<div class="warper container-fluid">
    <div class="row">
        <div class="col-md-12" style="position:inherit;">
                        <?php/* echo $letter_head['header'] ;*/?>
            <div class="panel panel-default">
                <div class="panel-heading"></div>
                <div class="panel-body">
                    <?php 
                    if ( $hide_title == false ){ 
                        $submit_link = 'hr-employment.php?page_mode=edit&page='.$last_id.'&type=edit&select_worker=Local' ;
                    }else{
                        $submit_link = 'hr-application.php?page_mode=edit&page='.$last_id.'&type=edit&select_worker=Local' ;
                    }
                    ?>

                    <form method="post" class="form-horizontal" id="quotationForm" enctype="multipart/form-data"
                        action="<?= $submit_link ?>" novalidate="novalidate">
                        <div class="container">
                            <table border="0" cellpadding="0" cellspacing="0" class="employment_table"
                                style="width:100%; padding:0; margin:0 auto;border-collapse: collapse; font-size: 16px;">
                                <tr>
                                    <td colspan="4">
                                        <?php if ( $hide_title == false ){ ?><div class="page-header">
                                            <h1><?= $lang['EMPLOYMENT APPLICATION FORM']?> <small><?= $lang['new']?></small><a
                                                    href="online-form.php?branch=<?php echo $_SESSION['url_get_branch_admin']; ?>"
                                                    class="btn btn-purple" style="float:right; background-color:#5e5bd0 ;color:white">Online
                                                    Form</a></h1>
                                            </div>
                                        <?php } ?>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">
                                        <table style="width:100%;" border="0" cellpadding="0" cellspacing="0">
                                            <tr>
                                                <td
                                                    style="width:100%;font-size:20px; padding:2px 0; text-align:center;background-color:#5e5bd0 ;color: white;">
                                                    <strong><?= $lang['EMPLOYMENT APPLICATION FORM']?></strong>
                                                </td>
                                            </tr>
                                        </table>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4" style="font-weight:bold; font-size:16px;">
                                        <table style="width: 100%;">
                                            <tr>
                                                <td style="width: 30%;">
                                                    <?= $lang['POSITION APPLIED FOR'] ?> :
                                                </td>
                                                <td>
                                                    <input type="hidden" name="positionApplyText"
                                                        id="positionApplyText" />
                                                    <?php
                                                $mysqli_query = "SELECT a.job_position_id, b.job_position_desc FROM setting_job_position a
                                                LEFT JOIN setting_job_position_translation b ON ( a.job_position_id = b.job_position_id )
                                                WHERE a.deleted_at IS NULL AND b.lang = 'en' AND a.job_position_show_al = 'Show'
                                                ORDER BY b.job_position_desc ASC";

                                                $mysqli_position = $mysqli->query($mysqli_query);
                                                if ($mysqli_position->num_rows > 0) {
                                                    echo '
                                                    <select id="positionApplySelect" name="positionApplySelect" style="width: 100%;height: 100%">
                                                    <option value="">' . $lang['select'] . '</option>';
                                                    while ($row_position = $mysqli_position->fetch_array(MYSQLI_ASSOC)) {
                                                        echo '<option value="' . $row_position['job_position_id'] . '">' . dataFilter($row_position['job_position_desc']) . '</option>';
                                                    }
                                                    echo '</select>';
                                                }
                                                ?>
                                                    <script>
                                                    const select = document.getElementById('positionApplySelect');
                                                    const input = document.getElementById('positionApplyText');
                                                    if (select && input) {
                                                        select.addEventListener('change', function() {
                                                            const selectedOption = this.options[this
                                                                .selectedIndex];
                                                            input.value = this.value ? selectedOption.text : '';
                                                        });
                                                    }
                                                    </script>
                                                </td>
                                            </tr>
                                        </table>
                                    </td>
                                </tr>

                                <tr>
                                    <td colspan="4" style="font-weight:bold; font-size:16px;">
                                        <table style="width: 100%;">
                                            <tr>
                                                <td style="width: 30%;"><?= $lang['EXPECTED SALARY'] ?> :</td>
                                                <td><input name="expectedSalary" type="number" step="0.01" min="0"
                                                        placeholder="0.00" style="width: 100%;" /></td>
                                            </tr>
                                        </table>
                                    </td>
                                </tr>

                                <tr>
                                    <td colspan="4" style="font-weight:bold; font-size:16px;">
                                        <table style="width: 100%;">
                                            <tr>
                                                <td style="width: 30%;"><?= $lang['NOTICE PERIOD'] ?> :</td>
                                                <td><input name="noticePeroid" type="number" min="0"
                                                        placeholder="<?= $lang['Days'] ?>" style="width: 100%;" /></td>
                                            </tr>
                                        </table>
                                    </td>
                                </tr>

                                <tr>
                                    <td colspan="4" style="font-weight:bold; font-size:16px;">
                                        <table style="width: 100%;">
                                            <tr>
                                                <td style="width: 30%;"><?= $lang['REFERRAL NAME (IF APPLICABLE)'] ?> :
                                                </td>
                                                <td><input name="referralName" type="text" style="width: 100%;" /></td>
                                            </tr>
                                        </table>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4" style="font-weight:bold; font-size:16px;">
                                        <table style="width: 100%;">
                                            <tr>
                                                <td style="width: 30%;">NRIC (ONLY NUMBER) :
                                                </td>
                                                <td>
                                                    <input name="nric" type="text" style="width: 100%;" />
                                                    <small style="color: gray;">without dash or space</small>
                                                </td>
                                            </tr>
                                        </table>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>

                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?= $lang['PERSONAL INFORMATION'] ?>
                                            </div>
                                            <div class="panel-body"
                                                style="padding: 0;font-size: 16px;font-weight: bold;">

                                                <table class="table table-bordered" style="margin: 0;padding: 0;">

                                                    <!-- Full Name -->
                                                    <tr>
                                                        <td colspan="4">
                                                            <table style="width: 100%;">
                                                                <tr>
                                                                    <td colspan="2">
                                                                        <?= $lang['FULL NAME (AS PER NRIC)'] ?> :
                                                                    </td>
                                                                </tr>
                                                                <tr>
                                                                    <td colspan="2"><input name="personal_name"
                                                                            type="text" style="width: 100%;"></td>
                                                                </tr>
                                                            </table>
                                                        </td>
                                                    </tr>

                                                    <!-- Chinese & Nickname -->
                                                    <tr>
                                                        <td colspan="4">
                                                            <table style="width: 100%;">
                                                                <tr>
                                                                    <td>
                                                                        <?= $lang['NAME IN CHINESE CHARACTER (IF APPLICABLE)'] ?>
                                                                        :
                                                                    </td>
                                                                    <td>
                                                                        <?= $lang['NICKNAME'] ?> :
                                                                    </td>
                                                                </tr>
                                                                <tr>
                                                                    <td><input name="personal_name_chinese" type="text"
                                                                            style="width: 100%;"></td>
                                                                    <td><input name="personal_name_nickname" type="text"
                                                                            style="width: 100%;"></td>
                                                                </tr>
                                                            </table>
                                                        </td>
                                                    </tr>

