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home.php
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home.php
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Untitled Document</title>
<script src="home_val.js" type="text/javascript">
</script>
<link href="style1.css" rel="stylesheet" type="text/css" />
</head>
<body onload="firstfocus();">
<?php
include('conn.php');
include('session.php');
if (($row['comm'] != "") && ($row['gender'] != "")) {header('location:app_sub.php');}
?>
<script type="text/javascript">
var challan = "<?php echo $row['fees']; ?>";
</script>
<p><a href="logout_rrb.php">logout</a>
<div align="center"><h1>Application Form</h1></div>
</h1>
<h2><center><noscript class="notice"><br /><br /><br /><br /><br /> Please Enable JavaScript In your Browser And Continue <br /><br /><br /><br /><br /></noscript></center></h2>
<div> <h3> Your Registration Id is : <?php echo $row['regno']; ?></h3>
<h3> Your Application Number is : <?php echo $row['app']; ?></h3>
</div>
<h4>Mandatory Fields *</h4>
<form id="theForm" name="theForm" method="post" action="insert.php" onsubmit="javaScript:return validateform(theForm);">
<?php
if ($row['fees'] == 'N')
{
echo '<fieldset>
<legend>Bank Challan Details <span class="notice">(For those who had deposited Fee)</span></legend>
<table width="78%" border="0" cellspacing="0" cellpadding="5">
<tr>
<td width="17%" height="37">Branch Name : </td>
<td colspan="3"><input name="br_name" type="text" id="br_name" size="80" /></td>
</tr>
<tr>
<td>Branch City : </td>
<td width="23%"><input name="br_city" type="text" id="br_city" maxlength="20" /></td>
<td width="16%">Branch Code : </td>
<td width="44%"><input name="br_code" type="text" id="br_code" /></td>
</tr>
<tr>
<td> Date of Deposit <br /></td>
<td><input name="dep_date" type="text" id="dep_date" /></td>
<td>Journal No :</td>
<td><input name="jr_no" type="text" id="jr_no" /></td>
</tr>
</table>
</fieldset>
'; }
?>
<!--<fieldset>
<legend>Bank Challan Details <span class="notice">(For those who had deposited Fee)</span></legend>
<table width="78%" border="0" cellspacing="0" cellpadding="5">
<tr>
<td width="17%" height="37">Branch Name : </td>
<td colspan="3"><input name="br_name" type="text" id="br_name" size="80" /></td>
</tr>
<tr>
<td>Branch City : </td>
<td width="23%"><input name="br_city" type="text" id="br_city" maxlength="20" /></td>
<td width="16%">Branch Code : </td>
<td width="44%"><input name="br_code" type="text" id="br_code" /></td>
</tr>
<tr>
<td> Date of Deposit <br /></td>
<td><input name="dep_date" type="text" id="dep_date" /></td>
<td>Journal No :</td>
<td><input name="jr_no" type="text" id="jr_no" /></td>
</tr>
</table>
</fieldset>
-->
<br />
<fieldset>
<legend>General Information</legend>
<table width="89%" border="0" cellpadding="5">
<tr>
<td width="40%" height="50">1. Candidate Name :</td>
<td width="40%"><input name="cname" type="text" id="cname" size="35" maxlength="35" value="<?php echo $row['cname']; ?>" disabled="disabled" /></td>
<td width="40%" colspan="2" rowspan="3">
<div align="center"><img src="<?php echo "upload/";echo $row['regno'];echo "P.jpg"; ?>" alt="Candidates photo not uploaded" name="pho" width="106" height="110" id="pho" />
<br />
<img src="<?php echo "upload/";echo $row['regno'];echo "S.jpg"; ?>" alt="Candidates Sign" name="sign" width="152" height="33" id="sign" />
</div></td>
</tr>
<tr>
<td height="50">2. Fathers Name : </td>
<td><input name="fname" type="text" id="fname" tabindex="2" size="35" maxlength="35" value="<?php echo $row['fname']; ?>" disabled="disabled"/></td>
</tr>
<tr>
<td height="50">3. Mothers Name : </td>
<td><input name="mname" type="text" id="mname" size="35" maxlength="35" value="<?php echo $row['mname']; ?>" disabled="disabled"/></td>
</tr>
</table>
<table width="90%" border="0" cellpadding="10"> <tr>
