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@imtiazahmad007
Last active February 10, 2017 03:12
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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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