                                                    <!-- DOB, Age, Email -->
                                                    <tr>
                                                        <td colspan="4">
                                                            <table style="width: 100%;">
                                                                <tr>
                                                                    <td>
                                                                        <?= $lang['DATE OF BIRTH'] ?> :
                                                                    </td>
                                                                    <td>
                                                                        <?= $lang['AGE'] ?> :
                                                                    </td>
                                                                    <td style="width: 50%;">
                                                                        <?= $lang['EMAIL ADDRESS'] ?> :
                                                                    </td>
                                                                </tr>
                                                                <tr>
                                                                    <td><input name="personal_dob"
                                                                            class="datetimepicker" type="text"
                                                                            style="width: 100%;"></td>
                                                                    <td><input name="personal_age" type="number"
                                                                            style="width: 100%;"></td>
                                                                    <td><input type="email" name="personal_email"
                                                                            style="width: 100%;" /></td>
                                                                </tr>
                                                            </table>
                                                        </td>
                                                    </tr>

                                                    <!-- Nationality & Religion -->
                                                    <tr>
                                                        <td colspan="4">
                                                            <table style="width: 100%;">
                                                                <tr>
                                                                    <td>
                                                                        <?= $lang['NATIONALITY'] ?> :
                                                                    </td>
                                                                    <td>
                                                                        <?= $lang['RELIGION'] ?> :
                                                                    </td>
                                                                </tr>
                                                                <tr>
                                                                    <td><input type="text" name="personal_nationality"
                                                                            style="width: 100%;" /></td>
                                                                    <td><input type="text" name="personal_religion"
                                                                            style="width: 100%;" /></td>
                                                                </tr>
                                                            </table>
                                                        </td>
                                                    </tr>

                                                    <!-- Mobile & Home Tel -->
                                                    <tr>
                                                        <td colspan="4">
                                                            <table style="width: 100%;">
                                                                <tr>
                                                                    <td>
                                                                        <?= $lang['MOBILE NO.'] ?> :
                                                                    </td>
                                                                    <td>
                                                                        <?= $lang['HOME TELEPHONE'] ?> :
                                                                    </td>
                                                                </tr>
                                                                <tr>
                                                                    <td><input type="text" name="personal_mobile"
                                                                            style="width: 100%;" /></td>
                                                                    <td><input type="text" name="personal_home_tel"
                                                                            style="width: 100%;" /></td>
                                                                </tr>
                                                            </table>
                                                        </td>
                                                    </tr>

                                                    <!-- Gender, Marital, License -->
                                                    <tr>
                                                        <td colspan="4">
                                                            <table style="width: 100%;">
                                                                <tr>
                                                                    <td style="width: 25%;">
                                                                        <?= $lang['GENDER'] ?> :
                                                                    </td>
                                                                    <td style="width: 25%;">
                                                                        <?= $lang['MARITAL STATUS'] ?> :
                                                                    </td>
                                                                    <td style="width: 50%;">
                                                                        <?= $lang['DRIVING LISENCE'] ?> :
                                                                    </td>
                                                                </tr>
                                                                <tr>
                                                                    <td style="vertical-align: top;">
                                                                        <label><input type="radio"
                                                                                name="personal_gender" value="male" />
                                                                            <?= $lang['MALE'] ?></label><br />
                                                                        <label><input type="radio"
                                                                                name="personal_gender" value="female" />
                                                                            <?= $lang['FEMALE'] ?></label>
                                                                    </td>
                                                                    <td style="vertical-align: top;">
                                                                        <label><input type="radio"
                                                                                name="personal_marital_status"
                                                                                value="single" />
                                                                            <?= $lang['SINGLE'] ?></label><br />
                                                                        <label><input type="radio"
                                                                                name="personal_marital_status"
                                                                                value="married" />
                                                                            <?= $lang['MARRIED'] ?></label><br />
                                                                        <label><input type="radio"
                                                                                name="personal_marital_status"
                                                                                value="divorced" />
                                                                            <?= $lang['DIVORCED'] ?></label><br />
                                                                        <label><input type="radio"
                                                                                name="personal_marital_status"
                                                                                value="windowed" />
                                                                            <?= $lang['WINDOWED'] ?></label><br />
                                                                        <label><input type="radio"
                                                                                name="personal_marital_status"
                                                                                value="seperated" />
                                                                            <?= $lang['SEPERATED'] ?></label>
                                                                    </td>
                                                                    <td style="vertical-align: top;">
                                                                        <div
                                                                            style="display: flex; align-items: center; gap: 10px; margin-bottom: 8px; margin-top: 8px;">
                                                                            <input type="radio" name="personal_lisence"
                                                                                id="radio_yes" value="yes" />
                                                                            <label for="radio_yes"
                                                                                style="margin: 0;"><?= $lang['YES'] ?></label>
                                                                            <span
                                                                                id="personal_lisence_class_title"><?= $lang['CLASS'] ?>:</span>
                                                                            <input type="text"
                                                                                name="personal_lisence_class"
                                                                                id="personal_lisence_class"
                                                                                style="height: 18px; font-size: 16px;">
                                                                        </div>
                                                                        <div
                                                                            style="display: flex; align-items: center; gap: 10px;">
                                                                            <input type="radio" name="personal_lisence"
                                                                                id="radio_no" value="no" />
                                                                            <label for="radio_no"
                                                                                style="margin: 0;"><?= $lang['NO'] ?></label>
                                                                        </div>
                                                                    </td>
                                                                </tr>
                                                            </table>

                                                            <script>
                                                            const yesRadio = document.getElementById('radio_yes');
                                                            const noRadio = document.getElementById('radio_no');
                                                            const classInput = document.getElementById(
                                                                'personal_lisence_class');
                                                            const classTitle = document.getElementById(
                                                                'personal_lisence_class_title');

                                                            function toggleClassInput() {
                                                                if (yesRadio.checked) {
                                                                    classInput.style.display = 'inline-block';
                                                                    classTitle.style.display = 'inline-block';
                                                                } else {
                                                                    classInput.style.display = 'none';
                                                                    classTitle.style.display = 'none';
                                                                    classInput.value = '';
                                                                }
                                                            }

                                                            yesRadio.addEventListener('change', toggleClassInput);
                                                            noRadio.addEventListener('change', toggleClassInput);
                                                            toggleClassInput();
                                                            </script>
                                                        </td>
                                                    </tr>

