. singleClick : true,
  730. step : 1
  731. });</SCRIPT>
  732.  
  733. &nbsp; &nbsp; AWARD UPON GRADUATION &nbsp; &nbsp;
  734. <select name="graduationaward">
  735. <option value=""></option>
  736. <option value="Doctoral Degree">Doctoral Degree</option>
  737. <option value="Master Degree">Master Degree</option>
  738. <option value="Bachelor Degree">Bachelor Degree</option>
  739. <option value="Associate Degree">Associate Degree</option>
  740. <option selected="selected" value="Higher Diploma">Higher Diploma</option>
  741. <option value="Diploma">Diploma</option>
  742. <option value="Certificate">Certificate</option>
  743.  
  744. </select>
  745.  
  746. </td>
  747. </tr>
  748. <tr>
  749. <td> PUBLIC EXAMINATIONS<br /><br /><br /><br /><br /><br /><br /></td>
  750.  
  751. <td>
  752. <table border="0">
  753.  
  754. <tr>
  755. <td align="center"><b>No.</b></td>
  756. <td align="center"><b>Date</b></td>
  757. <td align="center"><b>EXAM/QUALIFICATION</b></td>
  758. <td align="center"><b>SUBJECT NAME</b></td>
  759. <td align="center"><b>ACHIEVED GRADE</b></td>
  760. </tr>
  761.  
  762. <tr>
  763. <td>1</td>
  764. <td><select name="exyr1">
  765. <option value="">YYYY</option>
  766. <option value="2015">2015</option>
  767. <option value="2014">2014</option>
  768. <option value="2013">2013</option>
  769. <option value="2012">2012</option>
  770. <option value="2011">2011</option>
  771. <option value="2010">2010</option>
  772. <option value="2009">2009</option>
  773. <option value="2008">2008</option>
  774. <option value="2007">2007</option>
  775. <option value="2006">2006</option>
  776. <option value="2005">2005</option>
  777. <option value="2004">2004</option>
  778. <option value="2003">2003</option>
  779. <option value="2002">2002</option>
  780. <option value="2001">2001</option>
  781. <option value="2000">2000</option>
  782. <option value="1999">1999</option>
  783. <option value="1998">1998</option>
  784. <option value="1997">1997</option>
  785. <option value="1996">1996</option>
  786. <option value="1995">1995</option>
  787. <option value="1994">1994</option>
  788. <option value="1993">1993</option>
  789. <option value="1992">1992</option>
  790. <option value="1991">1991</option>
  791. <option value="1990">1990</option>
  792. <option value="1989">1989</option>
  793. <option value="1988">1988</option>
  794. <option value="1987">1987</option>
  795. <option value="1986">1986</option>
  796. <option value="1985">1985</option>
  797. <option value="1984">1984</option>
  798. <option value="1983">1983</option>
  799. <option value="1982">1982</option>
  800. <option value="1981">1981</option>
  801. <option value="1980">1980</option>
  802. <option value="1979">1979</option>
  803. <option value="1978">1978</option>
  804. <option value="1977">1977</option>
  805. <option value="1976">1976</option>
  806. <option value="1975">1975</option>
  807. <option value="1974">1974</option>
  808. <option value="1973">1973</option>
  809. <option value="1972">1972</option>
  810. <option value="1971">1971</option>
  811. <option value="1970">1970</option>
  812. <option value="1969">1969</option>
  813. <option value="1968">1968</option>
  814. <option value="1967">1967</option>
  815. <option value="1966">1966</option>
  816. <option value="1965">1965</option>
  817. <option value="1964">1964</option>
  818. <option value="1963">1963</option>
  819. <option value="1962">1962</option>
  820. <option value="1961">1961</option>
  821. <option value="1960">1960</option>
  822. <option value="1959">1959</option>
  823. <option value="1958">1958</option>
  824. <option value="1957">1957</option>
  825. <option value="1956">1956</option>
  826. <option value="1955">1955</option>
  827. <option value="1954">1954</option>
  828. <option value="1953">1953</option>
  829. <option value="1952">1952</option>
  830. <option value="1951">1951</option>
  831. <option value="1950">1950</option>
  832. <option value="1949">1949</option>
  833. <option value="1948">1948</option>
  834. <option value="1947">1947</option>
  835.  
  836. </select>
  837.  
  838. -
  839. <select id="exmt1" name="exmt1">
  840. <option value="">MM</option>
  841. <option value="1">01</option>
  842. <option value="2">02</option>
  843. <option value="3">03</option>
  844. <option value="4">04</option>
  845. <option value="5">05</option>
  846. <option value="6">06</option>
  847. <option value="7">07</option>
  848. <option value="8">08</option>
  849. <option value="9">09</option>
  850. <option value="10">10</option>
  851. <option value="11">11</option>
  852. <option value="12">12</option>
  853.  
  854. </select>
  855.  
  856.  
  857. </td>
  858. <td><input type="text" name="qualification1" maxlength="30" /></td>
  859. <td><input type="text" name="subjectname1" maxlength="30" /></td>
  860. <td><input type="text" name="grade1" maxlength="30" /></td>
  861. </tr>
  862.  
  863. <tr>
  864. <td>2</td>
  865. <td>
  866.  
  867. <select name="exyr2">
  868. <option value="">YYYY</option>
  869. <option value="2015">2015</option>
  870. <option value="2014">2014</option>
  871. <option value="2013">2013</option>
  872. <option value="2012">2012</option>
  873. <option value="2011">2011</option>
  874. <option value="2010">2010</option>
  875. <option value="2009">2009</option>
  876. <option value="2008">2008</option>
  877. <option value="2007">2007</option>
  878. <option value="2006">2006</option>
  879. <option value="2005">2005</option>
  880. <option value="2004">2004</option>
  881. <option value="2003">2003</option>
  882. <option value="2002">2002</option>
  883. <option value="2001">2001</option>
  884. <option value="2000">2000</option>
  885. <option value="1999">1999</option>
  886. <option value="1998">1998</option>
  887. <option value="1997">1997</option>
  888. <option value="1996">1996</option>
  889. <option value="1995">1995</option>
  890. <option value="1994">1994</option>
  891. <option value="1993">1993</option>
  892. <option value="1992">1992</option>
  893. <option value="1991">1991</option>
  894. <option value="1990">1990</option>
  895. <option value="1989">1989</option>
  896. <option value="1988">1988</option>
  897. <option value="1987">1987</option>
  898. <option value="1986">1986</option>
  899. <option value="1985">1985</option>
  900. <option value="1984">1984</option>
  901. <option value="1983">1983</option>
  902. <option value="1982">1982</option>
  903. <option value="1981">1981</option>
  904. <option value="1980">1980</option>
  905. <option value="1979">1979</option>
  906. <option value="1978">1978</option>
  907. <option value="1977">1977</option>
  908. <option value="1976">1976</option>
  909. <option value="1975">1975</option>
  910. <option value="1974">1974</option>
  911. <option value="1973">1973</option>
  912. <option value="1972">1972</option>
  913. <option value="1971">1971</option>
  914. <option value="1970">1970</option>
  915. <option value="1969">1969</option>
  916. <option value="1968">1968</option>
  917. <option value="1967">1967</option>
  918. <option value="1966">1966</option>
  919. <option value="1965">1965</option>
  920. <option value="1964">1964</option>
  921. <option value="1963">1963</option>
  922. <option value="1962">1962</option>
  923. <option value="1961">1961</option>
  924. <option value="1960">1960</option>
  925. <option value="1959">1959</option>
  926. <option value="1958">1958</option>
  927. <option value="1957">1957</option>
  928. <option value="1956">1956</option>
  929. <option value="1955">1955</option>
  930. <option value="1954">1954</option>
  931. <option value="1953">1953</option>
  932. <option value="1952">1952</option>
  933. <option value="1951">1951</option>
  934. <option value="1950">1950</option>
  935. <option value="1949">1949</option>
  936. <option value="1948">1948</option>
  937. <option value="1947">1947</option>
  938.  
