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index.php
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link rel="stylesheet" href="assets/css/bootstrap.min.css">
<link rel="stylesheet" href="assets/css/style.css">
<script defer src="assets/js/bootstrap.min.js"></script>
<script defer src="assets/js/script.js"></script>
<title>Personal Data Sheet</title>
</head>
<body>
<div class="container-fluid">
<nav class="navbar navbar-light">
<div class="container-fluid">
<a class="navbar-brand" href="#">
<img src="https://getbootstrap.com//docs/5.0/assets/brand/bootstrap-logo.svg" alt="" width="30" height="24" class="d-inline-block align-text-top">
Personal Data Sheet
</a>
</div>
</nav>
</div>
<div class="container">
<nav>
<div class="nav nav-tabs" id="nav-tab" role="tablist">
<button class="nav-link active" id="nav-home-tab" data-bs-toggle="tab" data-bs-target="#nav-home" type="button" role="tab" aria-controls="nav-home" aria-selected="true">C1</button>
<button class="nav-link" id="nav-profile-tab" data-bs-toggle="tab" data-bs-target="#nav-profile" type="button" role="tab" aria-controls="nav-profile" aria-selected="false">C2</button>
<button class="nav-link" id="nav-contact-tab" data-bs-toggle="tab" data-bs-target="#nav-contact" type="button" role="tab" aria-controls="nav-contact" aria-selected="false">C3</button>
<button class="nav-link" id="nav-contact2-tab" data-bs-toggle="tab" data-bs-target="#nav-contact2" type="button" role="tab" aria-controls="nav-contact2" aria-selected="false">C4</button>
</div>
</nav>
<div class="tab-content" id="nav-tabContent">
<!-- START WHOLE C1 -->
<div class="tab-pane fade show active" id="nav-home" role="tabpanel" aria-labelledby="nav-home-tab">
<div class="c1-container">
<div class="c1-container-header border-bottom">
<span>CS Form No. 212</span>
<br>
<span>Revised 2017</span>
<br>
<br>
<center><h1>PERSONAL DATA SHEET</h1></center>
<br>
<p><b>
WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s against the person concerned.
<br>
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
</b></p>
</div>
<br>
<div class="c1-container-body">
<div class="holder-box-0">
<div class="form-group row">
<label for="CSID" class="col-sm-2 col-form-label">1. CS ID No.</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="CSID" placeholder="CSID">
</div>
</div>
<br>
<h5><b> I. PERSONAL INFORMATION</b></h3>
<hr>
<br>
<div class="form-group row">
<label for="" class="col-sm-2 col-form-label">2. SURNAME</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="Surname" name="Surname" placeholder="Surname">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-2 col-form-label">FIRST NAME</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="Firstname" name="Firstname" placeholder="Firstname">
</div>
<label for="" class="col-sm-2 col-form-label">NAME EXTENSION (JR., SR)</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="NameExtension" placeholder="NameExtension">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-2 col-form-label">MIDDLE NAME</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="MiddleName" name="MiddleName" placeholder="MiddleName">
</div>
</div>
<br>
</div>
<hr>
<div class="holder-box-1">
<div class="box-1">
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">3. DATE OF BIRTH
(mm/dd/yyyy) </label>
<div class="col-sm-8">
<input type="date" class="form-control" id="DateOfBirth" placeholder="DateOfBirth">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">4. PLACE OF BIRTH</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="PlaceOfBirth" placeholder="PlaceOfBirth">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">5. SEX</label>
<div class="col-sm-8">
<input class="form-check-input" type="radio" name="Sex" id="Male" checked value="Male">
<label class="form-check-label" for="Male">
Male
</label>
<input class="form-check-input" type="radio" name="Sex" id="Female" value="Female">
<label class="form-check-label" for="Female">
Female
</label>
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">6. CIVIL STATUS</label>
<div class="col-sm-8">
<input class="form-check-input" type="radio" name="CivilStatus" id="Single" value="Single" checked>
<label class="form-check-label" for="Single">
Single
</label>
<input class="form-check-input" type="radio" name="CivilStatus" id="Married" value="Married">
<label class="form-check-label" for="Married">
Married
</label>
<input class="form-check-input" type="radio" name="CivilStatus" id="Widowed" value="Widowed">
<label class="form-check-label" for="Widowed">
Widowed
</label>
<br>
<input class="form-check-input" type="radio" name="CivilStatus" id="Seperated" value="Seperated">
<label class="form-check-label" for="Seperated">