                                                    <!-- Permanent Address -->
                                                    <tr>
                                                        <td colspan="4">
                                                            <table style="width: 100%;">
                                                                <tr>
                                                                    <td>
                                                                        <?= $lang['PERMANENT ADDRESS'] ?> :
                                                                    </td>
                                                                </tr>
                                                                <tr>
                                                                    <td><input type="text"
                                                                            name="personal_permanent_address"
                                                                            style="width: 100%;" /></td>
                                                                </tr>
                                                            </table>
                                                        </td>
                                                    </tr>

                                                    <!-- Residential Address -->
                                                    <tr>
                                                        <td colspan="4">
                                                            <table style="width: 100%;">
                                                                <tr>
                                                                    <td>
                                                                        <?= $lang['RESIDENTIAL ADDRESS'] ?> :
                                                                    </td>
                                                                </tr>
                                                                <tr>
                                                                    <td><input type="text"
                                                                            name="personal_residential_address"
                                                                            style="width: 100%;" /></td>
                                                                </tr>
                                                            </table>
                                                        </td>
                                                    </tr>

                                                </table>
                                            </div>
                                        </div>
                                    </td>
                                </tr>


                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>

                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?=$lang['FAMILY PARTICULARS']?>
                                            </div>
                                            <div class="panel-body" style="padding: 0;">

                                                <table border="0" cellpadding="0" cellspacing="0" width="100%"
                                                    style="font-size:16px;margin:0;border-bottom: 1px solid #000;border-right: 1px solid #000;">
                                                    <tr>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['NAME']?></th>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?=$lang['RELATIONSHIP']?></th>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?=$lang['AGE']?></th>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['OCCUPATION']?></th>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['COMPANY NAME']?></th>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_name[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_relationship[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_age[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_occupation[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_company[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>

                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="family_member_key[]" value="1" />
                                                            <input type="text" name="family_member_name[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_relationship[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_age[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_occupation[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_company[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>

                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="family_member_key[]" value="2" />
                                                            <input type="text" name="family_member_name[2]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_relationship[2]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_age[2]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_occupation[2]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_company[2]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>

                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="family_member_key[]" value="3" />
                                                            <input type="text" name="family_member_name[3]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_relationship[3]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_age[3]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_occupation[3]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_company[3]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>

                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="family_member_key[]" value="4" />
                                                            <input type="text" name="family_member_name[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_relationship[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_age[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_occupation[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_company[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>

                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="family_member_key[]" value="5" />
                                                            <input type="text" name="family_member_name[5]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_relationship[5]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_age[5]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_occupation[5]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_company[5]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>

                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="family_member_key[]" value="6" />
                                                            <input type="text" name="family_member_name[6]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_relationship[6]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_age[6]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_occupation[6]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_company[6]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>

                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="family_member_key[]" value="7" />
                                                            <input type="text" name="family_member_name[7]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_relationship[7]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_age[7]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_occupation[7]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="family_member_company[7]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>

                                                </table>
                                            </div>
                                        </div>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>

                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?= $lang['EDUCATIONAL LEVEL']?>
                                            </div>
                                            <div class="panel-body" style="padding: 0;">
                                                <table border="0" cellpadding="0" cellspacing="0" width="100%"
                                                    style="font-size:16px;border-bottom: 1px solid #000;border-right: 1px solid #000;">
                                                    <tr>
                                                        <th rowspan="2"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?=$lang['QUALIFICATIONS']?></th>
                                                        <th rowspan="2"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['NAME OF SCHOOL / COLLEGE / UNIVERSITY']?></th>
                                                        <th width="130px"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;text-align: center;">
                                                            <?=$lang['START']?>
                                                        </th>
                                                        <th width="130px"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;text-align: center;">
                                                            <?=$lang['FINISH']?>
                                                        </th>
                                                        <th width="160px" rowspan="2"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?=$lang['GRADE']?></th>
                                                    </tr>
                                                    <tr>
                                                        <th width="130px"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;text-align: center;">
                                                            <?=$lang['(month/year)']?>
                                                        </th>
                                                        <th width="130px"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;text-align: center;">
                                                            <?=$lang['(month/year)']?>
                                                        </th>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <select name="education_qualification[0]"
                                                                style="max-width:470px;margin:0px;border:0px;">
                                                                <option value=""><?= $lang['select'] ?></option>
                                                                <option value="qua_below_pmr">Below PMR</option>
                                                                <option value="qua_pmr_pt3">PMR / PT3</option>
                                                                <option value="qua_spm">SPM</option>
                                                                <option value="qua_certificate_skm_svm">Certificate/ SKM
                                                                    / SVM</option>
                                                                <option value="qua_alevel_uec">A-Level / UEC</option>
                                                                <option value="qua_diploma">Diploma</option>
                                                                <option value="qua_degree">Degree</option>
                                                                <option value="qua_master_degree">Master Degree</option>
                                                                <option value="qua_phd">PHD</option>
                                                            </select>
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_name_school[0]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="education_key[]" value="0" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_start_year[0]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_finish_year[0]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_grade[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <select name="education_qualification[1]"
                                                                style="max-width:470px;margin:0px;border:0px;">
                                                                <option value=""><?= $lang['select'] ?></option>
                                                                <option value="qua_below_pmr">Below PMR</option>
                                                                <option value="qua_pmr_pt3">PMR / PT3</option>
                                                                <option value="qua_spm">SPM</option>
                                                                <option value="qua_certificate_skm_svm">Certificate/ SKM
                                                                    / SVM</option>
                                                                <option value="qua_alevel_uec">A-Level / UEC</option>
                                                                <option value="qua_diploma">Diploma</option>
                                                                <option value="qua_degree">Degree</option>
                                                                <option value="qua_master_degree">Master Degree</option>
                                                                <option value="qua_phd">PHD</option>
                                                            </select>
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_name_school[1]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="education_key[]" value="1" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_start_year[1]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_finish_year[1]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_grade[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <select name="education_qualification[2]"
                                                                style="max-width:470px;margin:0px;border:0px;">
                                                                <option value=""><?= $lang['select'] ?></option>
                                                                <option value="qua_below_pmr">Below PMR</option>
                                                                <option value="qua_pmr_pt3">PMR / PT3</option>
                                                                <option value="qua_spm">SPM</option>
                                                                <option value="qua_certificate_skm_svm">Certificate/ SKM
                                                                    / SVM</option>
                                                                <option value="qua_alevel_uec">A-Level / UEC</option>
                                                                <option value="qua_diploma">Diploma</option>
                                                                <option value="qua_degree">Degree</option>
                                                                <option value="qua_master_degree">Master Degree</option>
                                                                <option value="qua_phd">PHD</option>
                                                            </select>
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_name_school[2]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="education_key[]" value="2" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_start_year[2]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_finish_year[2]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_grade[2]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <select name="education_qualification[3]"
                                                                style="max-width:470px;margin:0px;border:0px;">
                                                                <option value=""><?= $lang['select'] ?></option>
                                                                <option value="qua_below_pmr">Below PMR</option>
                                                                <option value="qua_pmr_pt3">PMR / PT3</option>
                                                                <option value="qua_spm">SPM</option>
                                                                <option value="qua_certificate_skm_svm">Certificate/ SKM
                                                                    / SVM</option>
                                                                <option value="qua_alevel_uec">A-Level / UEC</option>
                                                                <option value="qua_diploma">Diploma</option>
                                                                <option value="qua_degree">Degree</option>
                                                                <option value="qua_master_degree">Master Degree</option>
                                                                <option value="qua_phd">PHD</option>
                                                            </select>
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_name_school[3]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="education_key[]" value="3" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_start_year[3]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_finish_year[3]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_grade[3]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <select name="education_qualification[4]"
                                                                style="max-width:470px;margin:0px;border:0px;">
                                                                <option value=""><?= $lang['select'] ?></option>
                                                                <option value="qua_below_pmr">Below PMR</option>
                                                                <option value="qua_pmr_pt3">PMR / PT3</option>
                                                                <option value="qua_spm">SPM</option>
                                                                <option value="qua_certificate_skm_svm">Certificate/ SKM
                                                                    / SVM</option>
                                                                <option value="qua_alevel_uec">A-Level / UEC</option>
                                                                <option value="qua_diploma">Diploma</option>
                                                                <option value="qua_degree">Degree</option>
                                                                <option value="qua_master_degree">Master Degree</option>
                                                                <option value="qua_phd">PHD</option>
                                                            </select>
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_name_school[4]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="education_key[]" value="4" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_start_year[4]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_finish_year[4]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="education_grade[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                </table>
                                            </div>
                                        </div>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>
                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?= $lang['PROFESSIONAL QUALIFICATIONS (MEMBERSHIPS / TECHNICAL / PROFESSIONAL / OCCUPATION TRAINING)']?>
                                            </div>
                                            <div class="panel-body" style="padding: 0;">


