@extends('layouts.guest')
@include('layouts.profilestyle')
@section('content')
    <!-- Content Wrapper. Contains page content -->
    <div class="content-wrapper">
        <!-- Content Header (Page header) -->
        <div class="content-header">
            <div class="container-fluid">
                <div class="row mb-2">
                    <div class="col-sm-6">
                        <h1 class="m-0">Dashboard</h1>
                    </div><!-- /.col -->
                    <div class="col-sm-6">
                        <ol class="breadcrumb float-sm-right">
                            <li class="breadcrumb-item"><a href="#">Home</a></li>
                            <li class="breadcrumb-item active">Employee Register</li>
                        </ol>
                    </div><!-- /.col -->
                </div><!-- /.row -->
            </div><!-- /.container-fluid -->
        </div>
        <!-- /.content-header -->

        <!-- Main content -->
        <section class="content">
            <div class="container-fluid">
                <!-- Main row -->
                <div class="row">
                    <!-- Left col -->
                    <section class="col-lg-12 connectedSortable">
                        <!-- Custom tabs (Charts with tabs)-->
                        <div class="card">
                            <div class="card-header">
                                <h3 class="card-title">
                                    <i class="fas fa-chart-pie mr-1"></i>
                                    Add Employee
                                </h3>
                            </div><!-- /.card-header -->
                            <div class="card-body">
                                <form action="{{ route('employee/details/store') }}" method="post" enctype="multipart/form-data" id="uregister">
                                    @csrf
                                    <div class="row">
                                        <table class="table table-sm table-bordered">
                                            @foreach ($userregisterpages as $item)
                                            <tr>
                                                <td class="border-dark" style="width: 100px;" rowspan="4"><img src="{{ url('dist/images/logo.png') }}" alt="cc" style="width: 103%;padding-top:1rem;"></td>
                                                <td class="text-center text-bold border-dark" style="width: 600px;" rowspan="2"><h1>Najma Consultancy</h1></td>
                                                <td class="text-center text-bold border-dark" style="width: 160px;">Doc No</td>
                                                <td class="border-dark"><input type="text" class="w-100" name="documentno" value="{{ $item->document_no }}" readonly></td>
                                            </tr>
                                            <tr>
                                                <td class="text-center text-bold border-dark" style="">Rev. Date</td>
                                                <td class="border-dark"><input type="hidden" name="revdate" value="{{ $item->revision_date }}" readonly><input type="text" class="w-100" value="{{ \Carbon\Carbon::parse($item->revision_date)->format('M d, Y')}}" readonly></td>
                                            </tr>
                                            <tr>
                                                <td class="text-center text-bold border-dark" style="" rowspan="4"><h1>Employe Information Form</h1></td>
                                                <td class="text-center text-bold border-dark" style="">Rev. No.</td>
                                                <td class="border-dark"><input type="text" class="w-100" name="revno" value="{{ $item->revision_no }}" readonly></td>
                                            </tr>
                                            <tr>
                                                <td class="text-center text-bold border-dark" style="">Page No.</td>
                                                <td class="border-dark"><input type="text" class="w-100" name="pageno" value="{{ $item->page_no }}" readonly></td>
                                            </tr>
                                            @endforeach
                                        </table>
                                    </div><br>

                                    <div class="row">
                                        <div class="col d-flex"><span class="text-bold mt-1">Date : </span> <span class="pl-2"><input type="date" class="form-control @error('date') is-invalid @enderror" name="date" style="width: 10rem;" value="{{old('date')}}"></span></div>
                                    </div>
                                    @error('date')
                                        <div class="text-danger">{{ $message }}</div>
                                    @enderror
                                    <br>
                                    <section style="font-size: 14px;">
                                        <table class="table table-sm table-bordered">
                                            <tr>
                                                <td colspan="5" class="border-dark text-bold">Please tell us about yourself (please fill all the fileds in Capital Letter)</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark" style="width: 250px;">Full Name</td>
                                                <td class="border-dark" colspan="3"><input type="text" name="username" class="@error('username') is-invalid @enderror" style="width:100%;" value="{{old('username')}}">
                                                    @error('username')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                    <span class="text-danger error-text username_error"></span>
                                                </td>
                                                <td class="border-dark" rowspan="9">
                                                    <div class="circle">
                                                        <img class="profile-pic" src="{{ url('dist/images/profile_img_demo.png') }}">
