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143 | <!DOCTYPE html>
<html lang="en">
<head>
<%- include('partials/head') %>
</head>
<body>
<%- include('partials/navbar') %>
<div class="ui container segment" >
<h1 style="text-align: center;">Add New Citizen</h1>
<form class="ui form" method="post" onsubmit="addCitizen(event)" id="citizenForm">
<div class="field">
<label>Citizen ID</label>
<input
placeholder="Citizen ID"
name="citizen_id"
type="text"
autocomplete="off"
id="citizen_id"
/>
</div>
<div class="field">
<label>First Name</label>
<input
placeholder="First Name"
name="first_name"
type="text"
autocomplete="off"
id="first_name">
</div>
<div class="field">
<label>Middle Name</label>
<input
placeholder="Middle Name"
name="middle_name"
type="text"
autocomplete="off"
id="middle_name">
</div>
<div class="field">
<label>Last Name</label>
<input
placeholder="Last Name"
name="last_name"
type="text"
autocomplete="off"
id="last_name">
<div>
<div class="field">
<label>Address</label>
<input
placeholder="House number"
name="address"
type="text"
autocomplete="off"
id="address"
/>
</div>
<div class="field">
<label>Mobile Number</label>
<input
type="text"
name="mobile_number"
placeholder="Mobile Number"
id="mobile_number"
/>
</div>
<div class="field">
<label>Date of Birth</label>
<input type="date" name="dob" placeholder="DOB" id="dob" />
</div>
<div class="field">
<label>Gender</label>
<select class="ui dropdown" id="gender">
<option value="M" selected>Male</option>
<option value="F">Female</option>
</select>
</div>
<div class="field">
<label>Marital Status</label>
<select class="ui dropdown" id="marital_status">
<option value="M" selected>Married</option>
<option value="UM">Unmarried</option>
</select>
</div>
<div class = "field">
<label>Disabled</label>
<select class="ui dropdown" id="disabled">
<option value="Yes" selected>Yes</option>
<option value="No">No</option>
</select>
</div>
<div class="field">
<label>Disabled Percentage</label>
<input
type="text"
name="disbaled_percentage"
placeholder="Disabled Percentage"
id="disbaled_percentage"
/>
</div>
<div class="field">
<label>Caste</label>
<select class="ui dropdown" id="caste">
<option value="OC" selected>OC</option>
<option value="SC">SC</option>
<option value="ST">ST</option>
<option value="BC">BC</option>
</select>
</div>
<div class="field">
<label>State</label>
<select class="ui dropdown" id="state">
</select>
</div>
<div class="field">
<label>District</label>
<select class="ui dropdown" id="district">
</select>
</div>
<div class="field">
<lable>Mandal</lable>
<select class="ui dropdown" id="mandal">
</select>
</div>
<div class="field">
<label>Village Name</label>
<select class="ui dropdown" id="village">
</select>
</div>
<div class="ui primary button" id="add_citizen" >Submit</div>
<div class="ui error message"></div>
</form>
</div>
</body>
<%- include('partials/scripts') %>
<script src="/adduser.js"></script>
</html>
|
|