                                                <table border="0" cellpadding="0" cellspacing="0" width="100%"
                                                    style="font-size:16px;border-bottom: 1px solid #000;border-right: 1px solid #000;">
                                                    <tr>
                                                        <th rowspan="2"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?=$lang['PROFESSIONAL QUALIFICATION']?></th>
                                                        <th rowspan="2"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['ACCREDITED BY']?></th>
                                                        <th width="130px"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;text-align: center;">
                                                            <?= $lang['START']?></th>
                                                        <th width="130px"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;text-align: center;">
                                                            <?= $lang['FINISH']?></th>
                                                    </tr>
                                                    <tr>
                                                        <th width="130px"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;text-align: center;">
                                                            <?= $lang['(month/year)']?>
                                                        </th>
                                                        <th width="130px"
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;text-align: center;">
                                                            <?= $lang['(month/year)']?>
                                                        </th>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_qualification[0]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="professional_qualification_key[]"
                                                                value="0" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_accredited_by[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_start_year[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_finish_year[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_qualification[1]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="professional_qualification_key[]"
                                                                value="1" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_accredited_by[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_start_year[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_finish_year[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_qualification[2]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="professional_qualification_key[]"
                                                                value="2" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_accredited_by[2]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_start_year[2]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_finish_year[2]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_qualification[3]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="professional_qualification_key[]"
                                                                value="3" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_accredited_by[3]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_start_year[3]"
                                                                style="margin:0;" />
                                                        </td>

                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_finish_year[3]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_qualification[4]"
                                                                style="margin:0;" />
                                                            <input type="hidden" name="professional_qualification_key[]"
                                                                value="4" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="professional_accredited_by[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_start_year[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text"
                                                                name="professional_qualification_finish_year[4]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                </table>
                                            </div>
                                        </div>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">
                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?=$lang['LANGUAGE PROFICIENCY']?>
                                            </div>
                                            <div class="panel-body" style="padding: 0;">

                                                <table border="1" cellspacing="0" cellpadding="5"
                                                    style="border-collapse: collapse; width: 100%; text-align: center; font-size:16px;">
                                                    <thead>
                                                        <tr>
                                                            <th style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;"
                                                                rowspan="2"><?=$lang['LANGUAGE PROFICIENCY']?></th>
                                                            <th style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;"
                                                                colspan="3"><?=$lang['SPOKEN']?></th>
                                                            <th style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;"
                                                                colspan="3"><?=$lang['WRITTEN']?></th>
                                                        </tr>
                                                        <tr>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['GOOD']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['AVERAGE']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['POOR']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['GOOD']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['AVERAGE']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['POOR']?></th>
                                                        </tr>
                                                    </thead>
                                                    <tbody>
                                                        <!-- ENGLISH -->
                                                        <tr>
                                                            <td
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['ENGLISH']?></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_english" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_english" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_english" value="poor"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_english" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_english" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_english" value="poor"></td>
                                                        </tr>

                                                        <!-- MANDARIN -->
                                                        <tr>
                                                            <td
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['MANDARIN']?></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_mandarin" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_mandarin" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_mandarin" value="poor"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_mandarin" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_mandarin" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_mandarin" value="poor"></td>
                                                        </tr>

                                                        <!-- BAHASA MALAYSIA -->
                                                        <tr>
                                                            <td
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['BAHASA MALAYSIA']?></td>
                                                            <td><input style="margin:5px;" type="radio" name="spoken_bm"
                                                                    value="good"></td>
                                                            <td><input style="margin:5px;" type="radio" name="spoken_bm"
                                                                    value="average"></td>
                                                            <td><input style="margin:5px;" type="radio" name="spoken_bm"
                                                                    value="poor"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_bm" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_bm" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_bm" value="poor"></td>
                                                        </tr>

                                                        <!-- OTHERS 1 -->
                                                        <tr>
                                                            <td
                                                                style="border-top:1px solid #000;border-left:1px solid #000;">
                                                                <input type="text" placeholder="Other"
                                                                    name="language_other_1" style="margin: 0;">
                                                            </td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_other1" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_other1" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_other1" value="poor"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_other1" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_other1" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_other1" value="poor"></td>
                                                        </tr>

                                                        <!-- OTHERS 2 -->
                                                        <tr>
                                                            <td
                                                                style="border-top:1px solid #000;border-left:1px solid #000;">
                                                                <input type="text" placeholder="Other"
                                                                    name="language_other_2" style="margin: 0;">
                                                            </td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_other2" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_other2" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="spoken_other2" value="poor"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_other2" value="good"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_other2" value="average"></td>
                                                            <td><input style="margin:5px;" type="radio"
                                                                    name="written_other2" value="poor"></td>
                                                        </tr>
                                                    </tbody>
                                                </table>
                                            </div>
                                        </div>

                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>
                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?=$lang['REFERENCE DETAIL']?>
                                            </div>
                                            <div class="panel-body" style="padding: 0;">

