myMedisys/tomcatfiles/mymedisys-frontend/WEB-INF/classes/templates/page/worker/next-of-kin.html

<th:block th:utext="#{title.nok}"></th:block>
<form id="formNextOfKin" name="formNextOfKin"
	th:action="@{'/resources/next-of-kin'}" autocomplete="off"
	th:method="post" th:object="${profile}">
	<input type="hidden" th:value="${profile?.wrkrRegId}" name="workerRegId" />
	<input type="hidden" th:value="${profile?.workerProfile?.wrkrProfId}" name="wrkrProfId" />
	<input type="hidden" th:value="${profile?.wrkrRegNo}" name="wrkrRegNo" />
	<input type="hidden" th:value="${updateFlag}" name="updateFlag" />
	<div class="row">
		<div class="col-sm-12 col-md-6 col-lg-6">
			<div class="form-group">
				<th:block th:if="${!isView}">
					<label class="required bmd-label-floating" th:text="#{lbl.wrkr.fullname}"></label>
					<input type="text" class="form-control input-letter" name="name"
						th:field="*{workerProfile.workerKins[0].fullname}"
						required="required" maxlength="100" autofocus="autofocus" />
				</th:block>
			</div>
		</div>
		<div class="col-sm-12 col-md-6 col-lg-6">
			<div class="form-group is-focused">
				<th:block th:if="${!isView}">
					<label class="required bmd-label-floating" th:text="#{lbl.wrkr.relationship}"></label>
					<select name="relationSelection10" id="relationSelection10"
						th:field="*{workerProfile.workerKins[0].relationMtdt.mstrDtCode}"
						class="form-control" required="required">
						<option value="">Relation</option>
						<option th:each="relation : ${relationList}" th:value="${relation.mstrDtCode}" 
							th:text="${relation.mstrDtDesc.en}"></option>
					</select>
				</th:block>
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-12 col-md-6 col-lg-6">
			<div class="form-group">
				<th:block th:if="${!isView}">
					<label class="required bmd-label-floating" th:text="#{lbl.wrkr.dob}"></label>
					<input type="text" class="form-control datepicker dobKinPicker"
						th:field="*{workerProfile.workerKins[0].dob}" id="kinDateOfBirth"
						name="kinDateOfBirth" required="required" />
				</th:block>
			</div>
		</div>
		<div class="col-sm-12 col-md-6 col-lg-6">
			<div class="form-group">
				<th:block th:if="${!isView}">
					<label class="bmd-label-floating" th:text="#{lbl.wrkr.passport}"></label>
					<input type="text" class="form-control input-letter-number"
						th:field="*{workerProfile.workerKins[0].passportNo}"
						name="passportNo" maxlength="15" autofocus="autofocus" />
				</th:block>
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-12 col-md-6 col-lg-6">
			<div class="form-group">
				<th:block th:if="${!isView}">
					<label class="required bmd-label-floating" th:text="#{lbl.wrkr.contact}"></label>
					<input type="text" class="form-control input-contact input-number" 
					th:field="*{workerProfile.workerKins[0].contactNo}" required="required"
						autofocus="autofocus" maxlength="15" data-init-country="BD" />
				</th:block>
			</div>
		</div>
		<div class="col-sm-12 col-md-6 col-lg-6">
			<div class="form-group is-focused">
				<th:block th:if="${!isView}">
					<label class="required bmd-label-floating" th:text="#{lbl.wrkr.gender}"></label>
					<select name="genderSelection6" id="genderSelection6"
						th:field="*{workerProfile.workerKins[0].gender}" 
						class="form-control">
						<option value="">Gender</option>
						<option th:each="gender : ${genderList}" th:value="${gender.mstrDtCode}" 
							th:text="${gender.mstrDtDesc.en}"></option>
					</select>
				</th:block>
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-12 col-md-2 col-lg-12">
			<div class="form-group">
				<th:block th:if="${!isView}">
					<label class="required bmd-label-floating" th:text="#{lbl.wrkr.address}"></label>
					<textarea class="form-control clear-whitespace" maxlength="200" required="required"
						th:field="*{workerProfile.workerKins[0].addr1}"
						autofocus="autofocus" name="address"></textarea>
				</th:block>
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-12 col-md-6 col-lg-6">
			<div class="form-group">
				<th:block th:if="${!isView}">
					<label class="required bmd-label-floating" th:text="#{lbl.wrkr.zipcode}"></label>
					<input type="number" class="form-control input-number"
						th:field="*{workerProfile.workerKins[0].zipcode}"
						name="zipcode" required="required" maxlength="10" autofocus="autofocus" />
				</th:block>
			</div>
		</div>
		<div class="col-sm-12 col-md-6 col-lg-6">
			<div class="form-group is-focused">
				<th:block th:if="${!isView}">
					<label class="required bmd-label-floating" th:text="#{lbl.wrkr.country}"></label>
					<select name="workerProfile.workerKins[0].country.cntryCode" id="countrySelection10"
						th:field="*{workerProfile.workerKins[0].country.cntryCode}"
						class="form-control" required="required">
						<option value="">Select Country</option>
						<option th:each="country : ${countryList}" th:value="${country.cntryCode}" 
							th:text="${country.cntryDesc}" th:selected="${country.cntryCode == 'BD'}"></option>
					</select>
				</th:block>
			</div>
		</div>
	</div>
	<div class="pb-3 text-right">
		<div class="ml-auto button-group">
			<a class="btn waves-effect waves-light btn-secondary" th:href="@{${'/resources/previousTab?previousTab='+previousTab + '&wrkrRegId=' + profile?.wrkrRegId + '&updateFlag=' + updateFlag}}" aria-hidden="true">Previous</a>
			<button type="submit" class="btn waves-effect waves-light btn-primary btn-check-device">Save and Continue</button>
		</div>
	</div>
</form>