<td>4. Community : </td>
<td colspan="2"><input name="comm" id="comm" type="radio" value="UR" onclick="document.getElementById('comunity').style.display='none'" />
UR
<input name="comm" id="comm" type="radio" value="SC" onclick="document.getElementById('comunity').style.display='none'" />
SC
<input name="comm" id="comm" type="radio" value="ST" onclick="document.getElementById('comunity').style.display='none'" />
ST
<input name="comm" id="comm" type="radio" value="OBC" onclick="document.getElementById('comunity').style.display=''"/>
OBC<br />
<br />
<div id="comunity"><span class="notice">* Please state whether belonging to Minority Community :</span>
<label>
<input type="radio" name="minority" value="Y" onclick="document.getElementById('mincomm').style.display=''"/>
Yes</label>
<label>
<input type="radio" name="minority" value="N" onclick="document.getElementById('mincomm').style.display='none'"/>
No</label></div><br />
<div id="mincomm">
<span class="notice">* Indicate community :</span>
<select name="minoritycomm" id="minoritycomm">
<option value="0">Select</option>
<option value="01">Muslim</option>
<option value="02">Christian</option>
<option value="03">Sikh</option>
<option value="04">Parsi</option>
</select></div> </td>
</tr>
<tr>
<td>5. Gender </td>
<td colspan="2"><label>
<input type="radio" name="gender" value="M" />
Male</label>
<input type="radio" name="gender" value="F" />
Female</td>
</tr>
<tr>
<td>6. Date of Birth : </td>
<td colspan="2"><input name="dob1" type="text" id="dob1" size="2" disabled="disabled" value="<?php echo $row['bdd']; ?>"/>
-
<input name="dob2" type="text" id="dob2" size="2" disabled="disabled" value="<?php echo $row['bmm']; ?>"/>
-
<input name="dob3" type="text" id="dob3" size="4" disabled="disabled" value="<?php echo $row['byy']; ?>"/></td>
</tr>
<tr>
<td>7. Religion : </td>
<td colspan="2"><input type="radio" name="reli" value="01" />
Hindu
<input type="radio" name="reli" value="02" />
Muslim
<input type="radio" name="reli" value="03" />
Christian
<input type="radio" name="reli" value="04" />
Sikh
<input type="radio" name="reli" value="05" />
Buddhist
<input type="radio" name="reli" value="06" />
Jain
<input type="radio" name="reli" value="07" />
Others</td>
</tr>
<tr>
<td>8. Are you : </td>
<td colspan="2"><label>
<input name="gtexsm" type="checkbox" id="gtexsm" value="GT" onclick="gtemp();"/>
Govt. Employee</label>
<label>
<input type="checkbox" name="gtexsm" id="gtexsm" value="EX" onclick="exsm();"/>
Ex Servicemen</label> </td>
</tr>
<tr>
<td colspan="3"><div align="center" id="gtemp">
<span class="notice"> Present employment (to be filled by Railway/Centeral/State/PSU employees)</span>
<table width="90%" border="1" cellspacing="5" cellpadding="5">
<tr>
<th width="27%">Designation and Grade </th>
<th width="13%">Date from </th>
<th width="14%">Date to </th>
<th width="46%">Name & Address of Employer </th>
</tr>
<tr>
<td><div align="center">
<input name="gtemp1" type="text" id="gtemp1" size="35" />
</div></td>
<td><div align="center">
<input name="gtemp2" type="text" id="gtemp2" size="15" maxlength="10" />
</div></td>
<td><div align="center">
<input name="gtemp3" type="text" id="gtemp3" size="15" maxlength="10" />
</div></td>
<td><div align="center">
<input name="gtemp4" type="text" id="gtemp4" size="50" />
</div></td>
</tr>
</table></div></td>
</tr>
<tr>
<td colspan="3"><div align="center" id="exsm">
<span class="notice"> Ex-Serviceman (EX-SM) </span>
<table width="90%" border="1" cellspacing="5" cellpadding="5">
<tr>
<th width="27%">Date of enrolment </th>
<th width="24%">Date of attestation </th>
<th width="26%">Date of Discharge </th>
<th width="23%">Length of Service </th>
</tr>
<tr>
<td><div align="center">
<input name="exsm1" type="text" id="exsm1" size="35" />
</div></td>
<td><div align="center">