                                                <p style="margin: 5px;">
                                                    <?=$lang['LIST AT LEAST TWO (2) FORMER SUPERVISOR, HR MANAGER AND/OR COLLEAGUE.']?>
                                                <p>
                                                <table border="0" cellpadding="0" cellspacing="0" width="100%"
                                                    style="font-size:16px;border-bottom: 1px solid #000;border-right: 1px solid #000;">
                                                    <tr>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['Name']?></th>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['Position company']?></th>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['Contacts no']?></th>
                                                        <th
                                                            style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                            <?= $lang['Years known']?></th>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="references_key[]" value="0" />
                                                            <input type="text" name="references_name[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="references_position[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="references_contacts[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="references_years[0]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="hidden" name="references_key[]" value="1" />
                                                            <input type="text" name="references_name[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="references_position[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="references_contacts[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                        <td
                                                            style="border-top:1px solid #000;border-left:1px solid #000;">
                                                            <input type="text" name="references_years[1]"
                                                                style="margin:0;" />
                                                        </td>
                                                    </tr>
                                                </table>
                                            </div>
                                        </div>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>
                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?= $lang['EMPLOYMENT HISTORY']?>
                                            </div>
                                            <div class="panel-body"
                                                style="padding: 0; font-weight: bold; font-size: 16px;">
                                                <div class="form-group">
                                                    <div class="row" style="margin-top: 10px;">
                                                        <div class="col-sm-6">
                                                            <?=$lang['CURRENT COMPANY :']?>
                                                        </div>
                                                        <div class="col-sm-6">
                                                            <?=$lang['CURRENT POSITION :']?>
                                                        </div>
                                                    </div>
                                                    <div class="row">
                                                        <div class="col-sm-6">
                                                            <input name="current_company_name" type="text">
                                                        </div>

                                                        <div class="col-sm-6">
                                                            <input name="current_position_name" type="text">
                                                        </div>
                                                    </div>
                                                </div>
                                                <br />
                                                <div class="form-group row">
                                                    <div class="row">
                                                        <div class="col-sm-12">
                                                            <?=$lang['FULL ADDRESS :']?>
                                                        </div>
                                                    </div>
                                                    <div class="row">
                                                        <div class="col-sm-12">
                                                            <input name="current_company_full_address" type="text">
                                                        </div>
                                                    </div>
                                                </div>
                                                <br />
                                                <div class="form-group">
                                                    <div class="row">
                                                        <div class="col-sm-6">
                                                            <?=$lang['DATE JOIN :']?>
                                                        </div>
                                                        <div class="col-sm-6">
                                                            <?=$lang['DATE LEFT :']?>
                                                        </div>
                                                    </div>
                                                    <div class="row">
                                                        <div class="col-sm-6">
                                                            <input name="current_company_join_date" type="text"
                                                                class="datetimepicker">
                                                        </div>
                                                        <div class="col-sm-6">
                                                            <input name="current_company_left_date" type="text"
                                                                class="datetimepicker">
                                                        </div>
                                                    </div>
                                                </div>
                                                <br />
                                                <div class="form-group">
                                                    <div class="row">
                                                        <div class="col-sm-6">
                                                            <?=$lang['BASIC SALARY :']?>
                                                        </div>
                                                        <div class="col-sm-6">
                                                            <?=$lang['FIX AllOWANCE :']?>
                                                        </div>
                                                    </div>
                                                    <div class="row">
                                                        <div class="col-sm-6">
                                                            <input name="current_company_basic_salary" type="number"
                                                                step="0.01" min="0" placeholder="0.00">
                                                        </div>
                                                        <div class="col-sm-6">
                                                            <input name="current_company_fix_allowance" type="number"
                                                                step="0.01" min="0" placeholder="0.00">
                                                        </div>
                                                    </div>
                                                </div>
                                                <br />
                                                <div class="form-group row">
                                                    <div class="row">
                                                        <div class="col-sm-12">
                                                            <?=$lang['REASON FOR LEAVING :']?>
                                                        </div>
                                                    </div>
                                                    <div class="row">
                                                        <div class="col-sm-12">
                                                            <input name="current_company_leave_reason" type="text">
                                                        </div>
                                                    </div>
                                                </div>
                                                <br />
                                            </div>
                                        </div>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>
                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?=$lang['SUBSEQUENT EMPLOYMENT HISTORY']?>
                                            </div>
                                            <div class="panel-body"
                                                style="padding: 0; font-weight: bold; font-size: 16px;">


                                                <table width="100%" style="border-collapse: collapse;">
                                                    <!-- Block 1 -->
                                                    <tr>
                                                        <th colspan="4"
                                                            style="padding:10px 5px; text-align:center; font-weight:bold;">
                                                            <?=$lang['Employment Record']?> #1</th>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Company:']?></td>
                                                        <td><input name="subsequent_company_name[0]" type="text"
                                                                style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Position:']?></td>
                                                        <td><input name="subsequent_position_name[0]" type="text"
                                                                style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Date Join:']?></td>
                                                        <td><input name="subsequent_company_join_date[0]" type="text"
                                                                class="datetimepicker" style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Date Left:']?></td>
                                                        <td><input name="subsequent_company_left_date[0]" type="text"
                                                                class="datetimepicker" style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Basic Salary:']?></td>
                                                        <td><input name="subsequent_company_basic_salary[0]"
                                                                type="number" step="0.01" min="0" placeholder="0.00"
                                                                style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Fix Allowance:']?></td>
                                                        <td><input name="subsequent_company_fix_allowance[0]"
                                                                type="number" step="0.01" min="0" placeholder="0.00"
                                                                style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Reason for Leaving:']?></td>
                                                        <td colspan="3"><input name="subsequent_company_leave_reason[0]"
                                                                type="text" style="width:100%;"></td>
                                                    </tr>

                                                    <!-- Block 2 -->
                                                    <tr>
                                                        <th colspan="4"
                                                            style="padding:10px 5px; text-align:center; font-weight:bold;">
                                                            <?=$lang['Employment Record']?> #2</th>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Company:']?></td>
                                                        <td><input name="subsequent_company_name[1]" type="text"
                                                                style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Position:']?></td>
                                                        <td><input name="subsequent_position_name[1]" type="text"
                                                                style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Date Join:']?></td>
                                                        <td><input name="subsequent_company_join_date[1]" type="text"
                                                                class="datetimepicker" style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Date Left:']?></td>
                                                        <td><input name="subsequent_company_left_date[1]" type="text"
                                                                class="datetimepicker" style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Basic Salary:']?></td>
                                                        <td><input name="subsequent_company_basic_salary[1]"
                                                                type="number" step="0.01" min="0" placeholder="0.00"
                                                                style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Fix Allowance:']?></td>
                                                        <td><input name="subsequent_company_fix_allowance[1]"
                                                                type="number" step="0.01" min="0" placeholder="0.00"
                                                                style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Reason for Leaving:']?></td>
                                                        <td colspan="3"><input name="subsequent_company_leave_reason[1]"
                                                                type="text" style="width:100%;"></td>
                                                    </tr>

