/home/mip/public_html_/old-website/request_formx.php
<?
require_once("func_proc.php");
do_header("Manpower Request");
?>
<script>
function valme() {
if(document.formrequest.Business_Name.value=='') {
alert("Error: Enter Business Name.");
document.formrequest.Business_Name.focus();
return false;
}
if(document.formrequest.Address.value=='') {
alert("Error: Enter Business Address.");
document.formrequest.Address.focus();
return false;
}
if(document.formrequest.Telephone.value=='') {
alert("Error: Enter Telephone Number.");
document.formrequest.Telephone.focus();
return false;
}
if(document.formrequest.Email_Address.value=='') {
alert("Error: Enter Email Address.");
document.formrequest.Email_Address.focus();
return false;
}
if(document.formrequest.Email_Address.value.indexOf('@')<=0) {
alert("Error: Invalid Email Address.");
document.formrequest.Email_Address.focus();
return false;
}
if(document.formrequest.Nature.value=='') {
alert("Error: Enter Nature.");
document.formrequest.Nature.focus();
return false;
}
if(document.formrequest.recaptcha_response_field.value=='') {
alert("Error: Enter Captcha.");
document.formrequest.recaptcha_response_field.focus();
return false;
}
/*if(document.formrequest.txtCaptcha.value=='') {
alert("Error: Enter Captcha.");
document.formrequest.txtCaptcha.focus();
return false;
}*/
return true;
}
</script>
<table width="585" border="0" cellpadding="0" cellspacing="0">
<tr>
<td width="585" height="170" align="right" valign="top">
<table width="100%" height="159" border="0" align="center" cellpadding="0" cellspacing="0" background="images/iris_main_bgleft.gif" style="background-repeat:no-repeat">
<tr>
<td width="585" height="170" valign="top" style="padding-left:25px; padding-right:20px; padding-top:15px">
<p align="left"><span class="style3">MANPOWER</span><span class="style5">REQUEST FORM </span></p>
<div class="indent" align="justify">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td height="3px"></td>
</tr>
<tr>
<td style="padding:10px;">
<div id="result" align="left" style="display:none;">
<label></label>
</div>
<form action="sendmanpowerform.php" method="post" name="formrequest" onSubmit="return request_send()">
<table width="100%" cellpadding="0" cellspacing="0" border="0" bgcolor="#FFFFFF">
<tr>
<td align="left" valign="middle">
Note (<font color="#FF0000">*</font>) are required fields.
<table border="0" cellpadding="0" cellspacing="0" style="border-collapse:collapse">
<tr>
<td height="15" colspan="3"></td>
</tr>
<tr>
<td height="22" align="left"><strong>Business Name</strong></td>
<td align="left"><input name="Business_Name" type="text" size="35"></td>
<td align="left" valign="top"><font color="#FF0000">*</font></td>
</tr>
<tr>
<td height="22" valign="top" align="left"><strong>Business Address</strong></td>
<td align="left"><textarea name="Address" rows="2" cols="32"></textarea></td>
<td align="left" valign="top"><font color="#FF0000">*</font></td>
</tr>
<tr>
<td height="22" align="left"><strong>Telephone Number</strong></td>
<td align="left"><input name="Telephone" type="text" size="35"></td>
<td align="left" valign="top"><font color="#FF0000">*</font></td>
</tr>
<tr>
<td height="22" align="left"><strong>Fax Number</strong></td>
<td align="left"><input name="Fax" type="text" size="35"></td>
<td align="center"> </td>
</tr>
<tr>
<td height="22" align="left"><strong>Email Address</strong></td>
<td align="left"><input name="Email_Address" type="text" size="35"></td>
<td align="center"><font color="#FF0000">*</font></td>
</tr>
<tr>
<td height="22" align="left"><strong>Website</strong></td>
<td align="left"><input name="Website" type="text" size="35"></td>
<td align="center"> </td>
</tr>
<tr>
<td height="15"></td>
<td height="15"></td>