<input name="exsm2" type="text" id="exsm2" size="15" maxlength="10" />
</div></td>
<td><div align="center">
<input name="exsm3" type="text" id="exsm3" size="15" maxlength="10" />
</div></td>
<td><div align="center">
<input name="exsm4" type="text" id="exsm4" size="15" />
</div></td>
</tr>
</table></div></td>
</tr>
<tr>
<td>9. Are you Person with Disabilities </td>
<td colspan="2"><p>
<label>
<input type="radio" name="ph" value="Y" onclick="document.getElementById('phtype').style.display=''" />
Yes</label>
<label>
<input type="radio" name="ph" value="N" onclick="document.getElementById('phtype').style.display='none'"/>
No</label></p>
<div id="phtype" > <label> <span class="notice">( If Yes, Please Select ) :</span>
<select name="ph_yes" id="ph_yes">
<option value="0">Select</option>
<option value="VH">VH</option>
<option value="OH">OH</option>
<option value="HH">HH</option>
</select></label>
</div>
</p></td>
</tr>
<tr>
<td>10. Visible Mark of Idendification on Body </td>
<td colspan="2"><input name="id_mark" type="text" id="id_mark" size="20" maxlength="20" />
<span class="notice">(If No such mark write "NIL")</span> </td>
</tr>
</table>
<h2><center><noscript class="notice"><br /><br /><br /><br /><br /> Please Enable JavaScript In your Browser And Continue <br /><br /><br /><br /><br /></noscript></center></h2>
</fieldset>
<br />
<br />
<fieldset>
<legend> 11. Educational Qualification :</legend>
<table width="100%" border="1" cellspacing="2" cellpadding="5">
<tr>
<td width="22%"><div align="center"><strong>Academic</strong></div></td>
<td width="18%"><div align="center"><strong>Qualification</strong></div></td>
<td width="23%"><div align="center"><strong>Univ/Board</strong></div></td>
<td width="10%"><div align="center" class="style1">Year of Passing </div></td>
<td width="17%"><div align="center"><strong>Subject</strong></div></td>
<td width="10%"><div align="center"><strong>Marks (%) </strong></div></td>
</tr>
<tr>
<td><div align="center"><strong>SSC / X / Matric</strong></div></td>
<td> <div align="center">
<input type="text" id="a1" name="a1" />
</div></td>
<td> <div align="center">
<input name="a2" type="text" id="a2" size="35" />
</div></td>
<td> <div align="center">
<input name="a3" type="text" id="a3" size="5" maxlength="4" />
</div></td>
<td> <div align="center">
<input type="text" id="a4" name="a4" />
</div></td>
<td> <div align="center">
<input name="a5" type="text" id="a5" size="5" maxlength="5" />
</div></td>
</tr>
<tr>
<td><div align="center"><strong>Hr. Sec./ XII / Inter </strong></div></td>
<td><div align="center">
<input type="text" id="b1" name="b1" />
</div></td>
<td><div align="center">
<input name="b2" type="text" id="b2" size="35" />
</div></td>
<td>
<div align="center">
<input name="b3" type="text" id="b3" size="5" maxlength="4" />
</div></td>
<td>
<div align="center">
<input type="text" id="b4" name="b4" />
</div></td>
<td>
<div align="center">
<input name="b5" type="text" id="b5" size="5" maxlength="5" />
</div></td>
</tr>
<tr>
<td><div align="center"><strong>Graduation</strong></div></td>
<td><div align="center">
<input type="text" id="c1" name="c1" />
</div></td>
<td><div align="center">
<input name="c2" type="text" id="c2" size="35" />
</div></td>
<td>
<div align="center">
<input name="c3" type="text" id="c3" size="5" maxlength="4" />
</div></td>
<td>
<div align="center">
<input type="text" id="c4" name="c4" />
</div></td>
<td>
<div align="center">
<input name="c5" type="text" id="c5" size="5" maxlength="5" />
</div></td>
</tr>
<tr>
<td><div align="center"><strong>Post Graduation </strong></div></td>
<td><div align="center">
<input type="text" id="d1" name="d1" />
</div></td>
<td><div align="center">
<input name="d2" type="text" id="d2" size="35" />
</div></td>
<td>
<div align="center">
<input name="d3" type="text" id="d3" size="5" maxlength="4" />
</div></td>
<td>