                                                    <!-- Block 3 -->
                                                    <tr>
                                                        <th colspan="4"
                                                            style="padding:10px 5px; text-align:center; font-weight:bold;">
                                                            <?=$lang['Employment Record']?> #3</th>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Company:']?></td>
                                                        <td><input name="subsequent_company_name[2]" type="text"
                                                                style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Position:']?></td>
                                                        <td><input name="subsequent_position_name[2]" type="text"
                                                                style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Date Join:']?></td>
                                                        <td><input name="subsequent_company_join_date[2]" type="text"
                                                                class="datetimepicker" style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Date Left:']?></td>
                                                        <td><input name="subsequent_company_left_date[2]" type="text"
                                                                class="datetimepicker" style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Basic Salary:']?></td>
                                                        <td><input name="subsequent_company_basic_salary[2]"
                                                                type="number" step="0.01" min="0" placeholder="0.00"
                                                                style="width:100%;"></td>
                                                        <td style="padding:5px;"><?=$lang['Fix Allowance:']?></td>
                                                        <td><input name="subsequent_company_fix_allowance[2]"
                                                                type="number" step="0.01" min="0" placeholder="0.00"
                                                                style="width:100%;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;"><?=$lang['Reason for Leaving:']?></td>
                                                        <td colspan="3"><input name="subsequent_company_leave_reason[2]"
                                                                type="text" style="width:100%;"></td>
                                                    </tr>
                                                </table>
                                            </div>
                                        </div>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>
                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?=$lang['OTHER INFORMATION']?>
                                            </div>
                                            <div class="panel-body"
                                                style="padding: 0; font-weight: bold; font-size: 16px;">

                                                <p style="margin:10px">
                                                    <?=$lang['WHAT IS YOUR INVOLVEMENT IN THE FOLLOWING ACTIVITY :']?>
                                                </p>
                                                <table border="1" cellspacing="0" cellpadding="5"
                                                    style="border-collapse: collapse; width: 100%; text-align: center;">
                                                    <thead>
                                                        <tr>
                                                            <th style="padding:5px;border:1px solid #000;"></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['NEVER']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['OCCASIONALLY']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['AVERAGE']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['REGULARLY']?></th>
                                                            <th
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['HABITUAL']?></th>
                                                        </tr>
                                                    </thead>
                                                    <tbody>
                                                        <tr>
                                                            <td
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['GAMBLING']?></td>
                                                            <td><input style="margin:5px;" type="radio" name="gambling"
                                                                    value="never"></td>
                                                            <td><input style="margin:5px;" type="radio" name="gambling"
                                                                    value="occasionally"></td>
                                                            <td><input style="margin:5px;" type="radio" name="gambling"
                                                                    value="average"></td>
                                                            <td><input style="margin:5px;" type="radio" name="gambling"
                                                                    value="regularly"></td>
                                                            <td><input style="margin:5px;" type="radio" name="gambling"
                                                                    value="habitual"></td>
                                                        </tr>
                                                        <tr>
                                                            <td
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['DRINKING']?></td>
                                                            <td><input style="margin:5px;" type="radio" name="drinking"
                                                                    value="never"></td>
                                                            <td><input style="margin:5px;" type="radio" name="drinking"
                                                                    value="occasionally"></td>
                                                            <td><input style="margin:5px;" type="radio" name="drinking"
                                                                    value="average"></td>
                                                            <td><input style="margin:5px;" type="radio" name="drinking"
                                                                    value="regularly"></td>
                                                            <td><input style="margin:5px;" type="radio" name="drinking"
                                                                    value="habitual"></td>
                                                        </tr>
                                                        <tr>
                                                            <td
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['SMOKING']?></td>
                                                            <td><input style="margin:5px;" type="radio" name="smoking"
                                                                    value="never"></td>
                                                            <td><input style="margin:5px;" type="radio" name="smoking"
                                                                    value="occasionally"></td>
                                                            <td><input style="margin:5px;" type="radio" name="smoking"
                                                                    value="average"></td>
                                                            <td><input style="margin:5px;" type="radio" name="smoking"
                                                                    value="regularly"></td>
                                                            <td><input style="margin:5px;" type="radio" name="smoking"
                                                                    value="habitual"></td>
                                                        </tr>
                                                        <tr>
                                                            <td
                                                                style="padding:5px;border-top:1px solid #000;border-left:1px solid #000;">
                                                                <?=$lang['DRUG TAKING']?></td>
                                                            <td><input style="margin:5px;" type="radio" name="drug"
                                                                    value="never"></td>
                                                            <td><input style="margin:5px;" type="radio" name="drug"
                                                                    value="occasionally"></td>
                                                            <td><input style="margin:5px;" type="radio" name="drug"
                                                                    value="average"></td>
                                                            <td><input style="margin:5px;" type="radio" name="drug"
                                                                    value="regularly"></td>
                                                            <td><input style="margin:5px;" type="radio" name="drug"
                                                                    value="habitual"></td>
                                                        </tr>
                                                    </tbody>
                                                </table>
                                                <br />
                                                <br />
                                                <table cellpadding="5" cellspacing="5" width="100%"
                                                    style="border-collapse: collapse;">
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['1) DID YOU SUFFER FROM ANY PHYSICAL DISABILITY, CHRONIC AILMENT HANDICAP, ALLERGIES OR SERIOUS ILLNESS?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="disability"
                                                                value="yes"
                                                                onclick="toggleDetail('disability_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?><input type="text"
                                                                id="disability_detail" name="disability_detail"
                                                                style="display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="disability"
                                                                value="no"
                                                                onclick="toggleDetail('disability_detail', false)"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 2 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['2) ARE YOU TAKING ANY LONG-TERM MEDICATION FOR DIABETIC, ASTHMA, ETC.?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="medication"
                                                                value="yes"
                                                                onclick="toggleDetail('medication_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?><input type="text"
                                                                id="medication_detail" name="medication_detail"
                                                                style="width: 70%; display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="medication"
                                                                value="no"
                                                                onclick="toggleDetail('medication_detail', false)"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 3 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['3) PREGNANCY BEFORE JOINING (CURRENTLY / PLANNING IN COMING FEW THREE (3) MONTHS)?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="pregnancy"
                                                                value="yes"
                                                                onclick="toggleDetail('pregnancy_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?><input type="text"
                                                                id="pregnancy_detail" name="pregnancy_detail"
                                                                style="width: 70%; display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="pregnancy"
                                                                value="no"
                                                                onclick="toggleDetail('pregnancy_detail', false)"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 4 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['4) ARE YOU WILLING TO TRANSFER TO A NEW DEPARTMENT OR COMPANY IF THE OPPORTUNITY ARISES?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <div style="margin-top: 10px;">
                                                                <strong>A. WITH RELOCATION:</strong><br>
                                                                <label><input style="margin:5px;" type="radio"
                                                                        name="relocation" value="yes">
                                                                    <?=$lang['YES']?></label><br>
                                                                <label><input style="margin:5px;" type="radio"
                                                                        name="relocation" value="no">
                                                                    <?=$lang['NO']?></label>
                                                            </div>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <div style="margin-top: 10px;">
                                                                <strong>B. WITHOUT RELOCATION:</strong><br>
                                                                <label><input style="margin:5px;" type="radio"
                                                                        name="without_relocation" value="yes">
                                                                    YES</label><br>
                                                                <label><input style="margin:5px;" type="radio"
                                                                        name="without_relocation" value="no">
                                                                    <?=$lang['NO']?></label>
                                                            </div>
                                                        </td>
                                                    </tr>