  939. </select>
  940.  
  941. -
  942. <select id="exmt2" name="exmt2">
  943. <option value="">MM</option>
  944. <option value="1">01</option>
  945. <option value="2">02</option>
  946. <option value="3">03</option>
  947. <option value="4">04</option>
  948. <option value="5">05</option>
  949. <option value="6">06</option>
  950. <option value="7">07</option>
  951. <option value="8">08</option>
  952. <option value="9">09</option>
  953. <option value="10">10</option>
  954. <option value="11">11</option>
  955. <option value="12">12</option>
  956.  
  957. </select>
  958.  
  959.  
  960.  
  961. </td>
  962. <td><input type="text" name="qualification2" maxlength="30" /></td>
  963. <td><input type="text" name="subjectname2" maxlength="30" /></td>
  964. <td><input type="text" name="grade2" maxlength="30" /></td>
  965. </tr>
  966.  
  967. <tr>
  968. <td>3</td>
  969. <td><select name="exyr3">
  970. <option value="">YYYY</option>
  971. <option value="2015">2015</option>
  972. <option value="2014">2014</option>
  973. <option value="2013">2013</option>
  974. <option value="2012">2012</option>
  975. <option value="2011">2011</option>
  976. <option value="2010">2010</option>
  977. <option value="2009">2009</option>
  978. <option value="2008">2008</option>
  979. <option value="2007">2007</option>
  980. <option value="2006">2006</option>
  981. <option value="2005">2005</option>
  982. <option value="2004">2004</option>
  983. <option value="2003">2003</option>
  984. <option value="2002">2002</option>
  985. <option value="2001">2001</option>
  986. <option value="2000">2000</option>
  987. <option value="1999">1999</option>
  988. <option value="1998">1998</option>
  989. <option value="1997">1997</option>
  990. <option value="1996">1996</option>
  991. <option value="1995">1995</option>
  992. <option value="1994">1994</option>
  993. <option value="1993">1993</option>
  994. <option value="1992">1992</option>
  995. <option value="1991">1991</option>
  996. <option value="1990">1990</option>
  997. <option value="1989">1989</option>
  998. <option value="1988">1988</option>
  999. <option value="1987">1987</option>
  1000. <option value="1986">1986</option>
  1001. <option value="1985">1985</option>
  1002. <option value="1984">1984</option>
  1003. <option value="1983">1983</option>
  1004. <option value="1982">1982</option>
  1005. <option value="1981">1981</option>
  1006. <option value="1980">1980</option>
  1007. <option value="1979">1979</option>
  1008. <option value="1978">1978</option>
  1009. <option value="1977">1977</option>
  1010. <option value="1976">1976</option>
  1011. <option value="1975">1975</option>
  1012. <option value="1974">1974</option>
  1013. <option value="1973">1973</option>
  1014. <option value="1972">1972</option>
  1015. <option value="1971">1971</option>
  1016. <option value="1970">1970</option>
  1017. <option value="1969">1969</option>
  1018. <option value="1968">1968</option>
  1019. <option value="1967">1967</option>
  1020. <option value="1966">1966</option>
  1021. <option value="1965">1965</option>
  1022. <option value="1964">1964</option>
  1023. <option value="1963">1963</option>
  1024. <option value="1962">1962</option>
  1025. <option value="1961">1961</option>
  1026. <option value="1960">1960</option>
  1027. <option value="1959">1959</option>
  1028. <option value="1958">1958</option>
  1029. <option value="1957">1957</option>
  1030. <option value="1956">1956</option>
  1031. <option value="1955">1955</option>
  1032. <option value="1954">1954</option>
  1033. <option value="1953">1953</option>
  1034. <option value="1952">1952</option>
  1035. <option value="1951">1951</option>
  1036. <option value="1950">1950</option>
  1037. <option value="1949">1949</option>
  1038. <option value="1948">1948</option>
  1039. <option value="1947">1947</option>
  1040.  
  1041. </select>
  1042.  
  1043. -
  1044. <select id="exmt3" name="exmt3">
  1045. <option value="">MM</option>
  1046. <option value="1">01</option>
  1047. <option value="2">02</option>
  1048. <option value="3">03</option>
  1049. <option value="4">04</option>
  1050. <option value="5">05</option>
  1051. <option value="6">06</option>
  1052. <option value="7">07</option>
  1053. <option value="8">08</option>
  1054. <option value="9">09</option>
  1055. <option value="10">10</option>
  1056. <option value="11">11</option>
  1057. <option value="12">12</option>
  1058.  
  1059. </select></td>
  1060. <td><input type="text" name="qualification3" maxlength="30" /></td>
  1061. <td><input type="text" name="subjectname3" maxlength="30" /></td>
  1062. <td><input type="text" name="grade3" maxlength="30" /></td>
  1063. </tr>
  1064.  
  1065. <tr>
  1066. <td>4</td>
  1067. <td>
  1068. <select name="exyr4">
  1069. <option value="">YYYY</option>
  1070. <option value="2015">2015</option>
  1071. <option value="2014">2014</option>
  1072. <option value="2013">2013</option>
  1073. <option value="2012">2012</option>
  1074. <option value="2011">2011</option>
  1075. <option value="2010">2010</option>
  1076. <option value="2009">2009</option>
  1077. <option value="2008">2008</option>
  1078. <option value="2007">2007</option>
  1079. <option value="2006">2006</option>
  1080. <option value="2005">2005</option>
  1081. <option value="2004">2004</option>
  1082. <option value="2003">2003</option>
  1083. <option value="2002">2002</option>
  1084. <option value="2001">2001</option>
  1085. <option value="2000">2000</option>
  1086. <option value="1999">1999</option>
  1087. <option value="1998">1998</option>
  1088. <option value="1997">1997</option>
  1089. <option value="1996">1996</option>
  1090. <option value="1995">1995</option>
  1091. <option value="1994">1994</option>
  1092. <option value="1993">1993</option>
  1093. <option value="1992">1992</option>
  1094. <option value="1991">1991</option>
  1095. <option value="1990">1990</option>
  1096. <option value="1989">1989</option>
  1097. <option value="1988">1988</option>
  1098. <option value="1987">1987</option>
  1099. <option value="1986">1986</option>
  1100. <option value="1985">1985</option>
  1101. <option value="1984">1984</option>
  1102. <option value="1983">1983</option>
  1103. <option value="1982">1982</option>
  1104. <option value="1981">1981</option>
  1105. <option value="1980">1980</option>
  1106. <option value="1979">1979</option>
  1107. <option value="1978">1978</option>
  1108. <option value="1977">1977</option>
  1109. <option value="1976">1976</option>
  1110. <option value="1975">1975</option>
  1111. <option value="1974">1974</option>
  1112. <option value="1973">1973</option>
  1113. <option value="1972">1972</option>
  1114. <option value="1971">1971</option>
  1115. <option value="1970">1970</option>
  1116. <option value="1969">1969</option>
  1117. <option value="1968">1968</option>
  1118. <option value="1967">1967</option>
  1119. <option value="1966">1966</option>
  1120. <option value="1965">1965</option>
  1121. <option value="1964">1964</option>
  1122. <option value="1963">1963</option>
  1123. <option value="1962">1962</option>
  1124. <option value="1961">1961</option>
  1125. <option value="1960">1960</option>
  1126. <option value="1959">1959</option>
  1127. <option value="1958">1958</option>
  1128. <option value="1957">1957</option>
  1129. <option value="1956">1956</option>
  1130. <option value="1955">1955</option>
  1131. <option value="1954">1954</option>
  1132. <option value="1953">1953</option>
  1133. <option value="1952">1952</option>
  1134. <option value="1951">1951</option>
  1135. <option value="1950">1950</option>
  1136. <option value="1949">1949</option>
  1137. <option value="1948">1948</option>
  1138. <option value="1947">1947</option>
  1139.  
