File: //var/www/html/punjabcabs/resources/views/provider/application/index.blade.php
@extends('provider.layout.app')
@section('styles')
<style>
.form-control{
border: none;
}
.profile-form .form-group {
padding: 2px 0;
}
.profile-form .form-control{
border-bottom: 1px solid #504f4f;
height: 27px;
font-size: 14px;
}
.customtable td{
padding: 5px 10px;
}
.customtable input{
width: 18px;
height: 18px;
}
</style>
<link rel="stylesheet" type="text/css" href="https://cdnjs.cloudflare.com/ajax/libs/jquery-datetimepicker/2.5.4/jquery.datetimepicker.min.css" />
@endsection
@section('content')
<div class="pro-dashboard-head">
<div class="container">
<a href="{{ url('/provider') }}" class="pro-head-link">Drive Now</a>
<a href="#" class="pro-head-link ">@lang('driver.profile.profile')</a>
<a href="{{ route('provider.documents.index') }}" class="pro-head-link">@lang('driver.profile.manage_documents')</a>
<a href="#" class="pro-head-link active">Application</a>
<a href="{{ route('provider.location.index') }}" class="pro-head-link">@lang('driver.profile.update_location')</a>
</div>
</div>
<!-- Pro-dashboard-content -->
<div class="pro-dashboard-content gray-bg">
<div class="profile">
<!-- Profile head -->
<!-- Profile-content -->
<div class="profile-content gray-bg pad50">
<div class="container">
<div class="row no-margin">
<div class="col-md-8">
@include('common.notify')
</div>
<div class="col-lg-8 col-md-8 col-sm-8 col-xs-12 no-padding">
<h4>NEW APPLICATION DATA FORM</h4><br>
<form class="profile-form" action="{{route('provider.application.update')}}" method="POST" enctype="multipart/form-data" role="form">
{{csrf_field()}}
<!-- Prof-form-sub-sec -->
<div class="prof-form-sub-sec">
<div class="row no-margin">
<div class="prof-sub-col col-sm-4 col-xs-12 no-left-padding">
<div class="form-group">
<label>Name</label>
<input type="text" class="form-control" name="name" value="{{ old('name') }}" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-4 col-xs-12 no-right-padding">
<div class="form-group">
<label>Last Name</label>
<input type="text" class="form-control" name="last_name" value="{{ old('last_name') }}" autocomplete="off">
</div>
</div>
</div>
<div class="row no-margin">
<div class="prof-sub-col col-sm-4 col-xs-12 no-left-padding">
<div class="form-group">
<label>DOB</label>
<input type="text" value="{{ old('dob') }}" class="form-control" name="dob" id="dob" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-4 col-xs-12 no-right-padding">
<div class="form-group">
<label>SSN</label>
<input type="text" value="{{ old('ssn') }}" class="form-control" name="ssn" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-4 col-xs-12 no-right-padding">
<div class="form-group">
<label>PHONE #</label>
<input type="text" value="{{ old('phone') }}" class="form-control" name="phone" autocomplete="off">
</div>
</div>
</div>
<div class="row no-margin">
<div class="prof-sub-col col-sm-8 col-xs-12 no-left-padding">
<div class="form-group">
<label>Driver License</label>
<input type="text" value="{{ old('driver_license') }}" class="form-control" name="driver_license" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-4 col-xs-12 no-right-padding">
<div class="form-group">
<label>Expiration Date</label>
<input type="text" value="{{ old('expiration_date') }}" class="form-control" name="expiration_date" id="expiration" autocomplete="off">
</div>
</div>
</div>
<div class="row no-margin">
<div class="prof-sub-col col-sm-8 col-xs-12 no-left-padding">
<div class="form-group">
<label>Who is Your emergency contact person?</label>
<input type="text" value="{{ old('emergency_person') }}" class="form-control" name="emergency_person" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-4 col-xs-12 no-right-padding">
<div class="form-group">
<label>Phone #</label>
<input type="text" value="{{ old('emergency_phone') }}" class="form-control" name="emergency_phone" autocomplete="off">
</div>
</div>
</div>
<div class="row no-margin">
<div class="prof-sub-col col-sm-12 col-xs-12 no-left-padding">
<div class="form-group">
<label>Have you ever been convicted for crime</label><br>
Yes<input type="radio" class="form-control" name="crime" value="yes" style="width: 5%;display: inline-block;">
No
<input type="radio" class="form-control" name="crime" value="no" style="width: 5%;display: inline-block;">
(Say yes, it does not disqualify you)
<br><br>
if yes, please explain <input type="text" class="form-control" name="crime_explain" style="width: 76%;display: inline-block;">
</div>
</div>
</div>
<div class="row no-margin">
<div class="prof-sub-col col-sm-12 col-xs-12 no-left-padding">
<label>Tell us about your vehicle</label>