Seperated
</label>
<input class="form-check-input" type="radio" name="CivilStatus" id="Other/s" value="Other/s">
<label class="form-check-label" for="Other/s">
Other/s
</label>
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">7. HEIGHT (m)</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Height" placeholder="Height">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">8. WEIGHT (kg)</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Weight" placeholder="Weight">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">9. BLOOD TYPE</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="BloodType" placeholder="BloodType">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">10. GSIS ID NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="GSIS" placeholder="GSIS">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">11. PAG-IBIG ID NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="PagIBIG" placeholder="PagIBIG">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">12. PHILHEALTH NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="PHILHEALTH" placeholder="PHILHEALTH">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">13. SSS NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="SSS" placeholder="SSS">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">14. TIN NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="TIN" placeholder="TIN">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">15. AGENCY EMPLOYEE NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="AgencyNo" placeholder="AgencyNo">
</div>
</div>
</div>
<div class="box-1" style="margin-left: 1%;">
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">16. CITIZENSHIP</label>
<div class="col-sm-8">
<input class="form-check-input" type="radio" name="Citizenship1" id="Filipino" value="Filipino" checked>
<label class="form-check-label" for="Filipino">
Filipino
</label>
<input class="form-check-input" type="radio" name="Citizenship1" id="Dual" value="Dual">
<label class="form-check-label" for="Dual">
Dual Citizenship
</label>
</div>
</div>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"></label>
<div class="col-sm-8">
<input class="form-check-input" type="radio" name="Citizenship2" id="Birth" value="by birth" checked>
<label class="form-check-label" for="Birth">
by birth
</label>
<input class="form-check-input" type="radio" name="Citizenship2" id="Naturalization" value="by naturalization">
<label class="form-check-label" for="Naturalization">
by naturalization
</label>
<br>
<br>
<center>Pls. indicate country:</center>
</div>
</div>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">If holder of dual citizenship, please indicate the details.</label>
<div class="col-sm-8">
<br>
<input class="form-control" list="datalistOptions" id="DualCountry" placeholder="DualCountry">
<datalist id="DualCountry">
<option>select country</option>
<option value="AF">Afghanistan</option>
<option value="AX">Aland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, Democratic Republic of the Congo</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Cote D'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curacao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and Mcdonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="XK">Kosovo</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libyan Arab Jamahiriya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia, the Former Yugoslav Republic of</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="AN">Netherlands Antilles</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory, Occupied</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthelemy</option>
<option value="SH">Saint Helena</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="CS">Serbia and Montenegro</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan, Province of China</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.s.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</datalist>
</div>
</div>
<hr>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">17. RESIDENTIAL ADDRESS</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="ResHouse_Block_LotNo" placeholder="ResHouse_Block_LotNo">
</div>
<div class="col-sm-4">
<input type="text" class="form-control" id="ResStreet" placeholder="ResStreet">
</div>
</div>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"></label>
<div class="col-sm-4">
<input type="text" class="form-control" id="ResSubdivision_Village" placeholder="ResSubdivision_Village">
</div>
<div class="col-sm-4">
<input type="text" class="form-control" id="ResBarangay" placeholder="ResBarangay">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"></label>
