<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="row" style="width:95%; margin-left:auto; margin-right:auto;"> <div class="col-md-12"> <div class="row"> <h3>E-Form | MP-1-4-055 - Notification of Pay Rates - MPF55 - New Starter Form </h3><hr/> </div> <div class="row"> <div class="col-md-4"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title">Personal Information</h3> </div> <div class="panel-body"> <div class="row"> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Title</label> <div class="col-md-8"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Mr</option> <option value="2">Mrs</option> <option value="3">Miss</option> <option value="4">Ms</option> <option value="5">Dr</option> <option value="6">Rather Not Say</option> </select> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Surname</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Known As</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Date of Birth</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> </div> </div> </div> </div> <div class="col-md-4"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title">Address Information</h3> </div> <div class="panel-body"> <div class="row"> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Address 1</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Address 2</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Town/City</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Postcode</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Country</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> </div> </div> </div> </div> <div class="col-md-4"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title">Contact Information</h3> </div> <div class="panel-body"> <div class="row"> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Home Tel.</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Mob Tel.</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Personal Email Address</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> <br/> </div> </div> </div> </div> <br/> <div class="pull-right"> <a href="#" class="btn btn-success">Save and Continue</a> </div> </div> <hr/> <div class="row"> <div class="col-md-3"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title">Contract Information</h3> </div> <div class="panel-body"> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Contract Type</label> <div class="col-md-8"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Accomodation Only Personnel</option> <option value="2">Agency Personnel</option> <option value="3">Morson Projects Ltd Co</option> <option value="4">Morson Projects Ltd Consultant</option> <option value="5">Morson Projects Staff</option> <option value="6">Morson Projects Temporary Staff</option> <option value="7">Supplied by 2nd Tier Supplier</option> </select> </div> </div> </div> </div> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title">Service Information</h3> </div> <div class="panel-body"> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Start Date</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Finish Date</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Notice Period</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md"> </div> </div> </div> </div> </div> <div class="col-md-9 pull-right"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title">Contract Information</h3> </div> <div class="panel-body"> <div class="col-md-6"> <!-- Text input--> <div class="form-group"> <label class="col-md-5 control-label" for="textinput">Ltd Company Name</label> <div class="col-md-7"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-5 control-label" for="textinput">Company Addr. 1 (if different)</label> <div class="col-md-7"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-5 control-label" for="textinput">Company Addr. 2 (if different)</label> <div class="col-md-7"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-5 control-label" for="textinput">Company Town (if different)</label> <div class="col-md-7"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-5 control-label" for="textinput">Company Country (if different)</label> <div class="col-md-7"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-5 control-label" for="textinput">Company Postcode (if different)</label> <div class="col-md-7"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-5 control-label" for="textinput">Company Tel. (if different)</label> <div class="col-md-7"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/> <!-- Text input--> <div class="form-group"> <label class="col-md-5 control-label" for="textinput">Company VAT No.</label> <div class="col-md-7"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> </div> <div class="col-md-3"> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Agency Name</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Agency Mark Up</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--><br/> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Agency Charge Rate</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Client Charge Rate</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Client</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> </div> <div class="col-md-3"> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <br/><!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Forename</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> </div> </div> </div> </div> </div> </div> </div>