</div>
<div class="prof-sub-col col-sm-2 col-xs-12 no-left-padding">
<div class="form-group">
<label>Make</label>
<input type="text" value="{{ old('make') }}" class="form-control" name="make" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-2 col-xs-12 no-left-padding">
<div class="form-group">
<label>Model</label>
<input type="text" value="{{ old('model') }}" class="form-control" name="model" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-2 col-xs-12 no-left-padding">
<div class="form-group">
<label>Type</label>
<input type="text" value="{{ old('model_type') }}" class="form-control" name="model_type" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-2 col-xs-12 no-left-padding">
<div class="form-group">
<label>Year</label>
<input type="text" value="{{ old('year') }}" class="form-control" name="year" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-2 col-xs-12 no-left-padding">
<div class="form-group">
<label>Color</label>
<input type="text" value="{{ old('color') }}" class="form-control" name="color" autocomplete="off">
</div>
</div>
<div class="prof-sub-col col-sm-2 col-xs-12 no-left-padding">
<div class="form-group">
<label>License Plate</label>
<input type="text" value="{{ old('license_plate') }}" class="form-control" name="license_plate" autocomplete="off">
</div>
</div>
</div>
<div class="row no-margin">
<div class="prof-sub-col col-sm-12 col-xs-12 no-left-padding">
<table class="customtable">
<tr>
<td>what is your preferred schedule?</td>
<td>M</td>
<td>TU</td>
<td>WE</td>
<td>THU</td>
<td>FR</td>
<td>SAT</td>
<td>SUN</td>
</tr>
<tr>
<td>AM(7 am to 3 pm)</td>
<td><input type="checkbox" name="shift1[]" value="M"></td>
<td><input type="checkbox" name="shift1[]" value="TU"></td>
<td><input type="checkbox" name="shift1[]" value="WE"></td>
<td><input type="checkbox" name="shift1[]" value="THU"></td>
<td><input type="checkbox" name="shift1[]" value="FR"></td>
<td><input type="checkbox" name="shift1[]" value="SAT"></td>
<td><input type="checkbox" name="shift1[]" value="SUN"></td>
</tr>
<tr>
<td>PM(3 am to 11 pm)</td>
<td><input type="checkbox" name="shift2[]" value="M"></td>
<td><input type="checkbox" name="shift2[]" value="TU"></td>
<td><input type="checkbox" name="shift2[]" value="WE"></td>
<td><input type="checkbox" name="shift2[]" value="THU"></td>
<td><input type="checkbox" name="shift2[]" value="FR"></td>
<td><input type="checkbox" name="shift2[]" value="SAT"></td>
<td><input type="checkbox" name="shift2[]" value="SUN"></td>
</tr>
<tr>
<td>NIGHT (11 pm to 7 am</td>
<td><input type="checkbox" name="shift3[]" value="M"></td>
<td><input type="checkbox" name="shift3[]" value="TU"></td>
<td><input type="checkbox" name="shift3[]" value="WE"></td>
<td><input type="checkbox" name="shift3[]" value="THU"></td>
<td><input type="checkbox" name="shift3[]" value="FR"></td>
<td><input type="checkbox" name="shift3[]" value="SAT"></td>
<td><input type="checkbox" name="shift3[]" value="SUN"></td>
</tr>
</table>
</div>
<div class="prof-sub-col col-sm-12 col-xs-12 no-left-padding">
<label > (It does not need to be full shif of 8 hours)</label>
</div>
</div>
<div class="row no-margin">
<div class="prof-sub-col col-sm-12 col-xs-12 no-left-padding">
<p>I give my consent to, {{ Setting::get('site_title','Unicotaxi') }} to consult my criminal record, I understand that putting the false information automatically disqualifies me to work as an independent motorist for {{ Setting::get('site_title','Unicotaxi') }}</p>
<p>By clicking in the next bottom, I agree to send my personal information to {{ Setting::get('site_title','Unicotaxi') }} for it to be reviewed.</p>
<p>Sending this information to {{ Setting::get('site_title','Unicotaxi') }} does not obligate {{ Setting::get('site_title','Unicotaxi') }} for me to be accepted into the {{ Setting::get('site_title','Unicotaxi') }} independent riders team.</p>
</div>
</div>
</div>
<!-- End of prof-sub-sec -->
<!-- Prof-form-sub-sec -->
<div class="prof-form-sub-sec border-top">
<div class="col-xs-12 col-md-6 col-md-offset-3">
<button type="submit" class="btn btn-block btn-primary update-link">Submit</button>
</div>
</div>
<!-- End of prof-sub-sec -->
</form>
</div>
</div>
</div>
</div>
</div>
</div>
@endsection
@section('scripts')
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-datetimepicker/2.5.4/build/jquery.datetimepicker.full.min.js"></script>
<script>
var mindate = {!! json_encode( \Carbon\Carbon::today()->format('Y-m-d\TH:i') ) !!}
$('#dob').datetimepicker({
format:'Y-m-d',
timepicker: false
});
$('#expiration').datetimepicker({
format:'Y-m-d',
timepicker: false,
minDate: mindate
});
</script>
@endsection