@extends('index')
@section('content')

<div class="container">
    <div class="row">
        <div class="col-md-10 ">
            <form class="form-horizontal">
                <fieldset>
                    <!-- Form Name -->
                    <legend>CUENTA DE USUARIO</legend>
                    <!-- Text input-->                 
                    <div class="form-group">
                        <label class="col-md-4 control-label" for="Name (Full name)">Name (Full name)</label>  
                        <div class="col-md-4">
                            <div class="input-group">
                                <div class="input-group-addon">
                                    <i class="fa fa-user">
                                    </i>
                                </div>
                                <input id="Name (Full name)" name="Name (Full name)" type="text" placeholder="Name (Full name)" class="form-control input-md">
                            </div>   
                        </div>
                    </div>
                    <!-- File Button --> 
                    <div class="form-group">
                        <label class="col-md-4 control-label" for="Upload photo">Upload photo</label>
                        <div class="col-md-4">
                            <input id="Upload photo" name="Upload photo" class="input-file" type="file">
                        </div>
                    </div>

                    <!-- Text input-->
                    <div class="form-group">
                        <label class="col-md-4 control-label" for="Date Of Birth">Date Of Birth</label>  
                            <div class="col-md-4">

                                <div class="input-group">
                                    <div class="input-group-addon">
                                        <i class="fa fa-birthday-cake"></i>
                            
                                    </div>
                                    <input id="Date Of Birth" name="Date Of Birth" type="text" placeholder="Date Of Birth" class="form-control input-md">
                                </div>                                        
                            </div>
                        </div>
                        
                        <!-- Text input-->
                        <div class="form-group">
                            <label class="col-md-4 control-label" for="Father">Father's name</label>  
                            <div class="col-md-4">
                                <div class="input-group">
                                    <div class="input-group-addon">
                                        <i class="fa fa-male" style="font-size: 20px;"></i>                                
                                    </div>
                                    <input id="Father" name="Father" type="text" placeholder="Father's name" class="form-control input-md">                                
                                </div>                            
                            </div>
                        </div>
                        <!-- Text input-->
                        <div class="form-group">
                            <label class="col-md-4 control-label" for="Mother">Mother's Name</label>  
                                <div class="col-md-4">
                                    <div class="input-group">
                                        <div class="input-group-addon">
                                            <i class="fa fa-female" style="font-size: 20px;"></i>                                
                                        </div>
                                        <input id="Mother" name="Mother" type="text" placeholder="Mother's Name" class="form-control input-md">
                                    </div>                            
                                </div>
                            </div>
                            <!-- Multiple Radios (inline) -->
                            <div class="form-group">
                            <label class="col-md-4 control-label" for="Gender">Gender</label>
                            <div class="col-md-4"> 
                                <label class="radio-inline" for="Gender-0">
                                <input type="radio" name="Gender" id="Gender-0" value="1" checked="checked">
                                Male
                                </label> 
                                <label class="radio-inline" for="Gender-1">
                                <input type="radio" name="Gender" id="Gender-1" value="2">
                                Female
                                </label> 
                                <label class="radio-inline" for="Gender-2">
                                <input type="radio" name="Gender" id="Gender-2" value="3">
                                Other
                                </label>
                            </div>
                            </div>

                            <!-- Multiple Radios (inline) -->
                            <div class="form-group">
                            <label class="col-md-4 control-label" for="radios">Marital Status:</label>
                            <div class="col-md-4"> 
                                <label class="radio-inline" for="radios-0">
                                <input type="radio" name="radios" id="radios-0" value="1" checked="checked">
                                Married
                                </label> 
                                <label class="radio-inline" for="radios-1">
                                <input type="radio" name="radios" id="radios-1" value="2">
                                Unmarried
                                </label>
                            </div>
                            </div>

                            <!-- Text input-->
                            <!-- <div class="form-group">
                            <label class="col-md-4 control-label" for="Temporary Address">Temporary Address</label>  
                            <div class="col-md-4">

