Brijesh's Git Server — form-autocomplete @ 827aed0f598942db3a67af6061dbebfd9fc0cea7

test.html (view raw)

 1
 2
 3
 4
 5
 6
 7
 8
 9
 10
 11
 12
 13
 14
 15
 16
 17
 18
 19
 20
 21
 22
 23
 24
 25
 26
 27
 28
 29
 30
 31
 32
 33
 34
 35
 36
 37
 38
 39
 40
 41
 42
 43
 44
 45
 46
 47
 48
 49
 50
 51
 52
 53
 54
 55
 56
 57
 58
 59
 60
 61
 62
 63
 64
 65
 66
 67
 68
 69
 70
 71
 72
 73
 74
 75
 76
 77
 78
 79
 80
 81
 82
 83
 84
 85
 86
 87
 88
 89
 90
 91
 92
 93
 94
 95
 96
 97
 98
 99
 100
 101
 102
 103
 104
 105
 106
 107
 108
 109
 110
 111
 112
 113
 114
 115
 116
 117
 118
 119
 120
 121
 122
 123
 124
 125
 126
 127
 128
 129
 130
 131
 132
 133
 134
 135
 136
 137
 138
 139
 140
 141
 142
 
<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Form Test Page</title>
    <script src="https://cdn.tailwindcss.com"></script>
</head>
<body class="bg-gray-100 p-8">
    <div class="max-w-2xl mx-auto bg-white p-8 rounded-lg shadow-md">
        <h1 class="text-2xl font-bold mb-6 text-gray-800">User Registration Form</h1>
        
        <form class="space-y-6">
            <!-- Personal Information -->
            <div class="space-y-4">
                <h2 class="text-xl font-semibold text-gray-700">Personal Information</h2>
                
                <div class="grid grid-cols-2 gap-4">
                    <div>
                        <label for="firstName" class="block text-sm font-medium text-gray-700">First Name</label>
                        <input type="text" id="firstName" name="firstName" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                    </div>
                    <div>
                        <label for="lastName" class="block text-sm font-medium text-gray-700">Last Name</label>
                        <input type="text" id="lastName" name="lastName" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                    </div>
                </div>

                <div>
                    <label for="email" class="block text-sm font-medium text-gray-700">Email Address</label>
                    <input type="email" id="email" name="email" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                </div>

                <div>
                    <label for="phone" class="block text-sm font-medium text-gray-700">Phone Number</label>
                    <input type="tel" id="phone" name="phone" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                </div>

                <div>
                    <label for="dateOfBirth" class="block text-sm font-medium text-gray-700">Date of Birth</label>
                    <input type="date" id="dateOfBirth" name="dateOfBirth" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                </div>
            </div>

            <!-- Address Information -->
            <div class="space-y-4">
                <h2 class="text-xl font-semibold text-gray-700">Address</h2>
                
                <div>
                    <label for="streetAddress" class="block text-sm font-medium text-gray-700">Street Address</label>
                    <input type="text" id="streetAddress" name="streetAddress" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                </div>

                <div class="grid grid-cols-2 gap-4">
                    <div>
                        <label for="city" class="block text-sm font-medium text-gray-700">City</label>
                        <input type="text" id="city" name="city" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                    </div>
                    <div>
                        <label for="state" class="block text-sm font-medium text-gray-700">State</label>
                        <select id="state" name="state" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                            <option value="">Select State</option>
                            <option value="CA">California</option>
                            <option value="NY">New York</option>
                            <option value="TX">Texas</option>
                        </select>
                    </div>
                </div>

                <div>
                    <label for="zipCode" class="block text-sm font-medium text-gray-700">ZIP Code</label>
                    <input type="text" id="zipCode" name="zipCode" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                </div>
            </div>

            <!-- Professional Information -->
            <div class="space-y-4">
                <h2 class="text-xl font-semibold text-gray-700">Professional Information</h2>
                
                <div>
                    <label for="occupation" class="block text-sm font-medium text-gray-700">Occupation</label>
                    <input type="text" id="occupation" name="occupation" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                </div>

                <div>
                    <label for="company" class="block text-sm font-medium text-gray-700">Company</label>
                    <input type="text" id="company" name="company" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                </div>

                <div>
                    <label for="experience" class="block text-sm font-medium text-gray-700">Years of Experience</label>
                    <input type="number" id="experience" name="experience" min="0" max="50" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500">
                </div>

                <div>
                    <label for="skills" class="block text-sm font-medium text-gray-700">Skills</label>
                    <textarea id="skills" name="skills" rows="3" class="mt-1 block w-full rounded-md border border-gray-300 shadow-sm focus:border-blue-500 focus:ring-blue-500"></textarea>
                </div>
            </div>

            <!-- Preferences -->
            <div class="space-y-4">
                <h2 class="text-xl font-semibold text-gray-700">Preferences</h2>
                
                <div>
                    <label class="block text-sm font-medium text-gray-700">Communication Preferences</label>
                    <div class="mt-2 space-y-2">
                        <div class="flex items-center">
                            <input type="checkbox" id="emailUpdates" name="emailUpdates" class="h-4 w-4 rounded border-gray-300 text-blue-600 focus:ring-blue-500">
                            <label for="emailUpdates" class="ml-2 block text-sm text-gray-700">Email Updates</label>
                        </div>
                        <div class="flex items-center">
                            <input type="checkbox" id="smsUpdates" name="smsUpdates" class="h-4 w-4 rounded border-gray-300 text-blue-600 focus:ring-blue-500">
                            <label for="smsUpdates" class="ml-2 block text-sm text-gray-700">SMS Updates</label>
                        </div>
                    </div>
                </div>

                <div>
                    <label class="block text-sm font-medium text-gray-700">Newsletter Subscription</label>
                    <div class="mt-2 space-y-2">
                        <div class="flex items-center">
                            <input type="radio" id="weekly" name="newsletter" value="weekly" class="h-4 w-4 rounded border-gray-300 text-blue-600 focus:ring-blue-500">
                            <label for="weekly" class="ml-2 block text-sm text-gray-700">Weekly</label>
                        </div>
                        <div class="flex items-center">
                            <input type="radio" id="monthly" name="newsletter" value="monthly" class="h-4 w-4 rounded border-gray-300 text-blue-600 focus:ring-blue-500">
                            <label for="monthly" class="ml-2 block text-sm text-gray-700">Monthly</label>
                        </div>
                    </div>
                </div>
            </div>

            <div class="pt-4">
                <button type="submit" class="w-full bg-blue-600 py-2 px-4 text-white rounded-md hover:bg-blue-700 focus:outline-none focus:ring-2 focus:ring-blue-500 focus:ring-offset-2">
                    Submit Registration
                </button>
            </div>
        </form>
    </div>
</body>
</html>