                                                    </div>
                                                    <div class="p-image text-center">
                                                        <i class="fa fa-camera upload-button">Upload</i>
                                                        <input class="file-upload" name="profile" type="file" accept="image/*" />
                                                    </div>
                                                    <span class="text-danger error-text profile_error"></span>
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Date of Birth (dd/mm/yy)</td>
                                                <td class="border-dark" colspan="3"><input type="date" name="dob" class="@error('dob') is-invalid @enderror" style="width:100%;" value="{{old('dob')}}">
                                                    @error('dob')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Gender</td>
                                                <td class="border-dark" colspan="3"><input type="text" name="gender" class="@error('gender') is-invalid @enderror" style="width:100%;" value="{{old('gender')}}">
                                                    @error('gender')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Civil Status</td>
                                                <td class="border-dark" colspan="3">
                                                    <input type="text" name="civilstatus" style="width:100%;" value="{{old('civilstatus')}}">
                                                    @error('civilstatus')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Nationality</td>
                                                <td class="border-dark" colspan="3">
                                                    <input type="text" name="nationality" style="width:100%;" value="{{old('nationality')}}">
                                                    @error('nationality')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Passport Number</td>
                                                <td class="border-dark" style="width: 250px;">
                                                    <input type="text" name="passport" style="width:100%;" value="{{old('passport')}}">
                                                    @error('passport')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark" style="width: 110px;">Date of Expiry</td>
                                                <td class="border-dark" style="width: 250px;">
                                                    <input type="date" name="doe" style="width:100%;" value="{{old('doe')}}">
                                                    @error('doe')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Mobile Number [UAE]</td>
                                                <td class="border-dark" colspan="3">
                                                    <input type="text" name="uaemobileno" style="width:100%;" value="{{old('uaemobileno')}}">
                                                    @error('uaemobileno')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Mobile Number [Home Country]</td>
                                                <td class="border-dark" colspan="3"><input type="text" name="hcmobilenoone" style="width:100%;" value="{{old('hcmobilenoone')}}">
                                                    @error('hcmobilenoone')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Email Address</td>
                                                <td class="border-dark" colspan="3"><input type="text" name="email" style="width:100%;" value="{{old('email')}}">
                                                    @error('email')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                    <span class="text-danger error-text email_error"></span>
                                                </td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark text-bold" style="width: 250px;">Contact Details in Case of Emergency</td>
                                                <td class="border-dark text-bold text-center" style="background-color: #eee;width: 40%;">UAE</td>
                                                <td class="border-dark text-bold text-center" style="background-color: #eee;">Home Country</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Name</td>
                                                <td class="border-dark">
                                                    <input type="text" name="uaename" style="width:100%;" value="{{old('uaename')}}">
                                                    @error('uaename')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark">
                                                    <input type="text" name="hcname" style="width:100%;" value="{{old('hcname')}}">
                                                    @error('hcname')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Relation</td>
                                                <td class="border-dark">
                                                    <input type="text" name="uaerelation" style="width:100%;" value="{{old('uaerelation')}}">
                                                    @error('uaerelation')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark">
                                                    <input type="text" name="hcrelation" style="width:100%;" value="{{old('hcrelation')}}">
                                                    @error('hcrelation')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Mobile No.</td>
                                                <td class="border-dark">
                                                    <input type="text" name="uaemobilenotwo" style="width:100%;" value="{{old('uaemobilenotwo')}}">
                                                    @error('uaemobilenotwo')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark">
                                                    <input type="text" name="hcmobilenotwo" style="width:100%;" value="{{old('hcmobilenotwo')}}">
