Create a Registration (Application) Form
<html>
<head>
<title>APPLICATION FORM </title>
<style>
input:focus {box-shadow: 2px 1px 4px 2px skyblue;}
.mybutton {
color: rgb(255, 255, 255); font-size: 12px; line-height: 16px; padding: 6px; border-radius: 5px; font-family: Georgia, serif; font-weight: bold; background-image: linear-gradient(to right, rgb(28, 110, 164) 0%, rgb(35, 136, 203) 41%, rgb(20, 78, 117) 100%); box-shadow: rgb(0, 0, 0) 5px 5px 15px 5px; border: 2px solid rgb(28, 110, 164); display: inline-block;}
.mybutton:hover {
background: springgreen;color:blue; }
.mybutton:active {
background: orangered; }
legend{background:red;color:white; }
fieldset{border:3px solid darkslateblue;}
fieldset:hover{border:2px solid blue;}
legend:hover{background:darkgreen;font-size: 20px;}
</style>
</head>
<body leftmargin="200px">
<center><h1>ITCI Computer Institute Hardoi</h1>
<h2>Address:- Near SBI Bank, Infront of Gandhi Bhawan Hardoi UP Pin 241001<br>☎ +91 9026728220, +91 8423606968</h2>
<hr size="10"color="red"width="600">
<div style="background:teal;"><h2>Registraion Form<br></h2></div><hr size="10"color="red"width="600">
</center>
<form>
<fieldset>
<legend><h5>Personal Details</h5></legend>
<table width="100%" cellpadding="10px">
<tr>
<td>Applicant's full name </td>
<td>
<select >
<option>--Select --</option>
<option>Mr.</option>
<option>Ms.</option>
<option>Others</option>
</select>
<input type="text" size="20"/>
</td>
<td>Care Of </td>
<td><label>Parents</label><input type="radio" name="care" checked/><label>Guardian </label><input type="radio" name="care"/></td>
</tr>
<tr>
<td>Father's Name </td>
<td>
<select disabled >
<option>Mr.</option>
</select>
<input type="text" size="20"/>
</td>
<td>Mother's Name </td>
<td>
<select disabled >
<option>Mrs.</option>
</select>
<input type="text" size="20"/>
</td>
</tr>
<tr>
<td>Gender</td>
<td>
<label>Male</label><input type="radio" name="Gender"/>
<label>Female </label><input type="radio" name="Gender"/>
<label>Others </label><input type="radio" name="Gender"/>
</td>
<td>Date of Birth</td>
<td>
<input type="date"/>
</td>
</tr>
<tr>
<td>Marital Status</td>
<td>
<select>
<option>--Select--</option>
<option>Single</option>
<option>Married</option>
<option>Divorced</option>
<option>Widowed</option>
</select>
</td>
<td>Category </td>
<td>
<select>
<option>--Select--</option>
<option>General</option>
<option>OBC</option>
<option>SC</option>
<option>ST</option>
</select>
</td>
</tr>
<tr>
<td>Handicapped </td>
<td><label>No</label><input type="radio" name="Handicapped" checked/><label>Yes</label><input type="radio" name="Handicapped"/></td>
<td>Ex-Serviceman </td>
<td><label>No</label><input type="radio" name="Serviceman" checked/><label>Yes</label><input type="radio" name="Serviceman"/></td>
</tr>
<tr>
<td>EWS </td>
<td><label>No</label><input type="radio" name="EWS" checked/><label>Yes</label><input type="radio" name="EWS"/></td>
<td>Religion </td>
<td>
<select>
<option>--Select--</option>
<option>Hindu</option>
<option>Muslim</option>
<option>Jain</option>
<option>Christianity</option>
</select>
</td>
</tr>
</table>
</fieldset><br>
<fieldset>
<legend><h5>Contact Details</h5></legend>
<table width="100%" cellpadding="10px">
<tr>
<td>Mobile Number</td>
<td><input type="tel"/></td>
<td>Email ID</td>
<td><input type="email"/></td>
</tr>
<tr>
<td>Address Line 1</td>
<td><input type="text"/></td>
<td>Address Line 2</td>
<td><input type="text"/></td>
</tr>
<tr>
<td>City</td>
<td><input type="text"/></td>
<td>State</td>
<td>
<select>
<option>--Select--</option>
<option value="Andhra Pradesh">Andhra Pradesh</option>
<option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
<option value="Arunachal Pradesh">Arunachal Pradesh</option>
<option value="Assam">Assam</option>
<option value="Bihar">Bihar</option>
<option value="Chandigarh">Chandigarh</option>
<option value="Chhattisgarh">Chhattisgarh</option>
<option value="Dadar and Nagar Haveli">Dadar and Nagar Haveli</option>
<option value="Daman and Diu">Daman and Diu</option>
<option value="Delhi">Delhi</option>
