<link href="//netdna.bootstrapcdn.com/bootstrap/3.0.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.0.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<div class="container">
<div class="row">
<h1>Application Form</h1>
</div>
</div>
<form role="form" class="application-form" action="javascript:void(0);">
<fieldset>
<div class="form-top">
<div class="form-top-left">
<h3><span><i class="fa fa-calendar-check-o" aria-hidden="true"></i></span>Contact Details</h3>
<p>Enter Your Contact Information
</p>
</div>
</div>
<div class="form-bottom">
<div class="row">
<div class="form-group col-md-6 col-sm-6">
<input type="text" class="form-control" placeholder="Full Name" id="fname" required>
</div>
<div class="form-group col-md-6 col-sm-6">
<input type="text" name="email" placeholder="Email" class="form-email form-control" id="email" required>
</div>
</div>
<div class="form-group" style="margin-bottom:3px;">
<div class="row">
<div class="form-group col-md-9 col-sm-9">
<input type="date" class="form-control" placeholder="Date of Birth" id="pref_date" required>
</div>
<div class="form-group col-md-9 col-sm-9">
<input type="text" class="form-control" placeholder="Phone Number" id="contact_number" required>
</div>
</div>