                                                    @error('hcmobilenotwo')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" colspan="3">About your Country Address</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Permanent Address</td>
                                                <td class="border-dark" colspan="2">
                                                    <input type="text" name="permanentaddress" style="width:100%;" value="{{old('permanentaddress')}}">
                                                    @error('permanentaddress')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Current Address</td>
                                                <td class="border-dark" colspan="2">
                                                    <input type="text" name="currentaddress" style="width:100%;" value="{{old('currentaddress')}}">
                                                    @error('currentaddress')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">City, Emirate & Zip Code</td>
                                                <td class="border-dark" colspan="2">
                                                    <input type="text" name="emiratezipcode" style="width:100%;" value="{{old('emiratezipcode')}}">
                                                    @error('emiratezipcode')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" colspan="3">Your Educational Qualifications (Highest Degree)</td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark" style="width: 400px;">College/University</td>
                                                <td class="border-dark">
                                                    <input type="text" name="cuhd" style="width:100%;" value="{{old('cuhd')}}">
                                                    @error('cuhd')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Course Type (Regular/Diploma/Distance)</td>
                                                <td class="border-dark">
                                                    <input type="text" name="coursetypehd" style="width:100%;" value="{{old('coursetypehd')}}">
                                                    @error('coursetypehd')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" rowspan="2" style="padding: 20px;">Duration of The Course</td>
                                                <td class="border-dark">Diploma/Graduate/Post Graduate</td>
                                                <td class="border-dark" rowspan="2" style="padding-top: 1rem;">Subject Major :</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold">(Whichever is applicable)</td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark" style="width: 150px;">From</td>
                                                <td class="border-dark" style="width: 250px;">To</td>
                                                <td class="border-dark" style="width: 426px;padding-top: 0.5rem;" rowspan="2">
                                                    <textarea name="applicableone" id="" rows="2" class="w-100" value="{{old('applicableone')}}"></textarea>
                                                    @error('applicableone')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark" rowspan="2" style="padding-top: 0.5rem;">
                                                    <textarea name="smone" id="" rows="2" class="w-100" value="{{old('smone')}}"></textarea>
                                                    @error('smone')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">
                                                    <input type="date" name="fromhd" style="width:100%;" value="{{old('fromhd')}}">
                                                    @error('fromhd')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark">
                                                    <input type="date" name="tohd" style="width:100%;" value="{{old('tohd')}}">
                                                    @error('tohd')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark text-bold" colspan="3">Your Education Qualification (Degree/Diploma/School Certificate etc.)</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark" style="width:400px;">College/University/Board</td>
                                                <td class="border-dark" colspan="2">
                                                    <input type="text" name="cuboarddd" style="width:100%;" value="{{old('cuboarddd')}}">
                                                    @error('cuboarddd')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Course Type (Regular/Diploma/Distance)</td>
                                                <td class="border-dark" colspan="2">
                                                    <input type="text" name="coursetypedd" style="width:100%;" value="{{old('coursetypedd')}}">
                                                    @error('coursetypedd')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" rowspan="2" style="padding:20px;">Duration of The Course</td>
                                                <td class="border-dark">Diploma/Graduate/Post Graduate</td>
                                                <td class="border-dark" rowspan="2" style="padding-top: 1rem;">Subject Major :</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold">(Whichever is applicable)</td>
                                            </tr>


                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark" style="width: 150px;">From</td>
                                                <td class="border-dark" style="width: 250px;">To</td>
                                                <td class="border-dark" style="width: 426px;padding-top: 0.5rem;" rowspan="2">
                                                    <textarea name="applicabletwo" id="" rows="2" class="w-100" value="{{old('applicabletwo')}}"></textarea>
                                                    @error('applicabletwo')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark" rowspan="2" style="padding-top: 0.5rem;">
                                                    <textarea name="smtwo" id="" rows="2" class="w-100" value="{{old('smtwo')}}"></textarea>