  1140. </select>
  1141.  
  1142. -
  1143. <select id="exmt4" name="exmt4">
  1144. <option value="">MM</option>
  1145. <option value="1">01</option>
  1146. <option value="2">02</option>
  1147. <option value="3">03</option>
  1148. <option value="4">04</option>
  1149. <option value="5">05</option>
  1150. <option value="6">06</option>
  1151. <option value="7">07</option>
  1152. <option value="8">08</option>
  1153. <option value="9">09</option>
  1154. <option value="10">10</option>
  1155. <option value="11">11</option>
  1156. <option value="12">12</option>
  1157.  
  1158. </select>
  1159.  
  1160. </td>
  1161. <td><input type="text" name="qualification4" maxlength="30" /></td>
  1162. <td><input type="text" name="subjectname4" maxlength="30" /></td>
  1163. <td><input type="text" name="grade4" maxlength="30" /></td>
  1164. </tr>
  1165.  
  1166. <tr>
  1167. <td>5</td>
  1168. <td>
  1169. <select name="exyr5">
  1170. <option value="">YYYY</option>
  1171. <option value="2015">2015</option>
  1172. <option value="2014">2014</option>
  1173. <option value="2013">2013</option>
  1174. <option value="2012">2012</option>
  1175. <option value="2011">2011</option>
  1176. <option value="2010">2010</option>
  1177. <option value="2009">2009</option>
  1178. <option value="2008">2008</option>
  1179. <option value="2007">2007</option>
  1180. <option value="2006">2006</option>
  1181. <option value="2005">2005</option>
  1182. <option value="2004">2004</option>
  1183. <option value="2003">2003</option>
  1184. <option value="2002">2002</option>
  1185. <option value="2001">2001</option>
  1186. <option value="2000">2000</option>
  1187. <option value="1999">1999</option>
  1188. <option value="1998">1998</option>
  1189. <option value="1997">1997</option>
  1190. <option value="1996">1996</option>
  1191. <option value="1995">1995</option>
  1192. <option value="1994">1994</option>
  1193. <option value="1993">1993</option>
  1194. <option value="1992">1992</option>
  1195. <option value="1991">1991</option>
  1196. <option value="1990">1990</option>
  1197. <option value="1989">1989</option>
  1198. <option value="1988">1988</option>
  1199. <option value="1987">1987</option>
  1200. <option value="1986">1986</option>
  1201. <option value="1985">1985</option>
  1202. <option value="1984">1984</option>
  1203. <option value="1983">1983</option>
  1204. <option value="1982">1982</option>
  1205. <option value="1981">1981</option>
  1206. <option value="1980">1980</option>
  1207. <option value="1979">1979</option>
  1208. <option value="1978">1978</option>
  1209. <option value="1977">1977</option>
  1210. <option value="1976">1976</option>
  1211. <option value="1975">1975</option>
  1212. <option value="1974">1974</option>
  1213. <option value="1973">1973</option>
  1214. <option value="1972">1972</option>
  1215. <option value="1971">1971</option>
  1216. <option value="1970">1970</option>
  1217. <option value="1969">1969</option>
  1218. <option value="1968">1968</option>
  1219. <option value="1967">1967</option>
  1220. <option value="1966">1966</option>
  1221. <option value="1965">1965</option>
  1222. <option value="1964">1964</option>
  1223. <option value="1963">1963</option>
  1224. <option value="1962">1962</option>
  1225. <option value="1961">1961</option>
  1226. <option value="1960">1960</option>
  1227. <option value="1959">1959</option>
  1228. <option value="1958">1958</option>
  1229. <option value="1957">1957</option>
  1230. <option value="1956">1956</option>
  1231. <option value="1955">1955</option>
  1232. <option value="1954">1954</option>
  1233. <option value="1953">1953</option>
  1234. <option value="1952">1952</option>
  1235. <option value="1951">1951</option>
  1236. <option value="1950">1950</option>
  1237. <option value="1949">1949</option>
  1238. <option value="1948">1948</option>
  1239. <option value="1947">1947</option>
  1240.  
  1241. </select>
  1242.  
  1243. -
  1244. <select id="exmt5" name="exmt5">
  1245. <option value="">MM</option>
  1246. <option value="1">01</option>
  1247. <option value="2">02</option>
  1248. <option value="3">03</option>
  1249. <option value="4">04</option>
  1250. <option value="5">05</option>
  1251. <option value="6">06</option>
  1252. <option value="7">07</option>
  1253. <option value="8">08</option>
  1254. <option value="9">09</option>
  1255. <option value="10">10</option>
  1256. <option value="11">11</option>
  1257. <option value="12">12</option>
  1258.  
  1259. </select>
  1260.  
  1261. </td>
  1262. <td><input type="text" name="qualification5" maxlength="30" /></td>
  1263. <td><input type="text" name="subjectname5" maxlength="30" /></td>
  1264. <td><input type="text" name="grade5" maxlength="30" /></td>
  1265. </tr>
  1266. <tr>
  1267. <td></td>
  1268. <td></td>
  1269. <td align="center">(10 char max)</td>
  1270. <td align="center">(upto 2 decimal)</td>
  1271. </tr>
  1272. </table>
  1273.  
  1274. </td>
  1275. </tr>
  1276. <tr>
  1277. <th colspan="4" align="center"><b>
  1278. <hr/></b>
  1279.  
  1280. </th></tr>
  1281. <th colspan="4" align="left"><b>
  1282. AWARD NUMBER 1 (OPTIONAL) </b>
  1283.  
