<html>
<head>
<title>Applciation form</title>
</head>
<body>
<h1 style="text-align: center;"> Application Form</h1>
<!-- Personal Section -->
<fieldset>
<legend>Personal Details</legend>
<table>
<tr>
<td>Applicant's Full Name</td>
<td>
<select name="fullname">
<option value="" selected disabled>--Select--</option>
<option value="mr">Mr.</option>
<option value="mrs">Mrs.</option>
<option value="miss">Miss. </option>
</select>
</td>
<td>
<input type="text" id="name">
</td>
<td>Care Of</td>
<td>
<input type="radio" name="careof" id="parents">
<label for="parents">Parents</label>
<input type="radio" name="careof" id="guardian">
<label for="guardian">Guardian</label>
</td>
</tr>
<tr>
<td>Father's Name</td>
<td>
<select name="fullname">
<option value="mr" selected>Mr.</option>
<option value="mrs">Mrs.</option>
<option value="miss">Miss. </option>
</select>
</td>
<td> <input type="text" id="name"></td>
</td>
<td>Mother's Name</td>
<td>
<select name="fullname">
<option value="mr">Mr.</option>
<option value="mrs" selected>Mrs.</option>
<option value="miss">Miss. </option>
<input type="text" id="name">
</td>
</tr>
<tr>
<td>Gender</td>
<td colspan="2">
<input type="radio" name="gender" id="male">
<label for="male">Male</label>
<input type="radio" name="gender" id="female">
<label for="female">Female</label>
<input type="radio" name="gender" id="others">
<label for="others">Others</label>
</td>
<td>Date of Birth</td>
<td>
<input type="date" id="dob" name="dob"></td>
</tr>
</table>
</fieldset>
<!-- Contact Section -->
<fieldset>
<table>
<legend>Contact Details</legend>
<tr>
<td>Mobile Number</td>
<td><input type="number" name="number" id="pno"></td>
<td>Email ID</td>
<td><input type="email" name="email" id="emailaddress"></td>
</tr>
<tr>
<td>Permanent Address</td>
<td colspan="3"><input type="text" name="address" id="permanent-address"
style="width: 450px;"></td>
</tr>
<tr>
<td>Temporary Address</td>
<td colspan="3"><input type="text" name="address" id="temporary-address"
style="width: 450px;"></td>
</tr>
<tr>
<td>City</td>
<td><input type="text" name="city" id="cityname"></td>
<td>Province</td>
<td>
<select name="province">
<option value="" selected disabled>--Select--</option>
<option value="kos">Koshi Province</option>
<option value="mdh">Madhesh Province</option>
<option value="bgm">Bagmati Province</option>
<option value="gnd">Gandaki Province</option>
<option value="lmb">Lumbini Province</option>
<option value="krn">Karnali Province</option>
<option value="sdp">Sudurpashchim Province</option>
</select>
</td>
</tr>
<tr>
<td>Pin Code</td>
<td><input type="number" name="pin-code" id="pin-code" ></td>
</tr>
</table>
</fieldset>
<!-- Qualification Section -->
<fieldset>
<legend>Qualification Details</legend>
<table border="1" style="border-collapse: collapse;" >
<tr>
<td><b>Sr No.</b></td>
<td><b>Qualification</b></td>
<td><b>Board/University</b></td>
<td><b>Passing Year</b></td>
<td><b>Percentage</b></td>
</tr>
<tr>
<td>1</td>
<td>
<select name="qualification">
<option value="" selected disabled>--Select--</option>
<option value="10">10th Grade</option>
<option value="12">12th Grade</option>
<option value="bach">Bachelors</option>
</select>
</td>
<td><input type="text" name="brd/uni"></td>
<td><input type="number" name="passyear"></td>
<td><input type="number" name="percentage"></td>
</tr>
<tr>
<td>2</td>
<td>
<select name="qualification">
<option value="" selected disabled>--Select--</option>
<option value="10">10th Grade</option>
<option value="12">12th Grade</option>
<option value="bach">Bachelors</option>
</select>
</td>
<td><input type="text" name="brd/uni"></td>
<td><input type="number" name="passyear"></td>
<td><input type="number" name="percentage"></td>
</tr>
</table>
</fieldset>
<!-- Language Section -->
<fieldset>
<legend>Language Knowledge</legend>
<table border="1" style="border-collapse: collapse;">
<tr>
<th>Language</th>
<th>Reading</th>
<th>Writing</th>
<th>Spoken</th>
</tr>
<tr>
<td>Nepali</td>
<td><input type="checkbox" name="read"></td>
<td><input type="checkbox" name="write"></td>
<td><input type="checkbox" name="speak"></td>
</tr>
<tr>
<td>Hindi</td>
<td><input type="checkbox" name="read"></td>
<td><input type="checkbox" name="write"></td>
<td><input type="checkbox" name="speak"></td>
</tr>
<tr>
<td>English</td>
<td><input type="checkbox" name="read"></td>
<td><input type="checkbox" name="write"></td>
<td><input type="checkbox" name="speak"></td>
</tr>
</table>
</fieldset>
<!-- Identification Section -->
<fieldset>
<legend>Identification Details</legend>
<table>
<tr>
<td>Citizenship No.</td>
<td><input type="number" name="citizenshipno"></td>
<td>PAN Card Number</td>
<td><input type="number" name="pancardno"></td>
</tr>
<tr>
<td>Upload Photo</td>
<td><input type="file" accept="image/*"></td>
<td>Upload Signature</td>
<td><input type="file" accept="image/*"></td>
</tr>
</table>
</fieldset>
<br>
<div style="text-align: center;">
<button type="submit">Submit</button>
<button type="reset">Reset</button>
</div>
</body>
</html>