                                                    @error('smtwo')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">
                                                    <input type="date" name="fromdd" style="width:100%;" value="{{old('fromdd')}}">
                                                    @error('fromdd')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                                <td class="border-dark">
                                                    <input type="date" name="todd" style="width:100%;" value="{{old('todd')}}">
                                                    @error('todd')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                        </table>
                                    </section>
                                    <br>
                                    <section style="font-size: 14px;">
                                        <table class="table table-sm table-bordered">
                                            <tr>
                                                <td class="border-dark text-bold" colspan="4">Your Certification Course - A (If any)</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Course Name</td>
                                                <td class="border-dark" colspan="3">
                                                    <input type="text" name="coursename_a" style="width: 100%;" value="{{old('coursename_a')}}">
                                                    @error('coursename_a')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark" style="width: 200px;">Institute Name</td>
                                                <td class="border-dark">
                                                    <input type="text" name="institutename_a" style="width:100%;" value="{{old('institutename_a')}}">
                                                    @error('institutename_a')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Course Details</td>
                                                <td class="border-dark">
                                                    <input type="text" name="coursedetail_a" style="width:100%;" value="{{old('coursedetail_a')}}">
                                                    @error('coursedetail_a')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" colspan="3">Your Certification Courses – B (If any)</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Course Name</td>
                                                <td class="border-dark" colspan="2">
                                                    <input type="text" name="coursename_b" style="width:100%;" value="{{old('coursename_b')}}">
                                                    @error('coursename_b')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Institute Name</td>
                                                <td class="border-dark" colspan="2">
                                                    <input type="text" name="instituename_b" style="width:100%;" value="{{old('instituename_b')}}">
                                                    @error('instituename_b')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Course Details</td>
                                                <td class="border-dark" colspan="2">
                                                    <input type="text" name="coursedetails_b" style="width:100%;" value="{{old('coursedetails_b')}}">
                                                    @error('coursedetails_b')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                </td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered">
                                            <tr>
                                                <td class="border-dark text-bold" style="width: 200px;" colspan="4">Your Work History (A) <u>MOST RECENT EMPLOYMENT</u> </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark" style="width: 200px;">Company Name</td>
                                                <td class="border-dark"><input type="text" name="companyname_a" style="width:100%;" value="{{old('companyname_a')}}"></td>
                                                <td class="border-dark" style="width: 150px;">Employee Code</td>
                                                <td class="border-dark"><input type="text" name="employeecode_a" style="width:100%;" value="{{old('employeecode_a')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Designation</td>
                                                <td class="border-dark"><input type="text" name="designation_a" style="width:100%;" value="{{old('designation_a')}}"></td>
                                                <td class="border-dark">Department</td>
                                                <td class="border-dark"><input type="text" name="department_a" style="width:100%;" value="{{old('department_a')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Reporting person (Name, Designation, Email ID & Contact No.)</td>
                                                <td class="border-dark" colspan="3"><textarea name="reportingperson_a" id="" rows="3" class="w-100" value="{{old('reportingperson_a')}}"></textarea></td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark text-bold" style="width: 200px;" rowspan="2">Employment Period <br> (dd/mm/yy)</td>
                                                <td class="border-dark" style="width: 400px;">From</td>
                                                <td class="border-dark">To</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark"><input type="date" class="w-100" name="twofromdate_a" value="{{old('twofromdate_a')}}"></td>
                                                <td class="border-dark"><input type="date" class="w-100" name="twotodate_a" value="{{old('twotodate_a')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" rowspan="2">Address</td>
                                                <td class="border-dark" style="width: 426px;">Company/Branch Address</td>