  1284. </th>
  1285. <tr><td>1.LEVEL OF AWARD</td>
  1286. <td> <select name="awardlevel1">
  1287. <option value="">Please select</option>
  1288. <option value="Inter-school">Inter-school</option>
  1289. <option value="City/District-wide">City/District-wide</option>
  1290. <option value="Province/State-wide">Province/State-wide</option>
  1291. <option value="National">National</option>
  1292. <option value="Regional">Regional</option>
  1293. <option value="International">International</option>
  1294. <option value="Academic Award">Academic Award</option>
  1295. </select>
  1296. &nbsp; &nbsp; 1.NAME OF AWARDING BODY&nbsp; &nbsp;
  1297. <input type="text" name="awardingbody1" maxlength="30"/>
  1298. </td>
  1299. </tr>
  1300. <tr><td>1.QUALIFICATION/<br>AWARD NAME</td>
  1301. <td><input type="text" name="awardingname1" maxlength="30"/>
  1302. &nbsp; &nbsp; 1.BASIS OF AWARD&nbsp; &nbsp;
  1303. <select name="awardtype1">
  1304. <option value="">Please select</option>
  1305. <option value="By competition">By competition</option>
  1306. <option value="By participation">By participation</option>
  1307. <option value="By examination">By examination</option>
  1308. <option value="By nomination">By nomination</option>
  1309. <option value="Not applicable">Not applicable</option>
  1310. </select>
  1311. &nbsp; &nbsp;1.DATE OF AWARD &nbsp;
  1312. <select name="awardyear1">
  1313. <option value="">YYYY</option>
  1314. <option value="2015">2015</option>
  1315. <option value="2014">2014</option>
  1316. <option value="2013">2013</option>
  1317. <option value="2012">2012</option>
  1318. <option value="2011">2011</option>
  1319. <option value="2010">2010</option>
  1320. <option value="2009">2009</option>
  1321. <option value="2008">2008</option>
  1322. <option value="2007">2007</option>
  1323. <option value="2006">2006</option>
  1324. <option value="2005">2005</option>
  1325. <option value="2004">2004</option>
  1326. <option value="2003">2003</option>
  1327. <option value="2002">2002</option>
  1328. <option value="2001">2001</option>
  1329. <option value="2000">2000</option>
  1330. <option value="1999">1999</option>
  1331. <option value="1998">1998</option>
  1332. <option value="1997">1997</option>
  1333. <option value="1996">1996</option>
  1334. <option value="1995">1995</option>
  1335. <option value="1994">1994</option>
  1336. <option value="1993">1993</option>
  1337. <option value="1992">1992</option>
  1338. <option value="1991">1991</option>
  1339. <option value="1990">1990</option>
  1340. <option value="1989">1989</option>
  1341. <option value="1988">1988</option>
  1342. <option value="1987">1987</option>
  1343. <option value="1986">1986</option>
  1344. <option value="1985">1985</option>
  1345. <option value="1984">1984</option>
  1346. <option value="1983">1983</option>
  1347. <option value="1982">1982</option>
  1348. <option value="1981">1981</option>
  1349. <option value="1980">1980</option>
  1350. <option value="1979">1979</option>
  1351. <option value="1978">1978</option>
  1352. <option value="1977">1977</option>
  1353. <option value="1976">1976</option>
  1354. <option value="1975">1975</option>
  1355. <option value="1974">1974</option>
  1356. <option value="1973">1973</option>
  1357. <option value="1972">1972</option>
  1358. <option value="1971">1971</option>
  1359. <option value="1970">1970</option>
  1360. <option value="1969">1969</option>
  1361. <option value="1968">1968</option>
  1362. <option value="1967">1967</option>
  1363. <option value="1966">1966</option>
  1364. <option value="1965">1965</option>
  1365. <option value="1964">1964</option>
  1366. <option value="1963">1963</option>
  1367. <option value="1962">1962</option>
  1368. <option value="1961">1961</option>
  1369. <option value="1960">1960</option>
  1370. <option value="1959">1959</option>
  1371. <option value="1958">1958</option>
  1372. <option value="1957">1957</option>
  1373. <option value="1956">1956</option>
  1374. <option value="1955">1955</option>
  1375. <option value="1954">1954</option>
  1376. <option value="1953">1953</option>
  1377. <option value="1952">1952</option>
  1378. <option value="1951">1951</option>
  1379. <option value="1950">1950</option>
  1380. <option value="1949">1949</option>
  1381. <option value="1948">1948</option>
  1382. <option value="1947">1947</option>
  1383.  
  1384. </select>
  1385.  
  1386. -
  1387. <select name="awardmonth1" >
  1388. <option value="">MM</option>
  1389. <option value="1">01</option>
  1390. <option value="2">02</option>
  1391. <option value="3">03</option>
  1392. <option value="4">04</option>
  1393. <option value="5">05</option>
  1394. <option value="6">06</option>
  1395. <option value="7">07</option>
  1396. <option value="8">08</option>
  1397. <option value="9">09</option>
  1398. <option value="10">10</option>
  1399. <option value="11">11</option>
  1400. <option value="12">12</option>
  1401.  
  1402. </select>
  1403.  
  1404.  
  1405.  
  1406.  
  1407.  
  1408.  
  1409. </td>
  1410. </tr>
  1411. <th colspan="4" align="left"><b>
  1412. <hr style="border: 0;
  1413. border-bottom: 1px dashed #ccc;
  1414. background: #999;"/>AWARD NUMBER 2 (OPTIONAL)</th>
  1415.  
  1416.  
  1417.  
  1418. <tr><td>2.LEVEL OF AWARD</td>
  1419. <td> <select name="awardlevel2">
  1420. <option value="">Please select</option>
  1421. <option value="Inter-school">Inter-school</option>
  1422. <option value="City/District-wide">City/District-wide</option>
  1423. <option value="Province/State-wide">Province/State-wide</option>
  1424. <option value="National">National</option>
  1425. <option value="Regional">Regional</option>
  1426. <option value="International">International</option>
  1427. <option value="Academic Award">Academic Award</option>
  1428. </select>
  1429. &nbsp; &nbsp; 2.NAME OF AWARDING BODY&nbsp; &nbsp;
  1430. <input type="text" name="awardingbody2" maxlength="30"/>
  1431. </td>
  1432. </tr>
  1433. <tr><td>2.QUALIFICATION/<br>AWARD NAME</td>
  1434. <td><input type="text" name="awardingname2" maxlength="30"/>
  1435. &nbsp; &nbsp; 2.BASIS OF AWARD&nbsp; &nbsp;
  1436. <select name="awardtype2">
  1437. <option value="">Please select</option>
  1438. <option value="By competition">By competition</option>
  1439. <option value="By participation">By participation</option>
  1440. <option value="By examination">By examination</option>
  1441. <option value="By nomination">By nomination</option>
  1442. <option value="Not applicable">Not applicable</option>
  1443. </select>
  1444. &nbsp; &nbsp;2.DATE OF AWARD &nbsp;
  1445. <select name="awardyear2">
  1446. <option value="">YYYY</option>
  1447. <option value="2015">2015</option>
  1448. <option value="2014">2014</option>
  1449. <option value="2013">2013</option>
  1450. <option value="2012">2012</option>
  1451. <option value="2011">2011</option>
  1452. <option value="2010">2010</option>
  1453. <option value="2009">2009</option>
  1454. <option value="2008">2008</option>
  1455. <option value="2007">2007</option>
  1456. <option value="2006">2006</option>
  1457. <option value="2005">2005</option>
  1458. <option value="2004">2004</option>
  1459. <option value="2003">2003</option>
  1460. <option value="2002">2002</option>
  1461. <option value="2001">2001</option>
  1462. <option value="2000">2000</option>
  1463. <option value="1999">1999</option>
  1464. <option value="1998">1998</option>
  1465. <option value="1997">1997</option>
  1466. <option value="1996">1996</option>
  1467. <option value="1995">1995</option>
  1468. <option value="1994">1994</option>
  1469. <option value="1993">1993</option>
  1470. <option value="1992">1992</option>
  1471. <option value="1991">1991</option>
  1472. <option value="1990">1990</option>
  1473. <option value="1989">1989</option>
  1474. <option value="1988">1988</option>
  1475. <option value="1987">1987</option>
  1476. <option value="1986">1986</option>
  1477. <option value="1985">1985</option>
  1478. <option value="1984">1984</option>
  1479. <option value="1983">1983</option>
  1480. <option value="1982">1982</option>
  1481. <option value="1981">1981</option>
  1482. <option value="1980">1980</option>
  1483. <option value="1979">1979</option>
  1484. <option value="1978">1978</option>
  1485. <option value="1977">1977</option>
  1486. <option value="1976">1976</option>
  1487. <option value="1975">1975</option>
  1488. <option value="1974">1974</option>
  1489. <option value="1973">1973</option>
  1490. <option value="1972">1972</option>
  1491. <option value="1971">1971</option>
  1492. <option value="1970">1970</option>
  1493. <option value="1969">1969</option>
  1494. <option value="1968">1968</option>
  1495. <option value="1967">1967</option>
  1496. <option value="1966">1966</option>
  1497. <option value="1965">1965</option>
  1498. <option value="1964">1964</option>
  1499. <option value="1963">1963</option>
  1500. <option value="1962">1962</option>
  1501. <option value="1961">1961</option>
  1502. <option value="1960">1960</option>
  1503. <option value="1959">1959</option>
  1504. <option value="1958">1958</option>
  1505. <option value="1957">1957</option>
  1506. <option value="1956">1956</option>
  1507. <option value="1955">1955</option>
  1508. <option value="1954">1954</option>
  1509. <option value="1953">1953</option>
  1510. <option value="1952">1952</option>
  1511. <option value="1951">1951</option>
  1512. <option value="1950">1950</option>
  1513. <option value="1949">1949</option>
  1514. <option value="1948">1948</option>
  1515. <option value="1947">1947</option>
  1516.  