<td height="15"></td>
</tr>
<tr>
<td height="22" align="left"><strong>Contact Person</strong></td>
<td align="left"><input name="Contact_Person" type="text" size="35"></td>
<td align="center"> </td>
</tr>
<tr>
<td height="22" align="left"><strong>Position</strong></td>
<td align="left"><input name="Position" type="text" size="35"></td>
<td align="center"> </td>
</tr>
<tr>
<td height="22" align="left" style="padding-left:2px"><strong>Business License Number </strong></td>
<td align="left"><input name="License_Number" type="text" size="35"></td>
<td align="center"> </td>
</tr>
<tr>
<td height="22" align="left"><strong>Nature of Business</strong></td>
<td align="left"><input name="Nature" type="text" size="35"></td>
<td align="center"><font color="#FF0000">*</font> </td>
</tr>
<tr>
<td height="15" colspan="3"></td>
</tr>
</table>
<br />
<table border="0" cellpadding="0" cellspacing="0">
<tr>
<td width="175" height="29" align="center" valign="top"><strong>Position</strong></td>
<td width="150" align="center" valign="top" ><strong>Number Required</strong></td>
<td width="200" align="center" valign="top"><strong>Job Description (Qualification, age limit..etc)</strong></td>
</tr>
<tr id="fileInput1">
<td valign="top"><input name="Position1" type="text"></td>
<td align="center" valign="top"><input name="Number1" type="text" maxlength="10" size="5"></td>
<td><textarea name="Description1" rows="2"></textarea></td>
</tr>
<tr id="fileInput2">
<td valign="top"><input name="Position2" type="text"></td>
<td align="center" valign="top"><input name="Number2" type="text" size="5"></td>
<td><textarea name="Description2" rows="2"></textarea></td>
</tr>
<tr id="fileInput3">
<td valign="top"><input name="Position3" type="text"></td>
<td valign="top" align="center"><input name="Number3" type="text" size="5"></td>
<td><textarea name="Description3" rows="2"></textarea></td>
</tr>
<?
$row = 15;
for ($b=4; $b<=$row; $b++) {
echo "<tr style=display:none id=fileInput".$b.">
<td valign=top><input name=Position".$b." type=text></td>
<td valign=top align=center><input name=Number".$b." type=text size=5></td>
<td><textarea name=Description".$b." rows=2></textarea></td>
</tr>";
}
?>
<tr>
<td colspan="3" class="data" align="center"><p id="attachMoreLink"><a href="javascript:AddInput();" class="data">Add More</a></p></td>
</tr>
<tr>
<td colspan="3" valign="top" align="center" style="padding-bottom:10px;">
<!-- old captcha
<div style="border-color:#000000; border:solid 1px; width:150px;">
<input id="txtCaptcha" type="text" name="txtCaptcha" size="10" style="text-align:center" />
<img src="create_image.php" name="imgCaptcha" align="absmiddle" id="imgCaptcha" />
<input id="btnCaptcha" type="button" value=" Reset " name="btnCaptcha" onclick="getParam(document.formrequest)" />
<div id="capcha" style="color:#FF0000; padding:5px; display:none;" ></div>
<div id="result" style="display:none;"> </div>
</div>
old captcha -->
<?php
// register here https://www.google.com/recaptcha/admin/create?app=php to create key
require_once('recaptchalib.php');
$publickey = "6LfPIb0SAAAAAIG5n50JZCCxtfWJ5tpKAX18dmAt"; // athenna public key
echo recaptcha_get_html($publickey);
?>
</td>
</tr>
<tr>
<td colspan="3" align="center">
<input name="Send" type="submit" id="Send2" value=" Submit " onclick="return valme();">
<input name="clear" type="reset" value="Clear All">
<input name="cancel" type="button" id="cancel2" value="Cancel" onClick="javascript:history.back();"></td>
</tr>
<tr>
<td colspan="3"> </td>
</tr>
<iframe name="request_iframe" style="width: 400px; height: 100px; display: none;">
</iframe>
</table>
</td>
</tr>
</table>
</form>
</td>
</tr>
</table>
</div>
</td>
</tr>
</table>
</td>
</tr>
</table>
<?
do_rightContent();
do_footer();
?>