<div class="col-sm-4">
<input type="text" class="form-control" id="ResCity_Municipality" placeholder="ResCity_Municipality">
</div>
<div class="col-sm-4">
<input type="text" class="form-control" id="ResProvince" placeholder="ResProvince">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"><center>ZIP CODE</center> </label>
<div class="col-sm-8">
<input type="text" class="form-control" id="ResZipCode" placeholder="ResZipCode">
</div>
</div>
<hr>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">18. PERMANENT ADDRESS</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="PerHouse_Block_LotNo" placeholder="PerHouse_Block_LotNo">
</div>
<div class="col-sm-4">
<input type="text" class="form-control" id="PerStreet" placeholder="PerStreet">
</div>
</div>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"></label>
<div class="col-sm-4">
<input type="text" class="form-control" id="PerSubdivision_Village" placeholder="PerSubdivision_Village">
</div>
<div class="col-sm-4">
<input type="text" class="form-control" id="PerBarangay" placeholder="PerBarangay">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"></label>
<div class="col-sm-4">
<input type="text" class="form-control" id="PerCity_Municipality" placeholder="PerCity_Municipality">
</div>
<div class="col-sm-4">
<input type="text" class="form-control" id="PerProvince" placeholder="PerProvince">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"><center>ZIP CODE</center> </label>
<div class="col-sm-8">
<input type="text" class="form-control" id="PerZipCode" placeholder="PerZipCode">
</div>
</div>
<hr>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">19. TELEPHONE NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="TelephoneNumber" placeholder="TelephoneNumber">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">20. MOBILE NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="MobileNumber" placeholder="MobileNumber">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">21. E-MAIL ADDRESS (if any)</label>
<div class="col-sm-8">
<input type="email" class="form-control" id="EmailAdd" placeholder="EmailAdd">
</div>
</div>
</div>
</div>
<br>
<h5><b> II. FAMILY BACKGROUND</b></h3>
<hr>
<div class="holder-box-2">
<div class="box-1">
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">22. SPOUSE'S SURNAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Spouse_Surname" placeholder="Spouse_Surname">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"> FIRST NAME</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="Spouse_Firstname" placeholder="Spouse_Firstname">
</div>
<label for="" class="col-sm-2 col-form-label"> NAME EXTENSION (JR., SR)</label>
<div class="col-sm-2">
<input type="text" class="form-control" id="Spouse_NameExtension" placeholder="Spouse_NameExtension">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"> MIDDLE NAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Spouse_Middlename" placeholder="Spouse_Middlename">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"> OCCUPATION</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Spouse_Occupation" placeholder="Spouse_Occupation">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"> EMPLOYER/BUSINESS NAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Spouse_Employer_Businessname" placeholder="Spouse_Employer_Businessname">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"> BUSINESS ADDRESS</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Spouse_BusinessAddress" placeholder="Spouse_BusinessAddress">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"> TELEPHONE NO.</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Spouse_TelephoneNumber" placeholder="Spouse_TelephoneNumber">
</div>
</div>
</div>
<div class="box-1" style="margin-left: 1%;">
<div class="form-group row">
<label for="" class="col-sm-6 col-form-label">23. NAME of CHILDREN (Write full name and list all)</label>
<label for="" class="col-sm-6 col-form-label">DATE OF BIRTH (mm/dd/yyyy) </label>
</div>
<br>
<div class="form-group row">
<div class="col-sm-6">
<input type="text" class="form-control" id="Children_Fullname" placeholder="Children_Fullname">
</div>
<br>
<br>
<div class="col-sm-4">
<input type="date" class="form-control" id="Children_Birthdate" placeholder="Children_Birthdate">
</div>
<br>
<br>
<div class="col-sm-2">
<input type="button" class="btn btn-dark" id="Spouse-Add-Children" value="ADD">
</div>
</div>
<br>
<br>
<!-- <ol id="spouse-children" style="list-style-position: inside; padding: 0px;">
</ol> -->
<div class="table-responsive">
<table class="table table-bordered">
<thead>
<tr>
<th scope="col">NAME of CHILDREN</th>