  1517. </select>
  1518.  
  1519. -
  1520. <select name="awardmonth2" >
  1521. <option value="">MM</option>
  1522. <option value="1">01</option>
  1523. <option value="2">02</option>
  1524. <option value="3">03</option>
  1525. <option value="4">04</option>
  1526. <option value="5">05</option>
  1527. <option value="6">06</option>
  1528. <option value="7">07</option>
  1529. <option value="8">08</option>
  1530. <option value="9">09</option>
  1531. <option value="10">10</option>
  1532. <option value="11">11</option>
  1533. <option value="12">12</option>
  1534.  
  1535. </select>
  1536.  
  1537.  
  1538.  
  1539.  
  1540.  
  1541.  
  1542. </td>
  1543. </tr>
  1544. <th colspan="4" align="left"><b>
  1545. <hr style="border: 0;
  1546. border-bottom: 1px dashed #ccc;
  1547. background: #999;"/>AWARD NUMBER 3 (OPTIONAL)</th>
  1548. <tr><td>3.LEVEL OF AWARD</td>
  1549. <td> <select name="awardlevel3">
  1550. <option value="">Please select</option>
  1551. <option value="Inter-school">Inter-school</option>
  1552. <option value="City/District-wide">City/District-wide</option>
  1553. <option value="Province/State-wide">Province/State-wide</option>
  1554. <option value="National">National</option>
  1555. <option value="Regional">Regional</option>
  1556. <option value="International">International</option>
  1557. <option value="Academic Award">Academic Award</option>
  1558. </select>
  1559. &nbsp; &nbsp; 3.NAME OF AWARDING BODY&nbsp; &nbsp;
  1560. <input type="text" name="awardingbody3" maxlength="30"/>
  1561. </td>
  1562. </tr>
  1563. <tr><td>3.QUALIFICATION/<br>AWARD NAME</td>
  1564. <td><input type="text" name="awardingname3" maxlength="30"/>
  1565. &nbsp; &nbsp; 3.BASIS OF AWARD&nbsp; &nbsp;
  1566. <select name="awardtype3">
  1567. <option value="">Please select</option>
  1568. <option value="By competition">By competition</option>
  1569. <option value="By participation">By participation</option>
  1570. <option value="By examination">By examination</option>
  1571. <option value="By nomination">By nomination</option>
  1572. <option value="Not applicable">Not applicable</option>
  1573. </select>
  1574. &nbsp; &nbsp;3.DATE OF AWARD &nbsp;
  1575. <select name="awardyear3">
  1576. <option value="">YYYY</option>
  1577. <option value="2015">2015</option>
  1578. <option value="2014">2014</option>
  1579. <option value="2013">2013</option>
  1580. <option value="2012">2012</option>
  1581. <option value="2011">2011</option>
  1582. <option value="2010">2010</option>
  1583. <option value="2009">2009</option>
  1584. <option value="2008">2008</option>
  1585. <option value="2007">2007</option>
  1586. <option value="2006">2006</option>
  1587. <option value="2005">2005</option>
  1588. <option value="2004">2004</option>
  1589. <option value="2003">2003</option>
  1590. <option value="2002">2002</option>
  1591. <option value="2001">2001</option>
  1592. <option value="2000">2000</option>
  1593. <option value="1999">1999</option>
  1594. <option value="1998">1998</option>
  1595. <option value="1997">1997</option>
  1596. <option value="1996">1996</option>
  1597. <option value="1995">1995</option>
  1598. <option value="1994">1994</option>
  1599. <option value="1993">1993</option>
  1600. <option value="1992">1992</option>
  1601. <option value="1991">1991</option>
  1602. <option value="1990">1990</option>
  1603. <option value="1989">1989</option>
  1604. <option value="1988">1988</option>
  1605. <option value="1987">1987</option>
  1606. <option value="1986">1986</option>
  1607. <option value="1985">1985</option>
  1608. <option value="1984">1984</option>
  1609. <option value="1983">1983</option>
  1610. <option value="1982">1982</option>
  1611. <option value="1981">1981</option>
  1612. <option value="1980">1980</option>
  1613. <option value="1979">1979</option>
  1614. <option value="1978">1978</option>
  1615. <option value="1977">1977</option>
  1616. <option value="1976">1976</option>
  1617. <option value="1975">1975</option>
  1618. <option value="1974">1974</option>
  1619. <option value="1973">1973</option>
  1620. <option value="1972">1972</option>
  1621. <option value="1971">1971</option>
  1622. <option value="1970">1970</option>
  1623. <option value="1969">1969</option>
  1624. <option value="1968">1968</option>
  1625. <option value="1967">1967</option>
  1626. <option value="1966">1966</option>
  1627. <option value="1965">1965</option>
  1628. <option value="1964">1964</option>
  1629. <option value="1963">1963</option>
  1630. <option value="1962">1962</option>
  1631. <option value="1961">1961</option>
  1632. <option value="1960">1960</option>
  1633. <option value="1959">1959</option>
  1634. <option value="1958">1958</option>
  1635. <option value="1957">1957</option>
  1636. <option value="1956">1956</option>
  1637. <option value="1955">1955</option>
  1638. <option value="1954">1954</option>
  1639. <option value="1953">1953</option>
  1640. <option value="1952">1952</option>
  1641. <option value="1951">1951</option>
  1642. <option value="1950">1950</option>
  1643. <option value="1949">1949</option>
  1644. <option value="1948">1948</option>
  1645. <option value="1947">1947</option>
  1646.  
  1647. </select>
  1648.  
  1649. -
  1650. <select name="awardmonth3" >
  1651. <option value="">MM</option>
  1652. <option value="1">01</option>
  1653. <option value="2">02</option>
  1654. <option value="3">03</option>
  1655. <option value="4">04</option>
  1656. <option value="5">05</option>
  1657. <option value="6">06</option>
  1658. <option value="7">07</option>
  1659. <option value="8">08</option>
  1660. <option value="9">09</option>
  1661. <option value="10">10</option>
  1662. <option value="11">11</option>
  1663. <option value="12">12</option>
  1664.  