                                                    <!-- Question 5 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['5) HAVE YOU EVER BEEN DISMISSED, DISCHARGED, OR LAID OFF FROM ANY EMPLOYMENT?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td style="width: 40px;"><input style="margin:5px;" value="yes"
                                                                type="radio" name="dismissed"
                                                                onclick="toggleDetail('dismissed_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?><input type="text"
                                                                id="dismissed_detail" name="dismissed_detail"
                                                                style="width: 70%; display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input type="radio" style="margin:5px;" value="no"
                                                                name="dismissed"
                                                                onclick="toggleDetail('dismissed_detail', false)"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 6 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['6) HAVE YOU EVER BEEN CHARGED IN A COURT LAW?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input type="radio" style="margin:5px;" name="court"
                                                                value="yes"
                                                                onclick="toggleDetail('court_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?><input type="text"
                                                                id="court_detail" name="court_detail"
                                                                style="width: 70%; display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input type="radio" style="margin:5px;" value="no"
                                                                name="court"
                                                                onclick="toggleDetail('court_detail', false)"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 7 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['7) HAVE YOU BEEN DECLARED BANKRUPTCY?']?></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input value="yes" style="margin:5px;" type="radio"
                                                                name="bankruptcy"></td>
                                                        <td style="padding:5px;"><?=$lang['YES']?></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input value="no" style="margin:5px;" type="radio"
                                                                name="bankruptcy"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 8 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['8) ARE YOU CURRENTLY EXPERIENCING ANY FINANCIAL DIFFICULTIES?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input type="radio" style="margin:5px;" value="yes"
                                                                name="finance"
                                                                onclick="toggleDetail('finance_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?><input type="text"
                                                                id="finance_detail" name="finance_detail"
                                                                style="width: 70%; display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="finance"
                                                                value="no"
                                                                onclick="toggleDetail('finance_detail', false)"></td>
                                                        <td style="padding:5px;">NO</td>
                                                    </tr>

                                                    <!-- Question 9 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['9) HAVE YOU APPLIED TO OUR COMPANY BEFORE?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input type="radio" style="margin:5px;" value="yes"
                                                                name="applied"
                                                                onclick="toggleDetail('applied_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?><input type="text"
                                                                id="applied_detail" name="applied_detail"
                                                                style="width: 70%; display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="applied"
                                                                value="no"
                                                                onclick="toggleDetail('applied_detail', false)"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 10 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['10) HAVE YOU BEEN INVOLVED IN A TRADE DISPUTE REFERRED TO LABOUR COURT?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" value="yes"
                                                                name="dispute"
                                                                onclick="toggleDetail('dispute_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?><input type="text"
                                                                id="dispute_detail" name="dispute_detail"
                                                                style="width: 70%; display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="dispute"
                                                                value="no"
                                                                onclick="toggleDetail('dispute_detail', false)"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 11 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['11) DO YOU OWN A CAR AND/OR MOTORCYCLE WITH VALID LICENSE?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="vehicle"
                                                                value="yes"></td>
                                                        <td style="padding:5px;"><?=$lang['YES']?></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="vehicle"
                                                                value="no"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 12 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['12) ARE YOU WILLING TO WORK OVERTIME?']?></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="overtime"
                                                                value="yes"></td>
                                                        <td style="padding:5px;"><?=$lang['YES']?></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="overtime"
                                                                value="no"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 13 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['13) DO YOU HAVE ANY OTHER SIDE JOB OR BUSINESS?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="other_job"
                                                                value="yes"
                                                                onclick="toggleDetail('other_job_detail', true)"></td>
                                                        <td style="padding:5px;">
                                                            <?=$lang['IF YES, PLEASE GIVE DETAILS:']?> <input
                                                                type="text" id="applied_detail" name="other_job_detail"
                                                                style="width: 70%; display: none;"></td>
                                                    </tr>
                                                    <tr>
                                                        <td><input style="margin:5px;" type="radio" name="other_job"
                                                                value="no"
                                                                onclick="toggleDetail('other_job_detail', false)"></td>
                                                        <td style="padding:5px;"><?=$lang['NO']?></td>
                                                    </tr>

                                                    <!-- Question 14 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['14) WHAT ATTRACTED YOU TO THIS CAREER OPPORTUNITY?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td colspan="2" style="padding:0;">
                                                            <input type="text" name="attract"
                                                                style="margin:0; width: 100%;"
                                                                onclick="toggleDetail('applied_detail', false)">
                                                        </td>
                                                    </tr>

                                                    <!-- Question 15 -->
                                                    <tr>
                                                        <td style="padding:5px;" colspan="2">
                                                            <?=$lang['15) WHAT ARE YOUR CAREER GOALS IN 5 YEARS, AND HOW TO ACHIEVE THEM?']?>
                                                        </td>
                                                    </tr>
                                                    <tr>
                                                        <td colspan="2" style="padding:0;">
                                                            <input type="text" name="career_plan"
                                                                style="margin:0; width: 100%;"
                                                                onclick="toggleDetail('applied_detail', false)">
                                                        </td>
                                                    </tr>


                                                </table>
                                            </div>
                                        </div>
                                        <script>
                                        function toggleDetail(inputId, show) {
                                            const input = document.getElementById(inputId);
                                            input.style.display = show ? 'inline-block' : 'none';
                                            if (!show) input.value = '';
                                        }
                                        </script>
                                    </td>
                                </tr>

                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>
                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?=$lang['PRIVACY NOTICE FOR PERSONAL DATA']?>
                                            </div>
                                            <div class="panel-body"
                                                style="padding: 0; font-weight: bold; font-size: 16px;">

                                                <p style="margin:10px">BY PROVIDING PERSONAL DATA AS STATED IN THIS
                                                    EMPLOYMENT APPLICATION FORM, I HAVE CONSENTED YOUR COMPANY TO
                                                    PROCESS THE PERSONAL DATA IN ACCORDANCE WITH PERSONAL DATA
                                                    PROTECTION ACT, AND I FURTHER CONFIRM THAT ALL PERSONAL DATA
                                                    PROVIDED HEREIN ARE ACCURATE AND COMPLETE.</p>

