<html>
<head>
<title>APPLICATION FORM </title>
</head>
<body leftmargin="200px">
<center><h3>APPLICATION FORM </h3></center>
<form>
<fieldset>
<legend>Personal Details</legend>
<table width="100%" cellpadding="10px">
<tr>
<td>Applicant's full name </td>
<td>
<select >
<option>--Select --</option>
<option>Mr.</option>
<option>Ms.</option>
<option>Others</option>
</select>
<input type="text" size="20"/>
</td>
<td>Care Of </td>
<td><label>Parents</label><input type="radio" name="care" checked/><label>Guardian </label><input type="radio" name="care"/></td>
</tr>
<tr>
<td>Father's Name </td>
<td>
<select disabled >
<option>Mr.</option>
</select>
<input type="text" size="20"/>
</td>
<td>Mother's Name </td>
<td>
<select disabled >
<option>Mrs.</option>
</select>
<input type="text" size="20"/>
</td>
</tr>
<tr>
<td>Gender</td>
<td>
<label>Male</label><input type="radio" name="Gender"/>
<label>Female </label><input type="radio" name="Gender"/>
<label>Others </label><input type="radio" name="Gender"/>
</td>
<td>Date of Birth</td>
<td>
<input type="date"/>
</td>
</tr>
<tr>
<td>Marital Status</td>
<td>
<select>
<option>--Select--</option>
<option>Single</option>
<option>Married</option>
<option>Divorced</option>
<option>Widowed</option>
</select>
</td>
<td>Category </td>
<td>
<select>
<option>--Select--</option>
<option>General</option>
<option>OBC</option>
<option>SC</option>
<option>ST</option>
</select>
</td>
</tr>
<tr>
<td>Handicapped </td>
<td><label>No</label><input type="radio" name="Handicapped" checked/><label>Yes</label><input type="radio" name="Handicapped"/></td>
<td>Ex-Serviceman </td>
<td><label>No</label><input type="radio" name="Serviceman" checked/><label>Yes</label><input type="radio" name="Serviceman"/></td>
</tr>
<tr>
<td>EWS </td>
<td><label>No</label><input type="radio" name="EWS" checked/><label>Yes</label><input type="radio" name="EWS"/></td>
<td>Religion </td>
<td>
<select>
<option>--Select--</option>
<option>Hindu</option>
<option>Muslim</option>
<option>Jain</option>
<option>Christianity</option>
</select>
</td>
</tr>
</table>
</fieldset>
<fieldset>
<legend>Contact Details</legend>
<table width="100%" cellpadding="10px">
<tr>
<td>Mobile Number</td>
<td><input type="tel"/></td>
<td>Email ID</td>
<td><input type="email"/></td>
</tr>
<tr>
<td>Address Line 1</td>
<td><input type="text"/></td>
<td>Address Line 2</td>
<td><input type="text"/></td>
</tr>
<tr>
<td>City</td>
<td><input type="text"/></td>
<td>State</td>
<td>
<select>
<option>--Select--</option>
<option value="Andhra Pradesh">Andhra Pradesh</option>
<option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
<option value="Arunachal Pradesh">Arunachal Pradesh</option>
<option value="Assam">Assam</option>
<option value="Bihar">Bihar</option>
<option value="Chandigarh">Chandigarh</option>
<option value="Chhattisgarh">Chhattisgarh</option>
<option value="Dadar and Nagar Haveli">Dadar and Nagar Haveli</option>
<option value="Daman and Diu">Daman and Diu</option>
<option value="Delhi">Delhi</option>
<option value="Lakshadweep">Lakshadweep</option>
<option value="Puducherry">Puducherry</option>
<option value="Goa">Goa</option>
<option value="Gujarat">Gujarat</option>
<option value="Haryana">Haryana</option>
<option value="Himachal Pradesh">Himachal Pradesh</option>
<option value="Jammu and Kashmir">Jammu and Kashmir</option>
<option value="Jharkhand">Jharkhand</option>
<option value="Karnataka">Karnataka</option>