  1665. </select>
  1666.  
  1667.  
  1668. </td>
  1669. </tr>
  1670. <!----- JOB EXPERIENCE ---------------------------------------------------------->
  1671. <tr><th colspan="4"><hr></th></tr>
  1672. <tr>
  1673. <td><B>WORKING EXPERIENCE (OPTIONAL)</B></td></tr>
  1674. <tr>
  1675. <td> JOB TITLE / POSITION</td>
  1676. <td>
  1677. <input type="text" name="jobtitle1" maxlength="30"/>
  1678.  
  1679.  
  1680. &nbsp; COMPANY/ORGANIZATION NAME &nbsp; &nbsp;
  1681. <input type="text" name="companyname1" maxlength="30"/>
  1682. </td>
  1683. </tr>
  1684. <tr>
  1685. <td>EMPLOYMENT PERIOD</td>
  1686. <td>
  1687. FROM <select name="jobstartyear1">
  1688. <option value="">YYYY</option>
  1689.  
  1690. <option value="2015">2015</option>
  1691. <option value="2014">2014</option>
  1692. <option value="2013">2013</option>
  1693. <option value="2012">2012</option>
  1694. <option value="2011">2011</option>
  1695. <option value="2010">2010</option>
  1696. <option value="2009">2009</option>
  1697. <option value="2008">2008</option>
  1698. <option value="2007">2007</option>
  1699. <option value="2006">2006</option>
  1700. <option value="2005">2005</option>
  1701. <option value="2004">2004</option>
  1702. <option value="2003">2003</option>
  1703. <option value="2002">2002</option>
  1704. <option value="2001">2001</option>
  1705. <option value="2000">2000</option>
  1706. <option value="1999">1999</option>
  1707. <option value="1998">1998</option>
  1708. <option value="1997">1997</option>
  1709. <option value="1996">1996</option>
  1710. <option value="1995">1995</option>
  1711. <option value="1994">1994</option>
  1712. <option value="1993">1993</option>
  1713. <option value="1992">1992</option>
  1714. <option value="1991">1991</option>
  1715. <option value="1990">1990</option>
  1716. <option value="1989">1989</option>
  1717. <option value="1988">1988</option>
  1718. <option value="1987">1987</option>
  1719. <option value="1986">1986</option>
  1720. <option value="1985">1985</option>
  1721. <option value="1984">1984</option>
  1722. <option value="1983">1983</option>
  1723. <option value="1982">1982</option>
  1724. <option value="1981">1981</option>
  1725. <option value="1980">1980</option>
  1726. <option value="1979">1979</option>
  1727. <option value="1978">1978</option>
  1728. <option value="1977">1977</option>
  1729. <option value="1976">1976</option>
  1730. <option value="1975">1975</option>
  1731. <option value="1974">1974</option>
  1732. <option value="1973">1973</option>
  1733. <option value="1972">1972</option>
  1734. <option value="1971">1971</option>
  1735. <option value="1970">1970</option>
  1736. <option value="1969">1969</option>
  1737. <option value="1968">1968</option>
  1738. <option value="1967">1967</option>
  1739. <option value="1966">1966</option>
  1740. <option value="1965">1965</option>
  1741. <option value="1964">1964</option>
  1742. <option value="1963">1963</option>
  1743. <option value="1962">1962</option>
  1744. <option value="1961">1961</option>
  1745. <option value="1960">1960</option>
  1746. <option value="1959">1959</option>
  1747. <option value="1958">1958</option>
  1748. <option value="1957">1957</option>
  1749. <option value="1956">1956</option>
  1750. <option value="1955">1955</option>
  1751. <option value="1954">1954</option>
  1752. <option value="1953">1953</option>
  1753. <option value="1952">1952</option>
  1754. <option value="1951">1951</option>
  1755. <option value="1950">1950</option>
  1756. <option value="1949">1949</option>
  1757. <option value="1948">1948</option>
  1758. <option value="1947">1947</option>
  1759.  
  1760. </select>
  1761. - TO
  1762. <select name="jobendyear1">
  1763. <option value="">YYYY</option>
  1764. <option value="Present">Present</option>
  1765. <option value="2015">2015</option>
  1766. <option value="2014">2014</option>
  1767. <option value="2013">2013</option>
  1768. <option value="2012">2012</option>
  1769. <option value="2011">2011</option>
  1770. <option value="2010">2010</option>
  1771. <option value="2009">2009</option>
  1772. <option value="2008">2008</option>
  1773. <option value="2007">2007</option>
  1774. <option value="2006">2006</option>
  1775. <option value="2005">2005</option>
  1776. <option value="2004">2004</option>
  1777. <option value="2003">2003</option>
  1778. <option value="2002">2002</option>
  1779. <option value="2001">2001</option>
  1780. <option value="2000">2000</option>
  1781. <option value="1999">1999</option>
  1782. <option value="1998">1998</option>
  1783. <option value="1997">1997</option>
  1784. <option value="1996">1996</option>
  1785. <option value="1995">1995</option>
  1786. <option value="1994">1994</option>
  1787. <option value="1993">1993</option>
  1788. <option value="1992">1992</option>
  1789. <option value="1991">1991</option>
  1790. <option value="1990">1990</option>
  1791. <option value="1989">1989</option>
  1792. <option value="1988">1988</option>
  1793. <option value="1987">1987</option>
  1794. <option value="1986">1986</option>
  1795. <option value="1985">1985</option>
  1796. <option value="1984">1984</option>
  1797. <option value="1983">1983</option>
  1798. <option value="1982">1982</option>
  1799. <option value="1981">1981</option>
  1800. <option value="1980">1980</option>
  1801. <option value="1979">1979</option>
  1802. <option value="1978">1978</option>
  1803. <option value="1977">1977</option>
  1804. <option value="1976">1976</option>
  1805. <option value="1975">1975</option>
  1806. <option value="1974">1974</option>
  1807. <option value="1973">1973</option>
  1808. <option value="1972">1972</option>
  1809. <option value="1971">1971</option>
  1810. <option value="1970">1970</option>
  1811. <option value="1969">1969</option>
  1812. <option value="1968">1968</option>
  1813. <option value="1967">1967</option>
  1814. <option value="1966">1966</option>
  1815. <option value="1965">1965</option>
  1816. <option value="1964">1964</option>
  1817. <option value="1963">1963</option>
  1818. <option value="1962">1962</option>
  1819. <option value="1961">1961</option>
  1820. <option value="1960">1960</option>
  1821. <option value="1959">1959</option>
  1822. <option value="1958">1958</option>
  1823. <option value="1957">1957</option>
  1824. <option value="1956">1956</option>
  1825. <option value="1955">1955</option>
  1826. <option value="1954">1954</option>
  1827. <option value="1953">1953</option>
  1828. <option value="1952">1952</option>
  1829. <option value="1951">1951</option>
  1830. <option value="1950">1950</option>
  1831. <option value="1949">1949</option>
  1832. <option value="1948">1948</option>
  1833. <option value="1947">1947</option>
  1834.  
  1835. </select>&nbsp; &nbsp; &nbsp; WORK-TIME &nbsp; &nbsp; &nbsp;
  1836.  
  1837. <input type="radio" name="worktime1" value="Full-time" />Full-time
  1838. <input type="radio" name="worktime1" value="Part-time" />Part-time
  1839.  