                                                <p style="margin:10px">TO THE EXTENT THAT I HAVE PROVIDED ABOUT MY
                                                    FAMILY MEMBERS, SPOUSE, OTHER DEPENDENTS, AND PERSONAL REFERRALS
                                                    CONFIRM THAT I HAVE EXPLAINED TO THEM THAT THEIR PERSONAL DATA WILL
                                                    BE PROVIDED TO, AND PROCESSED BY YOUR COMPANY AND I REPRESENT AND
                                                    WARRANT THAT I HAVE OBTAINED THEIR CONSENT TO THE PROCESSING OF
                                                    THEIR PERSONAL DATA IN ACCORDANCE WITH PERSONAL DATA PROTECTION ACT.
                                                </p>

                                                <p style="margin:10px">I FURTHER AUTHORIZE AND CONSENT YOUR COMPANY TO
                                                    CONDUCT BACKGROUND SEARCH ON ME WHETHER BASED ON THE DATA PROVIDED
                                                    BY ME IN THIS EMPLOYMENT APPLICATION FORM OR RELATED INFORMATION
                                                    THAT YOUR COMPANY MAY OBTAIN FROM OTHER SOURCES FOR EVALUATING MY
                                                    JOB APPLICATION.</p>

                                                <br />
                                                <br />
                                                <label style="margin:10px">FULL NAME</label><input type="text"
                                                    name="privacy_name"><br>
                                                <label style="margin:10px"> NRIC NUMBER </label><input type="text"
                                                    name="privacy_nric_number"><br>
                                                <label style="margin:10px"> DATE</label> <input type="text"
                                                    name="privacy_date" class="datetimepicker"><br>
                                            </div>
                                        </div>
                                    </td>
                                </tr>

                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>

                                        <div class="panel panel-primary" style="border: 2px solid #5e5bd0;">
                                            <div class="panel-heading"
                                                style="font-size:16px; background-color: #5e5bd0;color: white;">
                                                <?= $lang['ACKNOWLEDGEMENT AND AUTHORIZATION']?>
                                            </div>
                                            <div class="panel-body"
                                                style="padding: 0; font-weight: bold; font-size: 16px;">

                                                <p style="margin:10px;">I HEREBY DECLARE THAT ALL PARTICULARS AND
                                                    DOCUMENTS GIVEN BY ME ON THIS EMPLOYMENT APPLICATION FORM ARE TO THE
                                                    BEST OF MY KNOWLEDGE AND BELIEF, TRUE AND CORRECT. I UNDERSTAND THAT
                                                    IF OR AT ANY TIME AFTER MY EMPLOYMENT, THE INFORMATION GIVEN ON THIS
                                                    FORM ARE FOUND TO BE FALSE, INCORRECT OR INCOMPLETE, THE COMPANY
                                                    RESERVES THE RIGHT TO DISMISS MY SERVICES WITHOUT NOTICE OR
                                                    COMPENSATION. </p>
                                                <br />
                                                <br />
                                                <label style="margin:10px">FULL NAME</label><input type="text"
                                                    name="acknowledgement_name"><br>
                                                <label style="margin:10px"> NRIC NUMBER </label><input type="text"
                                                    name="acknowledgement_nric_number"><br>
                                                <label style="margin:10px"> DATE</label><input type="text"
                                                    name="acknowledgement_privacy_date" class="datetimepicker"><br>
                                            </div>
                                        </div>
                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td colspan="4">&nbsp;</td>
                                </tr>
                                <tr>
                                    <td>
                                        <div>Please acknowledge by signing below :</div>
                                        <div style="width:350px;float:left;">
                                            <div id="signature-pad" style="width:350px;" class="signature-pad">
                                                <div id="protective-layer"
                                                    style="position: absolute;width: inherit;height: 150px; text-align: center;font-size: large;font-weight: bolder;padding: 50px 0px;">
                                                    Click To Sign Here</div>
                                                <div class="signature-pad--body">
                                                    <canvas
                                                        style="border: 1px solid #ccc; width:350px !important; height:150px !important;"></canvas>
                                                </div>
                                                <div class="signature-pad--footer">
                                                    <div class="signature-pad--actions">
                                                        <div>
                                                            <button type="button" class="button clear"
                                                                data-action="clear"><?= $lang['Clear']?></button>
                                                        </div>
                                                    </div>
                                                </div>
                                                <input type="hidden" name="application_signature_acknowledgement"
                                                    id="signature_pad" required="required" />
                                                <input type="hidden" name="application_signature_hidden_acknowledgement"
                                                    id="signature_pad_hidden" required="required" />
                                            </div>
                                        </div>
                                    </td>
                                </tr>
                            </table>
                        </div>
                        <br />

                        <script src="<?= PATH ?>scripts/signature_pad.umd.js"></script>
                        <script
                            src="<?= PATH ?>scripts/signature.js?v=<?= filemtime( $_SERVER["DOCUMENT_ROOT"].'/scripts/signature.js')  ?>">
                        </script>
                        <!-- <script src="<?= PATH ?>scripts/signature_pad.js"></script> -->


                        <!-- hidden input here -->
                        <table class="employment_table" border="0" cellpadding="0" cellspacing="0"
                            style="width:100%; padding:0; margin:0 auto;">
                            <tr>
                                <td colspan="4">&nbsp;</td>
                            </tr>
                            <tr>
                                <td colspan="4" style="border-bottom:1px solid #000;">&nbsp;</td>
                            </tr>
                            <tr>
                                <td colspan="4">&nbsp;</td>
                            </tr>
                            <tr>
                                <td colspan="4">
                                    <?php
                                    // check permission
            if ( permissionCheck($row_user, 'application-form-new') ){
                ?>
                                    <button id="apform_submit_btn" type="submit" class="btn btn-purple"
                                        style="float:right; background-color:#5e5bd0 ;color:white"><?= $lang['submit']?></button>
                                    <?php
            }
            ?>
                                    <input type="hidden" name="page_status" value="new" />
                                    <input type="hidden" name="hide" value="1">
                                    <input type="hidden" name="hide_select_worker" value="Local">
                                    <input type="hidden" name="employment_status" value="pending">
                                </td>
                            </tr>
                            <tr>
                                <td colspan="4">&nbsp;</td>
                            </tr>
                            <tr>
                                <td colspan="4">&nbsp;</td>
                            </tr>
                        </table>
                    </form>
                </div>
            </div>
        </div>
    </div>
</div>

<script>
$("#apform_submit_btn").click(function(event) {
    event.preventDefault();
    if (confirm("Please make sure you have inserted all the details and signed the form?") == true) {
        $("#quotationForm").submit();
    }
});
</script>