                                                <td class="border-dark">Cost to Company (Monthly Salary)</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark"><input type="text" class="w-100" name="cbaddress_a" value="{{old('cbaddress_a')}}"></td>
                                                <td class="border-dark"><input type="text" class="w-100" name="ctc_a" value="{{old('ctc_a')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Telephone</td>
                                                <td class="border-dark" colspan="2"><input type="text" class="w-100" name="telephone_a" value="{{old('telephone_a')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Reason(s) for Leaving:</td>
                                                <td class="border-dark" colspan="2"><input type="checkbox" id="" name="voluntary_a" value="{{old('voluntary_a')}}"> Voluntary</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" style="padding: 0px 0px 25px 5px;">Pease provide reasons:</td>
                                                <td class="border-dark" colspan="2">
                                                    <textarea name="ppr_a" id="" class="w-100" rows="2" value="{{old('ppr_a')}}"></textarea>
                                                </td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark text-bold" style="width: 200px;" colspan="4">Your Work History (B) <u>MOST RECENT EMPLOYMENT</u> </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark" style="width: 200px;">Company Name</td>
                                                <td class="border-dark"><input type="text" name="companyname_b" style="width:100%;" value="{{old('companyname_b')}}"></td>
                                                <td class="border-dark" style="width: 150px;">Employee Code</td>
                                                <td class="border-dark"><input type="text" name="employeecode_b" style="width:100%;" value="{{old('employeecode_b')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Designation</td>
                                                <td class="border-dark"><input type="text" name="designation_b" style="width:100%;" value="{{old('designation_b')}}"></td>
                                                <td class="border-dark">Department</td>
                                                <td class="border-dark"><input type="text" name="department_b" style="width:100%;" value="{{old('department_b')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Reporting person (Name, Designation, Email ID & Contact No.)</td>
                                                <td class="border-dark" colspan="3"><textarea name="reportingperson_b" id="" rows="3" class="w-100" value="{{old('reportingperson_b')}}"></textarea></td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark text-bold" style="width: 200px;" rowspan="2">Employment Period <br> (dd/mm/yy)</td>
                                                <td class="border-dark" style="width: 400px;">From</td>
                                                <td class="border-dark">To</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark"><input type="date" class="w-100" name="twofromdate_b" value="{{old('twofromdate_b')}}"></td>
                                                <td class="border-dark"><input type="date" class="w-100" name="twotodate_b" value="{{old('twotodate_b')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" rowspan="2">Address</td>
                                                <td class="border-dark" style="width: 426px;">Company/Branch Address</td>
                                                <td class="border-dark">Cost to Company (Monthly Salary)</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark"><input type="text" class="w-100" name="cbaddress_b" value="{{old('cbaddress_b')}}"></td>
                                                <td class="border-dark"><input type="text" class="w-100" name="ctc_b" value="{{old('ctc_b')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Telephone</td>
                                                <td class="border-dark" colspan="2"><input type="text" class="w-100" name="telephone_b" value="{{old('telephone_b')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Reason(s) for Leaving:</td>
                                                <td class="border-dark" colspan="2"><input type="checkbox" name="" id="" name="voluntary_b" value="{{old('voluntary_b')}}"> Voluntary</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" style="padding: 0px 0px 25px 5px;">Pease provide reasons:</td>
                                                <td class="border-dark" colspan="2">
                                                    <textarea name="ppr_b" id="" class="w-100" rows="2" value="{{old('ppr_b')}}"></textarea>
                                                </td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark text-bold" colspan="3">Resident VISA Details –Only Fill the following columns if you are on Resident / Spouse Visa</td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark" style="width: 200px;" rowspan="">Permit Entry No:</td>
                                                <td class="border-dark"><input type="text" class="w-100" name="peno" value="{{old('peno')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">U.I.D No:</td>
                                                <td class="border-dark"><input type="text" class="w-100" name="uidno" value="{{old('uidno')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Place & Date of Issue:</td>
                                                <td class="border-dark"><input type="date" class="w-100" name="pdoi" value="{{old('pdoi')}}"></td>
                                            </tr>
                                        </table>
                                    </section><br><br>
                                    <!-- third form employee register -->
                                    <section style="font-size: 14px;">
                                        <table class="table table-sm table-bordered" style="margin-top: -17px;">
                                            <tr>
                                                <td class="border-dark" style="width: 250px;">Valid until:</td>