<div align="center">
<input type="text" id="d4" name="d4" />
</div></td>
<td>
<div align="center">
<input name="d5" type="text" id="d5" size="5" maxlength="5" />
</div></td>
</tr>
<tr>
<td><div align="center"><strong>Others</strong></div></td>
<td><div align="center">
<input type="text" name="e1" />
</div></td>
<td><div align="center">
<input name="e2" type="text" size="35" />
</div></td>
<td><div align="center">
<input name="e3" type="text" size="5" maxlength="4" />
</div></td>
<td>
<div align="center">
<input type="text" name="e4" />
</div></td>
<td>
<div align="center">
<input name="e5" type="text" size="5" />
</div></td>
</tr>
</table>
</fieldset>
<br />
<br />
<h2><center><noscript class="notice"><br /><br /><br /><br /><br /> Please Enable JavaScript In your Browser And Continue <br /><br /><br /><br /><br /></noscript></center></h2>
<fieldset>
<legend>Address</legend>
<table width="100%" border="0" cellspacing="2" cellpadding="10">
<tr>
<td>12. Permanent Address :- </td>
<td colspan="2">Address:<br />
<textarea name="padd" cols="50" id="padd" rows="2" ></textarea>
<p>
City:-
<input name="pcity" type="text" id="pcity" size="15" maxlength="15" />
Pin Code :-
<input name="ppin" type="text" id="ppin" size="15" maxlength="6" />
</p>
<p>Dist :-
<input name="pdist" type="text" id="pdist" size="15" />
State :-
<select name="pstate" id="pstate" >
<option value="--Select--">--Select--</option>
<option value="Andhra Pradesh">Andhra Pradesh</option>
<option value="Arunachal Pradesh">Arunachal Pradesh</option>
<option value="Assam">Assam</option>
<option value="Bihar">Bihar</option>
<option value="Chhattisgarh">Chhattisgarh</option>
<option value="Delhi">Delhi</option>
<option value="Gujarat">Gujarat</option>
<option value="Goa">Goa</option>
<option value="Haryana">Haryana</option>
<option value="Himachal Pradesh">Himachal Pradesh</option>
<option value="Jammu & Kashmir">Jammu & Kashmir</option>
<option value="Jharkhand">Jharkhand</option>
<option value="Karnataka">Karnataka</option>
<option value="Kerala">Kerala</option>
<option value="Madhya Pradesh">Madhya Pradesh</option>
<option value="Maharashtra">Maharashtra</option>
<option value="Manipur">Manipur</option>
<option value="Meghalaya">Meghalaya</option>
<option value="Mizoram">Mizoram</option>
<option value="Nagaland">Nagaland</option>
<option value="Orissa">Orissa</option>
<option value="Punjab">Punjab</option>
<option value="Rajasthan">Rajasthan</option>
<option value="Sikkim">Sikkim</option>
<option value="Tamil Nadu">Tamil Nadu</option>
<option value="Tripura">Tripura</option>
<option value="Uttar Pradesh">Uttar Pradesh</option>
<option value="Uttarakhand">Uttarakhand</option>
<option value="West Bengal">West Bengal</option>
<option value="Andaman & Nicobar">Andaman & Nicobar</option>
<option value="Chandigarh">Chandigarh</option>
<option value="Dadra & Nagar Haveli">Dadra & Nagar Haveli</option>
<option value="Daman & Diu">Daman & Diu</option>
<option value="Lakshadweep">Lakshadweep</option>
<option value="Puducherry">Puducherry</option>
<option value="OTHER - not from India">OTHER - not from India</option>
</select>
</p></td>
</tr>
<tr>
<td>13. Nearest Railway Station :- </td>
<td colspan="2"><input name="nrly" type="text" id="nrly" size="35" maxlength="35" />
<span class="notice">( For Issuing free Railway Pass to SC/ST candidates)</span></td>
</tr>
<tr>
<td> 14. Correspondence Address :- </td>
<td colspan="2"><p>
<label>
If Same as Permanent Address ( Select Yes ) :-
<input type="radio" name="sameadd" value="Y" onclick="document.getElementById('caddress').style.display='none'" />
Yes</label>
<label>
<input type="radio" name="sameadd" value="N" onclick="document.getElementById('caddress').style.display=''" />
No</label><br /><div id="caddress">Address:<br />
<textarea name="cadd" cols="50" rows="2" id="cadd"></textarea>