  1840.  
  1841. </td>
  1842. </tr>
  1843. <th colspan="4" align="left"><b>
  1844. <hr style="border: 0;
  1845. border-bottom: 1px dashed #ccc;
  1846. background: #999;"/></th>
  1847. <tr>
  1848. <td> JOB TITLE / POSITION</td>
  1849. <td>
  1850. <input type="text" name="jobtitle2" maxlength="30"/>
  1851.  
  1852.  
  1853. &nbsp; COMPANY/ORGANIZATION NAME &nbsp; &nbsp;
  1854. <input type="text" name="companyname2" maxlength="30"/>
  1855. </td>
  1856. </tr>
  1857. <tr>
  1858. <td>EMPLOYMENT PERIOD</td>
  1859. <td>
  1860. FROM <select name="jobstartyear2">
  1861. <option value="">YYYY</option>
  1862.  
  1863. <option value="2015">2015</option>
  1864. <option value="2014">2014</option>
  1865. <option value="2013">2013</option>
  1866. <option value="2012">2012</option>
  1867. <option value="2011">2011</option>
  1868. <option value="2010">2010</option>
  1869. <option value="2009">2009</option>
  1870. <option value="2008">2008</option>
  1871. <option value="2007">2007</option>
  1872. <option value="2006">2006</option>
  1873. <option value="2005">2005</option>
  1874. <option value="2004">2004</option>
  1875. <option value="2003">2003</option>
  1876. <option value="2002">2002</option>
  1877. <option value="2001">2001</option>
  1878. <option value="2000">2000</option>
  1879. <option value="1999">1999</option>
  1880. <option value="1998">1998</option>
  1881. <option value="1997">1997</option>
  1882. <option value="1996">1996</option>
  1883. <option value="1995">1995</option>
  1884. <option value="1994">1994</option>
  1885. <option value="1993">1993</option>
  1886. <option value="1992">1992</option>
  1887. <option value="1991">1991</option>
  1888. <option value="1990">1990</option>
  1889. <option value="1989">1989</option>
  1890. <option value="1988">1988</option>
  1891. <option value="1987">1987</option>
  1892. <option value="1986">1986</option>
  1893. <option value="1985">1985</option>
  1894. <option value="1984">1984</option>
  1895. <option value="1983">1983</option>
  1896. <option value="1982">1982</option>
  1897. <option value="1981">1981</option>
  1898. <option value="1980">1980</option>
  1899. <option value="1979">1979</option>
  1900. <option value="1978">1978</option>
  1901. <option value="1977">1977</option>
  1902. <option value="1976">1976</option>
  1903. <option value="1975">1975</option>
  1904. <option value="1974">1974</option>
  1905. <option value="1973">1973</option>
  1906. <option value="1972">1972</option>
  1907. <option value="1971">1971</option>
  1908. <option value="1970">1970</option>
  1909. <option value="1969">1969</option>
  1910. <option value="1968">1968</option>
  1911. <option value="1967">1967</option>
  1912. <option value="1966">1966</option>
  1913. <option value="1965">1965</option>
  1914. <option value="1964">1964</option>
  1915. <option value="1963">1963</option>
  1916. <option value="1962">1962</option>
  1917. <option value="1961">1961</option>
  1918. <option value="1960">1960</option>
  1919. <option value="1959">1959</option>
  1920. <option value="1958">1958</option>
  1921. <option value="1957">1957</option>
  1922. <option value="1956">1956</option>
  1923. <option value="1955">1955</option>
  1924. <option value="1954">1954</option>
  1925. <option value="1953">1953</option>
  1926. <option value="1952">1952</option>
  1927. <option value="1951">1951</option>
  1928. <option value="1950">1950</option>
  1929. <option value="1949">1949</option>
  1930. <option value="1948">1948</option>
  1931. <option value="1947">1947</option>
  1932.  
  1933. </select>
  1934. - TO
  1935. <select name="jobendyear2">
  1936. <option value="">YYYY</option>
  1937. <option value="Present">Present</option>
  1938. <option value="2015">2015</option>
  1939. <option value="2014">2014</option>
  1940. <option value="2013">2013</option>
  1941. <option value="2012">2012</option>
  1942. <option value="2011">2011</option>
  1943. <option value="2010">2010</option>
  1944. <option value="2009">2009</option>
  1945. <option value="2008">2008</option>
  1946. <option value="2007">2007</option>
  1947. <option value="2006">2006</option>
  1948. <option value="2005">2005</option>
  1949. <option value="2004">2004</option>
  1950. <option value="2003">2003</option>
  1951. <option value="2002">2002</option>
  1952. <option value="2001">2001</option>
  1953. <option value="2000">2000</option>
  1954. <option value="1999">1999</option>
  1955. <option value="1998">1998</option>
  1956. <option value="1997">1997</option>
  1957. <option value="1996">1996</option>
  1958. <option value="1995">1995</option>
  1959. <option value="1994">1994</option>
  1960. <option value="1993">1993</option>
  1961. <option value="1992">1992</option>
  1962. <option value="1991">1991</option>
  1963. <option value="1990">1990</option>
  1964. <option value="1989">1989</option>
  1965. <option value="1988">1988</option>
  1966. <option value="1987">1987</option>
  1967. <option value="1986">1986</option>
  1968. <option value="1985">1985</option>
  1969. <option value="1984">1984</option>
  1970. <option value="1983">1983</option>
  1971. <option value="1982">1982</option>
  1972. <option value="1981">1981</option>
  1973. <option value="1980">1980</option>
  1974. <option value="1979">1979</option>
  1975. <option value="1978">1978</option>
  1976. <option value="1977">1977</option>
  1977. <option value="1976">1976</option>
  1978. <option value="1975">1975</option>
  1979. <option value="1974">1974</option>
  1980. <option value="1973">1973</option>
  1981. <option value="1972">1972</option>
  1982. <option value="1971">1971</option>
  1983. <option value="1970">1970</option>
  1984. <option value="1969">1969</option>
  1985. <option value="1968">1968</option>
  1986. <option value="1967">1967</option>
  1987. <option value="1966">1966</option>
  1988. <option value="1965">1965</option>
  1989. <option value="1964">1964</option>
  1990. <option value="1963">1963</option>
  1991. <option value="1962">1962</option>
  1992. <option value="1961">1961</option>
  1993. <option value="1960">1960</option>
  1994. <option value="1959">1959</option>
  1995. <option value="1958">1958</option>
  1996. <option value="1957">1957</option>
  1997. <option value="1956">1956</option>
  1998. <option value="1955">1955</option>
  1999. <option value="1954">1954</option>
  2000. <option value="1953">1953</option>
  2001. <option value="1952">1952</option>
  2002. <option value="1951">1951</option>
  2003. <option value="1950">1950</option>
  2004. <option value="1949">1949</option>
  2005. <option value="1948">1948</option>
  2006. <option value="1947">1947</option>
  2007.  
  2008. </select>&nbsp; &nbsp; &nbsp; WORK-TIME &nbsp; &nbsp; &nbsp;
  2009.  
  2010. <input type="radio" name="worktime2" value="Full-time" />Full-time
  2011. <input type="radio" name="worktime2" value="Part-time" />Part-time
  2012.  
  2013.  