                                                <td class="border-dark" colspan="2"><input type="text" name="validuntil" style="width:100%;" value="{{old('validuntil')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Insurance Details :</td>
                                                <td class="border-dark"><input type="text" name="insurancedetails" style="width:100%;" value="{{old('insurancedetails')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Name, contact No. of Sponsor:</td>
                                                <td class="border-dark" colspan="2"><input type="text" name="namecontactnoofsponsor" style="width:100%;" value="{{old('namecontactnoofsponsor')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Remarks if any:</td>
                                                <td class="border-dark" colspan="2"><input type="text" name="remarksifany" style="width:100%;" value="{{old('remarksifany')}}"></td>
                                            </tr>
                                        </table>
                                        <table class="table table-sm table-bordered">
                                            <tr>
                                                <td class="border-dark text-bold" colspan="4">Medical History –Only fill the following columns if you have any medical conditions</td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark" style="width: 320px;">Details of your medical condition</td>
                                                <td class="border-dark" colspan="2"><input type="text" name="medicalcondition" style="width:100%;" value="{{old('medicalcondition')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Treatment details</td>
                                                <td class="border-dark"><input type="text" name="treatment" style="width:100%;" value="{{old('treatment')}}"></td>

                                            </tr>
                                            <tr>
                                                <td class="border-dark">Details of the Medicine (If you need to take it on the office hours)</td>
                                                <td class="border-dark" colspan="2"><input type="text" name="detailsotmedicine" style="width:100%;" value="{{old('detailsotmedicine')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Name and contact details of the Doctor/ Hospital where you are taking the treatment </td>
                                                <td class="border-dark" colspan="2"><input type="text" name="ncdhospital" style="width:100%;" value="{{old('ncdhospital')}}"></td>
                                            </tr>
                                            <tr>
                                                <td class="border-dark">Remarks if any</td>
                                                <td class="border-dark" colspan="2"><input type="text" name="remarksifanytwo" style="width:100%;" value="{{old('remarksifanytwo')}}"></td>
                                            </tr>

                                        </table>
                                    </section>
                                    <div class="text-center text-bold">
                                        <h2>Declaration</h2>
                                    </div>
                                    <div class="text-center text-bold">
                                        <p>TO WHOM IT MAY CONCERN</p>
                                    </div>
                                    <div class="">
                                        <p>I also declare the information provided by me in my resume and application for employment, to <b>Najma Consultancy</b> and its representative(s) is authentic and I am liable for all inaccuracies and omissions.</p>
                                    </div>
                                    <table class="table table-sm table-bordered">
                                        <tr>
                                            <td class="border-dark bg-light">Name in Block Capitals</td>
                                            <td class="border-dark" colspan="3"><input type="text" name="nibcapital" style="width:100%;" value="{{old('nibcapital')}}"></td>
                                        </tr>
                                        <tr>
                                            <td class="border-dark bg-light">Place</td>
                                            <td class="border-dark"><input type="text" name="place" style="width:100%;" value="{{old('place')}}">
                                                @error('place')
                                                    <div class="text-danger">{{ $message }}</div>
                                                @enderror
                                            </td>
                                            <td class="border-dark text-center bg-light">Date (DD/MM/YYYY)</td>
                                            <td class="border-dark"><input type="date" class="w-100" name="lastdate" value="{{old('lastdate')}}">
                                                @error('last_date')
                                                    <div class="text-danger">{{ $message }}</div>
                                                @enderror
                                            </td>
                                        </tr>
                                    </table>
                                    <hr style="background-color: #000;padding: 1px;">
                                    <div>
                                        <h4><b>Welcome to NAJMA Consultancy!</b></h4>
                                    </div><br>
                                    <p>We are excited to have you as part of the NAJMA family. NAJMA is committed to high quality work and superior care in all aspects of our business. As part of the team, we hope you will discover that the pursuit of excellence is a rewarding aspect of your career here.</p>
                                    <br>
                                    <div>