<th scope="col">DATE OF BIRTH</th>
<th scope="col">Control</th>
</tr>
</thead>
<tbody id="spouse-children">
</tbody>
</table>
</div>
<br>
<div class="form-group row">
<hr style="margin: 0;">
<label for="" class="col-sm-12 col-form-label" style="font-size: 0.5em; color: red; font-style: italic;"><center>(Continue on separate sheet if necessary)</center></label>
<hr>
</div>
</div>
</div>
<div class="holder-box-2">
<div class="box-1">
<hr>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">23. FATHER'S SURNAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Father_Surname" placeholder="Father_Surname">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label"> FIRST NAME</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="Father_Firstname" placeholder="Father_Firstname">
</div>
<label for="" class="col-sm-2 col-form-label"> NAME EXTENSION (JR., SR)</label>
<div class="col-sm-2">
<input type="text" class="form-control" id="Father_NameExtension" placeholder="Father_NameExtension">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">MIDDLE NAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Father_Middlename" placeholder="Father_Middlename">
</div>
</div>
<hr>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">24. MOTHER'S MAIDEN NAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Mother_MaidenName" placeholder="Mother_MaidenName">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">SURNAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Mother_Surname" placeholder="Mother_Surname">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">FIRST NAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Mother_Firstname" placeholder="Mother_Firstname">
</div>
</div>
<br>
<div class="form-group row">
<label for="" class="col-sm-4 col-form-label">MIDDLE NAME</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="Mother_Middlename" placeholder="Mother_Middlename">
</div>
</div>
</div>
<div class="box-1" style="margin-left: 1%;">
</div>
</div>
<br>
<br>
<h5><b> III. EDUCATIONAL BACKGROUND</b></h3>
<hr>
<div class="form-group row">
<label for="" class="col-sm-2 col-form-label edu-label">LEVEL</label>
<label for="" class="col-sm-2 col-form-label edu-label">ELEMENTARY</label>
<label for="" class="col-sm-2 col-form-label edu-label">SECONDARY</label>
<label for="" class="col-sm-2 col-form-label edu-label">Vocational COURSE</label>
<label for="" class="col-sm-2 col-form-label edu-label">COLLEGE</label>
<label for="" class="col-sm-2 col-form-label edu-label">GRADUATE STUDIES </label>
</div>
<div class="form-group row">
<label for="" class="col-sm-2 col-form-label">NAME OF SCHOOL (Write in full)</label>
<div class="col-sm-2">
<input type="text" class="form-control" id="NOF_Elementary" placeholder="NOF_Elementary">
</div>
<div class="col-sm-2">
<input type="text" class="form-control" id="NOF_Secondary" placeholder="NOF_Secondary">
</div>
<div class="col-sm-2">
<input type="text" class="form-control" id="NOF_Vocational" placeholder="NOF_Vocational">
</div>
<div class="col-sm-2">
<input type="text" class="form-control" id="NOF_College" placeholder="NOF_College">
</div>
<div class="col-sm-2">
<input type="text" class="form-control" id="NOF_Graduate" placeholder="NOF_Graduate">
</div>
<br>
<br>
<br>
<hr>
<br>
</div>
<div class="form-group row">
<label for="" class="col-sm-2 col-form-label">BASIC EDUCATION / DEGREE/COURSE (Write in full) </label>
<div class="col-sm-2">
<input type="text" class="form-control" id="BE_D_C_Elementary" placeholder="BE_D_C_Elementary">
</div>
<div class="col-sm-2">
<input type="text" class="form-control" id="BE_D_C_Secondary" placeholder="BE_D_C_Secondary">
</div>
<div class="col-sm-2">
<input type="text" class="form-control" id="BE_D_C_Vocational" placeholder="BE_D_C_Vocational">
</div>
<div class="col-sm-2">
<input type="text" class="form-control" id="BE_D_C_College" placeholder="BE_D_C_College">
</div>
<div class="col-sm-2">
<input type="text" class="form-control" id="BE_D_C_Graduate" placeholder="BE_D_C_Graduate">
</div>
<br>
<br>
<br>
<hr>
<br>
</div>
<div class="form-group row">
<br>
<br>
<label for="" class="col-sm-2 col-form-label">PERIOD OF ATTENDANCE</label>
<div class="col-sm-2">
<label for="">ELEMENTARY</label>
<input type="text" class="form-control" id="POA_From_Elementary" placeholder="POA_From_Elementary">
<input type="text" class="form-control" id="POA_To_Elementary" placeholder="POA_To_Elementary">
<br>
</div>
<div class="col-sm-2">
<label for="">SECONDARY</label>
<input type="text" class="form-control" id="POA_From_Secondary" placeholder="POA_From_Secondary">
<input type="text" class="form-control" id="POA_To_Secondary" placeholder="POA_To_Secondary">