  2014. </td>
  2015. </tr>
  2016. <th colspan="4" align="left"><b>
  2017. <hr style="border: 0;
  2018. border-bottom: 1px dashed #ccc;
  2019. background: #999;"/></th>
  2020. <tr>
  2021. <td> JOB TITLE / POSITION</td>
  2022. <td>
  2023. <input type="text" name="jobtitle3" maxlength="30"/>
  2024.  
  2025.  
  2026. &nbsp; COMPANY/ORGANIZATION NAME &nbsp; &nbsp;
  2027. <input type="text" name="companyname3" maxlength="30"/>
  2028. </td>
  2029. </tr>
  2030. <tr>
  2031. <td>EMPLOYMENT PERIOD</td>
  2032. <td>
  2033. FROM <select name="jobstartyear3">
  2034. <option value="">YYYY</option>
  2035.  
  2036. <option value="2015">2015</option>
  2037. <option value="2014">2014</option>
  2038. <option value="2013">2013</option>
  2039. <option value="2012">2012</option>
  2040. <option value="2011">2011</option>
  2041. <option value="2010">2010</option>
  2042. <option value="2009">2009</option>
  2043. <option value="2008">2008</option>
  2044. <option value="2007">2007</option>
  2045. <option value="2006">2006</option>
  2046. <option value="2005">2005</option>
  2047. <option value="2004">2004</option>
  2048. <option value="2003">2003</option>
  2049. <option value="2002">2002</option>
  2050. <option value="2001">2001</option>
  2051. <option value="2000">2000</option>
  2052. <option value="1999">1999</option>
  2053. <option value="1998">1998</option>
  2054. <option value="1997">1997</option>
  2055. <option value="1996">1996</option>
  2056. <option value="1995">1995</option>
  2057. <option value="1994">1994</option>
  2058. <option value="1993">1993</option>
  2059. <option value="1992">1992</option>
  2060. <option value="1991">1991</option>
  2061. <option value="1990">1990</option>
  2062. <option value="1989">1989</option>
  2063. <option value="1988">1988</option>
  2064. <option value="1987">1987</option>
  2065. <option value="1986">1986</option>
  2066. <option value="1985">1985</option>
  2067. <option value="1984">1984</option>
  2068. <option value="1983">1983</option>
  2069. <option value="1982">1982</option>
  2070. <option value="1981">1981</option>
  2071. <option value="1980">1980</option>
  2072. <option value="1979">1979</option>
  2073. <option value="1978">1978</option>
  2074. <option value="1977">1977</option>
  2075. <option value="1976">1976</option>
  2076. <option value="1975">1975</option>
  2077. <option value="1974">1974</option>
  2078. <option value="1973">1973</option>
  2079. <option value="1972">1972</option>
  2080. <option value="1971">1971</option>
  2081. <option value="1970">1970</option>
  2082. <option value="1969">1969</option>
  2083. <option value="1968">1968</option>
  2084. <option value="1967">1967</option>
  2085. <option value="1966">1966</option>
  2086. <option value="1965">1965</option>
  2087. <option value="1964">1964</option>
  2088. <option value="1963">1963</option>
  2089. <option value="1962">1962</option>
  2090. <option value="1961">1961</option>
  2091. <option value="1960">1960</option>
  2092. <option value="1959">1959</option>
  2093. <option value="1958">1958</option>
  2094. <option value="1957">1957</option>
  2095. <option value="1956">1956</option>
  2096. <option value="1955">1955</option>
  2097. <option value="1954">1954</option>
  2098. <option value="1953">1953</option>
  2099. <option value="1952">1952</option>
  2100. <option value="1951">1951</option>
  2101. <option value="1950">1950</option>
  2102. <option value="1949">1949</option>
  2103. <option value="1948">1948</option>
  2104. <option value="1947">1947</option>
  2105.  
  2106. </select>
  2107. - TO
  2108. <select name="jobendyear3">
  2109. <option value="">YYYY</option>
  2110. <option value="Present">Present</option>
  2111. <option value="2015">2015</option>
  2112. <option value="2014">2014</option>
  2113. <option value="2013">2013</option>
  2114. <option value="2012">2012</option>
  2115. <option value="2011">2011</option>
  2116. <option value="2010">2010</option>
  2117. <option value="2009">2009</option>
  2118. <option value="2008">2008</option>
  2119. <option value="2007">2007</option>
  2120. <option value="2006">2006</option>
  2121. <option value="2005">2005</option>
  2122. <option value="2004">2004</option>
  2123. <option value="2003">2003</option>
  2124. <option value="2002">2002</option>
  2125. <option value="2001">2001</option>
  2126. <option value="2000">2000</option>
  2127. <option value="1999">1999</option>
  2128. <option value="1998">1998</option>
  2129. <option value="1997">1997</option>
  2130. <option value="1996">1996</option>
  2131. <option value="1995">1995</option>
  2132. <option value="1994">1994</option>
  2133. <option value="1993">1993</option>
  2134. <option value="1992">1992</option>
  2135. <option value="1991">1991</option>
  2136. <option value="1990">1990</option>
  2137. <option value="1989">1989</option>
  2138. <option value="1988">1988</option>
  2139. <option value="1987">1987</option>
  2140. <option value="1986">1986</option>
  2141. <option value="1985">1985</option>
  2142. <option value="1984">1984</option>
  2143. <option value="1983">1983</option>
  2144. <option value="1982">1982</option>
  2145. <option value="1981">1981</option>
  2146. <option value="1980">1980</option>
  2147. <option value="1979">1979</option>
  2148. <option value="1978">1978</option>
  2149. <option value="1977">1977</option>
  2150. <option value="1976">1976</option>
  2151. <option value="1975">1975</option>
  2152. <option value="1974">1974</option>
  2153. <option value="1973">1973</option>
  2154. <option value="1972">1972</option>
  2155. <option value="1971">1971</option>
  2156. <option value="1970">1970</option>
  2157. <option value="1969">1969</option>
  2158. <option value="1968">1968</option>
  2159. <option value="1967">1967</option>
  2160. <option value="1966">1966</option>
  2161. <option value="1965">1965</option>
  2162. <option value="1964">1964</option>
  2163. <option value="1963">1963</option>
  2164. <option value="1962">1962</option>
  2165. <option value="1961">1961</option>
  2166. <option value="1960">1960</option>
  2167. <option value="1959">1959</option>
  2168. <option value="1958">1958</option>
  2169. <option value="1957">1957</option>
  2170. <option value="1956">1956</option>
  2171. <option value="1955">1955</option>
  2172. <option value="1954">1954</option>
  2173. <option value="1953">1953</option>
  2174. <option value="1952">1952</option>
  2175. <option value="1951">1951</option>
  2176. <option value="1950">1950</option>
  2177. <option value="1949">1949</option>
  2178. <option value="1948">1948</option>
  2179. <option value="1947">1947</option>
  2180.  
  2181. </select>&nbsp; &nbsp; &nbsp; WORK-TIME &nbsp; &nbsp; &nbsp;
  2182.  
  2183. <input type="radio" name="worktime3" value="Full-time" />Full-time
  2184. <input type="radio" name="worktime3" value="Part-time" />Part-time
  2185.  
  2186.  
  2187. </td>
  2188. </tr>
  2189.  
  2190.  
  2191. <!----- Submit and Reset ------------------------------------------------->
  2192. <tr>
  2193. <td colspan="2" align="center">
  2194. <input type='submit' value="submit">
  2195. <input type="reset" value="Reset"/>
  2196. </td>
  2197. </tr>
  2198. </table>
  2199. </form>
  2200.  
  2201.  
  2202. </body>
  2203. </html>
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