                                        <h6>Along with CIF, Please attach the self attested copies of the following documents;</h6>
                                        <ul>
                                            <li>
                                                Updated CV
                                                <div class="col-lg-6">
                                                    <input type="file" name="documentcv" class="form-control" id="" value="{{old('documentcv')}}">
                                                    @error('document_cv')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                    <span class="text-danger error-text documentcv_error"></span>
                                                </div>
                                            </li>
                                            <li>
                                                Passport Copy
                                                <div class="col-lg-6">
                                                    <input type="file" name="passportcopy" class="form-control" id="" value="{{old('passportcopy')}}">
                                                    @error('document_passport_copy')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                    <span class="text-danger error-text passportcopy_error"></span>
                                                </div>
                                            </li>
                                            <li>
                                                Passport Size Photo
                                                <div class="col-lg-6">
                                                    <input type="file" name="passportphoto" class="form-control" id="" value="{{old('passportphoto')}}">
                                                    @error('document_passport_photo')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                    <span class="text-danger error-text passportphoto_error"></span>
                                                </div>
                                            </li>
                                            <li>
                                                All your educational certificates with Mark sheets
                                                <div class="col-lg-6">
                                                    <input type="file" name="marksheet" class="form-control" id="" value="{{old('marksheet')}}">
                                                    @error('document_mark_sheet')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                    <span class="text-danger error-text marksheet_error"></span>
                                                </div>
                                            </li>
                                            <li>
                                                All your Experience Certificates
                                                <div class="col-lg-6">
                                                    <input type="file" name="experience_certificates" class="form-control" id="" value="{{old('experience_certificates')}}">
                                                    @error('document_experience_certificates')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                    <span class="text-danger error-text experience_certificates_error"></span>
                                                </div>
                                            </li>
                                            <li>
                                                Visa Copy (If you are on Sponsor Visa)
                                                <div class="col-lg-6">
                                                    <input type="file" name="sponsorvisa" class="form-control" id="" value="{{old('sponsorvisa')}}">
                                                    @error('document_sponsor_visa')
                                                        <div class="text-danger">{{ $message }}</div>
                                                    @enderror
                                                    <span class="text-danger error-text sponsorvisa_error"></span>
                                                </div>
                                            </li>
                                        </ul>
                                    </div>
                                    <div class="row">
                                        <div class="col">
                                            <button type="submit" class="btn btn-success">Submit</button>
                                        </div>
                                    </div>
                                </form>
                            </div><!-- /.card-body -->
                            <hr>
                            <div class="row">
                                <div class="col-lg-12 text-center">
                                    <span style="font-size: 11px;"><b>This document and its contents are strictly confidential and should not be disclosed, copied, distributed, or shared with any third party, including individuals within or outside of your organization, without </b></span><br>
                                    <span style="font-size: 11px;"><b>the explicit written consent of Najma Human Resources Consultancy (NAJMA)</b></span><br><br>
                                    <span style="font-size: 15px;">P.O. Box 32390, Al Diyafa Center, Satwa, Dubai, UAE. Tel: +971 4 3453780, Email: najmauae@eim.ae, najma@emirates.net.ae, www.najmaconsultancy.com /Est. 1997</span>
                                </div>
                            </div>
                        </div>
                    </section>
                    <!-- /.Left col -->
                </div>
            </div><!-- /.container-fluid -->
        </section>
        <!-- /.content -->
    </div>
    <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>
    <script>
        $("#uregister").on('submit', function(e){
            e.preventDefault();

            $.ajax({
                url:$(this).attr('action'),
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@endsection