<option value="Lakshadweep">Lakshadweep</option>
<option value="Puducherry">Puducherry</option>
<option value="Goa">Goa</option>
<option value="Gujarat">Gujarat</option>
<option value="Haryana">Haryana</option>
<option value="Himachal Pradesh">Himachal Pradesh</option>
<option value="Jammu and Kashmir">Jammu and Kashmir</option>
<option value="Jharkhand">Jharkhand</option>
<option value="Karnataka">Karnataka</option>
<option value="Kerala">Kerala</option>
<option value="Madhya Pradesh">Madhya Pradesh</option>
<option value="Maharashtra">Maharashtra</option>
<option value="Manipur">Manipur</option>
<option value="Meghalaya">Meghalaya</option>
<option value="Mizoram">Mizoram</option>
<option value="Nagaland">Nagaland</option>
<option value="Odisha">Odisha</option>
<option value="Punjab">Punjab</option>
<option value="Rajasthan">Rajasthan</option>
<option value="Sikkim">Sikkim</option>
<option value="Tamil Nadu">Tamil Nadu</option>
<option value="Telangana">Telangana</option>
<option value="Tripura">Tripura</option>
<option value="Uttar Pradesh">Uttar Pradesh</option>
<option value="Uttarakhand">Uttarakhand</option>
<option value="West Bengal">West Bengal</option>
</select>
</td>
</tr>
<tr>
<td>Pin Code</td>
<td><input type="text"/></td>
</tr>
</table>
</fieldset><br>
<fieldset>
<legend><h5>Qualification Details</h5></legend>
<table width="100%" cellpadding="10px">
<tr>
<th>Sr No.</th>
<th>Qualification</th>
<th>Board/University</th>
<th>Passing Year</th>
<th>Max Marks</th>
<th>Marks Obtain</th>
<th>Percentage</th>
</tr>
<tr>
<td>1</td>
<td>
<select>
<option>--Select--</option>
<option>10th</option>
<option>12th</option>
<option>Graduate</option>
<option>Post Graduate</option>
</select>
</td>
<td>
<input type="text"/>
</td>
<td>
<input type="number" min="1990" max="2022"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="100"/>
</td>
</tr>
<tr>
<td>2</td>
<td>
<select>
<option>--Select--</option>
<option>10th</option>
<option>12th</option>
<option>Graduate</option>
<option>Post Graduate</option>
</select>
</td>
<td>
<input type="text"/>
</td>
<td>
<input type="number" min="1990" max="2022"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="100"/>
</td>
</tr>
<tr>
<td>3</td>
<td>
<select>
<option>--Select--</option>
<option>10th</option>
<option>12th</option>
<option>Graduate</option>
<option>Post Graduate</option>
</select>
</td>
<td>
<input type="text"/>
</td>
<td>
<input type="number" min="1990" max="2022"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="100"/>
</td>
</tr>
<tr>
<td>4</td>
<td>
<select>
<option>--Select--</option>
<option>10th</option>
<option>12th</option>
<option>Graduate</option>
<option>Post Graduate</option>
</select>
</td>
<td>
<input type="text"/>
</td>
<td>
<input type="number" min="1990" max="2022"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="100"/>
</td>
</tr>
</table>
</fieldset><br>
<fieldset>
<legend><h5>Language Knowledge</h5></legend>
<table width="100%">
<tr>
<td>Language</td>
<td>Reading</td>
<td>Writing</td>
<td>Spoken</td>
</tr>
<tr>
<td>Hindi</td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
</tr>
<tr>
<td>English</td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
</tr>
<tr>
<td>Urdu</td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
</tr>
</table>
</fieldset><br>
<fieldset>
<legend><h5>Identification Details</h5></legend>
<table align="center">
<tr>
<td>Aadhar Card Number</td>
<td><input type="text" maxlength="12"/></td>
<td>PAN Card Number</td>
<td><input type="text" maxlength="9"/></td>
</tr>
<tr>
<td>Upload Photo</td>
<td><input type="file"/></td>
<td>Upload Signature</td>
<td><input type="file"/></td>
</tr>
</table>
</fieldset>
<br/>
<center>
<input type="submit" value="Submit"action="post"class="mybutton">
<input type="reset" value="Back"action="post"class="mybutton">
</center>
</form>
<address align="right">
Written by <a href="mailto:itcihardoi@gmail.com">Satyam Trivedi</a>.<br>
Contact us at:<br>
Head Post Office Road, Hardoi<br>
India
</address>
</body>
</html>
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