This the form:
<div style="border: 0px #000 solid; padding:0px 0 0 5px; width:auto;"><h3 align="center"><b>Job Seeker Application Form:</b></div></h3>
<div id="container" class="ltr"><form name="cliform" method="post" action="cli_app_check.php" enctype="multipart/form-data">
<table width="100%" align="center"><tr><td>
<table width="100%" align="center" cellpadding="0" cellspacing="10"><tr><td align="right">Title :</td><td width="16%"><select name="title"><option value="000">Select Title</option><option value="Dr.">Dr.</option><option value="Mr.">Mr.</option><option value="Mrs.">Mrs.</option><option value="Miss.">Miss.</option></select></td><td align="right">Surname :</td><td><input name="sname" type="text" id="sname"></td><td align="right">Other Names :</td><td><input name="onames" type="text" id="onames"></td></tr>
<tr><td align="right">Marital Status :</td><td width="16%"><select name="mstatus"><option value="000">Select Status</option><option value="Single">Single</option><option value="Married">Married</option><option value="Divorced">Divorced</option><option value="Widow">Widow</option><option value="Widower">Widower</option></select></td><td align="right">Sex:</td><td><select name="sex"><option value="000">Select Sex</option><option value="Male">Male</option><option value="Female">Female</option></select></td><td align="right">Date of Birth:</td><td><input name="dob" id="inputField"></td></tr>
<tr><td align="right">Maiden Name:</td><td width="16%"><input name="mname" type="text" id="mname"></td><td align="right">State of Origin:</td><td><select name="stateO">
<option value="000">Select State</option>
<option value="Abia">Abia</option>
<option value="Abuja">Abuja</option>
<option value="Adamawa">Adamawa</option>
<option value="Akwa Ibom">Akwa Ibom</option>
<option value="Anambra">Anambra</option>
<option value="Bauchi">Bauchi</option>
<option value="Bayelsa">Bayelsa</option>
<option value="Benue">Benue</option>
<option value="Borno">Borno</option>
<option value="Cross River">Cross River</option>
<option value="Delta">Delta</option>
<option value="Ebonyi">Ebonyi</option>
<option value="Edo">Edo</option>
<option value="Ekiti">Ekiti</option>
<option value="Enugu">Enugu</option>
<option value="Gombe">Gombe</option>
<option value="Imo">Imo</option>
<option value="Jigawa">Jigawa</option>
<option value="Kaduna">Kaduna</option>
<option value="Kano">Kano</option>
<option value="Katsina">Katsina</option>
<option value="Kebbi">Kebbi</option>
<option value="Kogi">Kogi</option>
<option value="Kwara">Kwara</option>
<option value="Lagos">Lagos</option>
<option value="Nassarawa">Nassarawa</option>
<option value="Niger">Niger</option>
<option value="Ogun">Ogun</option>
<option value="Ondo">Ondo</option>
<option value="Osun">Osun</option>
<option value="Oyo">Oyo</option>
<option value="Plateau">Plateau</option>
<option value="Rivers">Rivers</option>
<option value="Sokoto">Sokoto</option>
<option value="Taraba">Taraba</option>
<option value="Yobe">Yobe</option>
<option value="Zamfara">Zamfara</option>
</select></td><td align="right">L.G.A.:</td><td><input name="lga" type="text" id="lga"></td></tr>
<tr><td align="right">Contact Address:</td><td colspan="2" align="left"><textarea name="conaddress" cols="30" rows="5"></textarea></td><td align="right">Village Address :</td><td colspan="2" align="left"><textarea name="viladdress" cols="30" rows="5"></textarea></td></tr>
<tr><td align="right">Email Address:</td><td><input name="email" type="text" id="email"></td><td align="right">Telephone:</td><td><input name="phone" type="text" id="phone"></td><td align="right">Religion:</td><td><select name="religion"><option value="000">Select Religion</option><option value="Christian">Christian</option><option value="Muslim">Muslim</option><option value="Traditional">Traditional</option></select></td></tr>
<tr><td align="right">Father's Name :</td><td><input name="fatname" type="text" id="fatname"></td><td align="right">Mother's Name:</td><td><input name="motname" type="text" id="motname"></td><td align="right">Name of Spouse:</td><td><input name="spouse" type="text" id="spouse"></td></tr>
<tr><td align="right">Number of Children :</td><td><input name="numchild" type="text" id="numchild"></td><td align="right">Boy (s):</td><td><input name="boys" type="text" id="boys"></td><td align="right">Girl (s):</td><td><input name="girls" type="text" id="girls"></td></tr>
<tr><td align="right"><label for='uploaded_file'> Upload your CV</label>:</td><td colspan="5" align="left"><input name="uploaded_file" type="file" id="cv"></td></tr>
<tr><td colspan="6" align="left"><hr width="100%"></td></tr>
<tr><td colspan="6" align="center"><table width="100%">
<tr><td colspan="4" align="center"><b>Educational Institutions Attended:</b></td></tr>
<b><tr><td width="10%" align="center"></td><td width="35%" align="center"><b>Levels of Education</b></td><td width="35%" align="center"><b>Name of Institution/Professional Body</b></td><td width="20%" align="center"><b>From ......to ......</b></td></tr></b>
<tr><td align="center">A</td><td align="center">Primary Education</td><td align="center"><input name="priatt" type="text"></td><td><input name="pridate" type="text"></td></tr>
<tr><td align="center">B</td><td align="center">Secondary Education</td><td align="center"><input name="secatt" type="text"></td><td><input name="secdate" type="text"></td></tr>
<tr><td align="center">C</td><td align="center">Tertiary Education</td><td align="center"><input name="taratt" type="text" /></td><td><input name="tardate" type="text" /></td></tr>
<tr><td align="center">D</td><td align="center">Post Graduate</td><td align="center"><input name="pgatt" type="text" /></td><td><input name="pgdate" type="text" /></td></tr>
<tr><td align="center">E</td><td align="center">Doctoral</td><td align="center"><input name="docatt" type="text" /></td><td><input name="docdate" type="text" /></td></tr>
<tr><td align="center">F</td><td align="center">Professional Body 1</td><td align="center"><input name="pbody1" type="text" id="pbody1"></td><td><input name="pbody1date" type="text" /></td></tr>
<tr><td align="center">G</td><td align="center">Professional Body 2</td><td align="center"><input name="pbody2" type="text" id="pbody2"></td><td><input name="pbody2date" type="text" /></td></tr>
</table></td></tr>
<tr><td colspan="6" align="left"><hr width="100%"></td></tr>
<tr><td colspan="6" align="center"><table width="100%">
<tr><td colspan="4" align="center"><b>Qualifications Obtained/Course of Study or Area of Specialisation:</b></td></tr>
<b><tr><td width="10%" align="center"></td><td width="35%" align="center"><b>Levels of Education</b></td><td width="35%" align="center"><b>Qualification</b></td><td width="20%" align="center"><b>Course of Study</b></td></tr></b>
<tr><td align="center">A</td><td align="center">Primary Education</td><td align="center"><input name="priq" type="text"></td><td><input name="priqcourse" type="text" /></td></tr>
<tr><td align="center">B</td><td align="center">Secondary Education</td><td align="center"><input name="secq" type="text"/></td><td><input name="secqcourse" type="text" /></td></tr>
sparkles_links 0 Newbie Poster
rotten69 20 Posting Whiz
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