</p>
</p>
<p> City:-
<input name="ccity" type="text" id="ccity" size="15" />
Pin Code :-
<input name="cpin" type="text" id="cpin" size="15" />
</p>
<p>Dist :-
<input name="cdist" type="text" id="cdist" size="15" />
State :-
<select name="cstate" id="cstate" >
<option value="--Select--">--Select--</option>
<option value="Andhra Pradesh">Andhra Pradesh</option>
<option value="Arunachal Pradesh">Arunachal Pradesh</option>
<option value="Assam">Assam</option>
<option value="Bihar">Bihar</option>
<option value="Chhattisgarh">Chhattisgarh</option>
<option value="Delhi">Delhi</option>
<option value="Gujarat">Gujarat</option>
<option value="Goa">Goa</option>
<option value="Haryana">Haryana</option>
<option value="Himachal Pradesh">Himachal Pradesh</option>
<option value="Jammu & Kashmir">Jammu & Kashmir</option>
<option value="Jharkhand">Jharkhand</option>
<option value="Karnataka">Karnataka</option>
<option value="Kerala">Kerala</option>
<option value="Madhya Pradesh">Madhya Pradesh</option>
<option value="Maharashtra">Maharashtra</option>
<option value="Manipur">Manipur</option>
<option value="Meghalaya">Meghalaya</option>
<option value="Mizoram">Mizoram</option>
<option value="Nagaland">Nagaland</option>
<option value="Orissa">Orissa</option>
<option value="Punjab">Punjab</option>
<option value="Rajasthan">Rajasthan</option>
<option value="Sikkim">Sikkim</option>
<option value="Tamil Nadu">Tamil Nadu</option>
<option value="Tripura">Tripura</option>
<option value="Uttar Pradesh">Uttar Pradesh</option>
<option value="Uttarakhand">Uttarakhand</option>
<option value="West Bengal">West Bengal</option>
<option value="Andaman & Nicobar">Andaman & Nicobar</option>
<option value="Chandigarh">Chandigarh</option>
<option value="Dadra & Nagar Haveli">Dadra & Nagar Haveli</option>
<option value="Daman & Diu">Daman & Diu</option>
<option value="Lakshadweep">Lakshadweep</option>
<option value="Puducherry">Puducherry</option>
<option value="OTHER - not from India">OTHER - not from India</option>
</select>
</p></div> </td>
</tr>
<tr>
<td>15. Marital Status :- </td>
<td colspan="2"><p>
<label>
<input type="radio" name="married" value="S" />
Single</label>
<label>
<input type="radio" name="married" value="M" />
Married</label>
</p></td>
</tr>
<tr>
<td>16. Medium of Examination :- </td>
<td colspan="2"><select name="medium" id="medium">
<option value="0">--select--</option>
<option value="01">HINDI</option>
<option value="02">ENGLISH</option>
</select> </td>
</tr>
<tr>
<td>17. Nationality </td>
<td><p>
<label>
<input type="radio" id="nationality" name="nationality" value="01" />
Indian</label>
<label>
<input type="radio" id="nationality" name="nationality" value="02" />
Others</label>
<br />
</p></td>
</tr>
<tr>
<td>18. Are you seeking Age relaxation :- </td>
<td><label>
<input name="ageRelx" type="radio" value="Y" onclick="document.getElementById('relx').style.display=''"/>
Yes</label>
<label>
<input type="radio" name="ageRelx" value="N" onclick="document.getElementById('relx').style.display='none'"/>
No</label></td>
<td><div id="relx" align="center">
<span class="notice"> ( If Yes, Please Select ) :</span>
<select name="ageReason" id="ageReason">
<option value="0">--Select--</option>
<option value="01">SC / ST</option>
<option value="02">OBC</option>
<option value="03">Ex-SM</option>
<option value="04">PWD</option>
<option value="05">Railway Employee</option>
<option value="06">Judicially Seprated</option>
<option value="07">Divorced Woman</option>
<option value="08">Widow</option>
<option value="09">J & K resident</option>
<option value="10">Course Completed Act Appremtice</option>
</select></div></td>
</tr>
</table>
</fieldset>
<div align="center">
<input type="reset" value="Reset">
<input type="submit" name="submit" id="submit" value="Submit" /></div>
</form>
</body>
</html>