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<table style="width:60%"> | |
<tr> | |
<td> | |
<form action="#" method="post" name="job_application" id="job_form"> | |
<fieldset> | |
<legend><h3>Personal Information</h3></legend> | |
<label for="fullname">Full Name:</label> | |
<input type="text" id="name_field" name="name"><br> | |
<label for="address">Home Address:</label> | |
<input type="text" id="address_field" name="address"><br> | |
<label for="phone">Phone Number:</label> | |
<input type="text" id="phone_field" name="phone"> | |
<br> | |
<br> | |
<b> Account Details: </b><br> | |
<label for="email-address">Email Address:</label> | |
<input type="text" id="email_field" name="email"><br> | |
<label for="password">Password:</label> | |
<input type="password" id="password_field" name="password"><br> | |
<br> | |
<br> | |
<b> Gender: </b><br> | |
<input type="radio" name="gender" value="male" checked> Male<br> | |
<input type="radio" name="gender" value="female"> Female<br> | |
<input type="radio" name="gender" value="other"> Not Disclose<br> | |
</fieldset> | |
<br> | |
<fieldset> | |
<legend><h3>Department Interest</h3></legend> | |
<b>State</b> | |
<select> | |
<option value="New Jersey" selected>New Jersey</option> | |
<option value="New York">New York</option> | |
<option value="Texas">Texas</option> | |
<option value="California">California</option> | |
</select> | |
<br> | |
<br> | |
<input type="checkbox" name="departmentAcc" value="Accounting" checked>Accounting | |
<br> | |
<input type="checkbox" name="departmentHR" value="HR">Human Resources | |
<br> | |
<input type="checkbox" name="departmentComp" value="Compliance">Compliance | |
<br> | |
<input type="checkbox" name="departmentIT" value="IT">Information Tech | |
<br> | |
</fieldset><br> | |
<fieldset> | |
<legend><h3>Create Account</h3></legend> | |
<input type="submit" id="submit" name="submit" value="Submit"> | |
</fieldset> | |
</form> | |
</td> | |
<td> | |
<div> | |
<textarea rows="15" id="output_value" cols="40"></textarea> | |
</div> | |
</td> | |
<tr> | |
</table> |
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