<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 ---------->
<form class="form-horizontal">
<fieldset class="form-group">
<!-- Primeira Linha -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Vale Transporte</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValValeTransp" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/dia </span>
</div>
</div>
</div>
<div class="form-group col-md-6">
<label class="col-md-4 control-label" for="appendedtext">Desconto Vale Transporte</label>
<div class="col-md-4">
<div class="input-group">
<input id="DescValeTransp" name="appendedtext" class="form-control" placeholder="100,00" type="text" maxlength="5" onblur="AjeitaNumInput(this, 5, 2, 1, 1)" required="">
<span class="input-group-addon">%</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Segunda Linha -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Plano Médico</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValPlanoMedico" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/mês</span>
</div>
</div>
</div>
<div class="form-group col-md-6">
<label class="col-md-4 control-label" for="appendedtext">Desconto Plano Médico</label>
<div class="col-md-4">
<div class="input-group">
<input id="DescPlanoMedico" name="appendedtext" class="form-control" placeholder="100,00" type="text" maxlength="5" onblur="AjeitaNumInput(this, 5, 2, 1, 1)" required="">
<span class="input-group-addon">%</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Terceira Linha -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Plano Odontológico</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValPlanoOdontologico" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/mês</span>
</div>
</div>
</div>
<div class="form-group col-md-6">
<label class="col-md-4 control-label" for="appendedtext">Desconto Pl. Odontol.</label>
<div class="col-md-4">
<div class="input-group">
<input id="DescPlanoOdontologico" name="appendedtext" class="form-control" placeholder="100,00" type="text" maxlength="5" onblur="AjeitaNumInput(this, 5, 2, 1, 1)" required="">
<span class="input-group-addon">%</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Quarta Linha -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Ticket Alimentação<br>ou Cesta Básica</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValTicketAlimentacaoDia" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/dia </span>
</div>
</div>
</div>
<div class="form-group col-md-6">
<label class="col-md-4 control-label" for="appendedtext">Desconto Alimentação</label>
<div class="col-md-4">
<div class="input-group">
<input id="DescTicketAlimentacaoDia" name="appendedtext" class="form-control" placeholder="100,00" type="text" maxlength="5" onblur="AjeitaNumInput(this, 5, 2, 1, 1)" required="">
<span class="input-group-addon">%</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Linha 5 -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Ticket Alimentação<br>ou Cesta Básica</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValTicketAlimentacaoMes" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/mês</span>
</div>
</div>
</div>
<div class="form-group col-md-6">
<label class="col-md-4 control-label" for="appendedtext">Desconto Alimentação</label>
<div class="col-md-4">
<div class="input-group">
<input id="DescTicketAlimentacaoMes" name="appendedtext" class="form-control" placeholder="100,00" type="text" maxlength="5" onblur="AjeitaNumInput(this, 5, 2, 1, 1)" required="">
<span class="input-group-addon">%</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Linha 6 -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Ticket Refeição</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValTicketRefeicaoDia" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/dia </span>
</div>
</div>
</div>
<div class="form-group col-md-6">
<label class="col-md-4 control-label" for="appendedtext">Desconto Refeição</label>
<div class="col-md-4">
<div class="input-group">
<input id="DescTicketRefeicaoDia" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="5" onblur="AjeitaNumInput(this, 5, 2, 1, 1)" required="">
<span class="input-group-addon">%</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Linha 7 -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Ticket Refeição</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValTicketRefeicaoMes" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/mês</span>
</div>
</div>
</div>
<div class="form-group col-md-6">
<label class="col-md-4 control-label" for="appendedtext">Desconto Refeição</label>
<div class="col-md-4">
<div class="input-group">
<input id="DescTicketRefeicaoMes" name="appendedtext" class="form-control" placeholder="100,00" type="text" maxlength="5" onblur="AjeitaNumInput(this, 5, 2, 1, 1)" required="">
<span class="input-group-addon">%</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Linha 8 -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Seguro de Vida</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValSegVida" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/mês</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Linha 9 -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Adicional de Assiduidade</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValAdicAssid" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/mês</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Linha 10 -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Programa de Assistência Familiar (PAF)</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValPAF" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/mês</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
<!-- Linha 10 -->
<div class="form-group col-md-6">
<label class="col-md-6 control-label" for="appendedtext">Programa de Qualificação Profissional e Marketing (PQM)</label>
<div class="col-md-6">
<div class="input-group">
<input id="ValPQM" name="appendedtext" class="form-control" placeholder="9.999.999,99" type="text" maxlength="12" onblur="AjeitaNumInput(this, 12, 2, 1, 1)" required="">
<span class="input-group-addon">R$/mês</span>
</div>
</div>
</div>
<br>
<div class="clearfix"></div>
</fieldset>
</form>