<option value="Kerala">Kerala</option>
<option value="Madhya Pradesh">Madhya Pradesh</option>
<option value="Maharashtra">Maharashtra</option>
<option value="Manipur">Manipur</option>
<option value="Meghalaya">Meghalaya</option>
<option value="Mizoram">Mizoram</option>
<option value="Nagaland">Nagaland</option>
<option value="Odisha">Odisha</option>
<option value="Punjab">Punjab</option>
<option value="Rajasthan">Rajasthan</option>
<option value="Sikkim">Sikkim</option>
<option value="Tamil Nadu">Tamil Nadu</option>
<option value="Telangana">Telangana</option>
<option value="Tripura">Tripura</option>
<option value="Uttar Pradesh">Uttar Pradesh</option>
<option value="Uttarakhand">Uttarakhand</option>
<option value="West Bengal">West Bengal</option>
</select>
</td>
</tr>
<tr>
<td>Pin Code</td>
<td><input type="text"/></td>
</tr>
</table>
</fieldset>
<fieldset>
<legend>Qualification Details</legend>
<table width="100%" cellpadding="10px">
<tr>
<th>Sr No.</th>
<th>Qualification</th>
<th>Board/University</th>
<th>Passing Year</th>
<th>Max Marks</th>
<th>Marks Obtain</th>
<th>Percentage</th>
</tr>
<tr>
<td>1</td>
<td>
<select>
<option>--Select--</option>
<option>10th</option>
<option>12th</option>
<option>Graduate</option>
<option>Post Graduate</option>
</select>
</td>
<td>
<input type="text"/>
</td>
<td>
<input type="number" min="1990" max="2022"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="100"/>
</td>
</tr>
<tr>
<td>2</td>
<td>
<select>
<option>--Select--</option>
<option>10th</option>
<option>12th</option>
<option>Graduate</option>
<option>Post Graduate</option>
</select>
</td>
<td>
<input type="text"/>
</td>
<td>
<input type="number" min="1990" max="2022"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="100"/>
</td>
</tr>
<tr>
<td>3</td>
<td>
<select>
<option>--Select--</option>
<option>10th</option>
<option>12th</option>
<option>Graduate</option>
<option>Post Graduate</option>
</select>
</td>
<td>
<input type="text"/>
</td>
<td>
<input type="number" min="1990" max="2022"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="100"/>
</td>
</tr>
<tr>
<td>4</td>
<td>
<select>
<option>--Select--</option>
<option>10th</option>
<option>12th</option>
<option>Graduate</option>
<option>Post Graduate</option>
</select>
</td>
<td>
<input type="text"/>
</td>
<td>
<input type="number" min="1990" max="2022"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="10000"/>
</td>
<td>
<input type="number" min="0" max="100"/>
</td>
</tr>
</table>
</fieldset>
<fieldset>
<legend>Language Knowledge</legend>
<table width="100%">
<tr>
<td>Language</td>
<td>Reading</td>
<td>Writing</td>
<td>Spoken</td>
</tr>
<tr>
<td>Hindi</td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
</tr>
<tr>
<td>English</td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
</tr>
<tr>
<td>Urdu</td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
<td><input type="checkbox"/></td>
</tr>
</table>
</fieldset>
<fieldset>
<legend>Identification Details</legend>
<table>
<tr>
<td>Aadhar Card Number</td>
<td><input type="text" maxlength="12"/></td>
<td>PAN Card Number</td>
<td><input type="text" maxlength="9"/></td>
</tr>
<tr>
<td>Upload Photo</td>
<td><input type="file"/></td>
<td>Upload Signature</td>
<td><input type="file"/></td>
</tr>
</table>
</fieldset>
<br/>
<center>
<input type="submit" value="Submit"/>
<input type="reset" value="Back"/>
</center>
</form>
</body>
</html>