                            <div class="input-group">
                                <div class="input-group-addon">
                                <i class="fa fa-home" style="font-size:20px;"></i>
                                    
                                </div>
                            <input id="Temporary Address" name="Temporary Address" type="text" placeholder="Temporary Address" class="form-control input-md">
                                </div>
                            
                                
                            </div>
                            </div>
                            -->
                            <div class="form-group">
                            <label class="col-md-4 control-label col-xs-12" for="Permanent Address">Permanent Address</label>  
                            <div class="col-md-2  col-xs-4">
                            <input id="Permanent Address" name="Permanent Address" type="text" placeholder="District" class="form-control input-md ">
                            </div>

                            <div class="col-md-2 col-xs-4">

                            <input id="Permanent Address" name="Permanent Address" type="text" placeholder="Area" class="form-control input-md ">
                            </div>                            
                            </div>

                            <div class="form-group">
                            <label class="col-md-4 control-label" for="Permanent Address"></label>  
                            <div class="col-md-2  col-xs-4">
                            <input id="Permanent Address" name="Permanent Address" type="text" placeholder="Street" class="form-control input-md ">
                            
                            </div>
                            </div>
                            <div class="form-group">
                            <label class="col-md-4 control-label col-xs-12" for="Temporary Address">Temporary Address</label>  
                            <div class="col-md-2  col-xs-4">
                            <input id="Temporary Address" name="Temporary Address" type="text" placeholder="District" class="form-control input-md ">
                            </div>

                            <div class="col-md-2 col-xs-4">

                            <input id="Temporary Address" name="Temporary Address" type="text" placeholder="Area" class="form-control input-md ">
                            </div>

                            
                            </div>

                            <div class="form-group">
                            <label class="col-md-4 control-label" for="Temporary Address"></label>  
                            <div class="col-md-2  col-xs-4">
                            <input id="Temporary Address" name="Temporary Address" type="text" placeholder="Street" class="form-control input-md ">
                            
                            </div>
                        </div>




<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Primary Occupation">Primary Occupation</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-briefcase"></i>
        
       </div>
      <input id="Primary Occupation" name="Primary Occupation" type="text" placeholder="Primary Occupation" class="form-control input-md">
      </div>
  
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Secondary Occupation (if any)">Secondary Occupation (if any)</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
      <i class="fa fa-briefcase"></i>
        
       </div>
     <input id="Secondary Occupation (if any)" name="Secondary Occupation (if any)" type="text" placeholder="Secondary Occupation (if any)" class="form-control input-md">
      </div>
  
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Skills">Skills</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-graduation-cap"></i>
        
       </div>
     <input id="Skills" name="Skills" type="text" placeholder="Skills" class="form-control input-md">
      </div>
 
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Phone number ">Phone number </label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-phone"></i>
        
       </div>
    <input id="Phone number " name="Phone number " type="text" placeholder="Primary Phone number " class="form-control input-md">
    
      </div>
      <div class="input-group othertop">
       <div class="input-group-addon">
     <i class="fa fa-mobile fa-1x" style="font-size: 20px;"></i>
        
       </div>
    <input id="Phone number " name="Secondary Phone number " type="text" placeholder=" Secondary Phone number " class="form-control input-md">
    
      </div>
  
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Email Address">Email Address</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-envelope-o"></i>
        
       </div>
    <input id="Email Address" name="Email Address" type="text" placeholder="Email Address" class="form-control input-md">
    
      </div>
  
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Availability time">Availability time</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-clock-o"></i>
        
       </div>
    <input id="Availability time" name="Availability time" type="text" placeholder="Availability time" class="form-control input-md">
    
      </div>
  
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Available Service Area">Available Service Area</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-street-view"></i>
        
       </div>
   <input id="Available Service Area" name="Available Service Area" type="text" placeholder="Available Service Area" class="form-control input-md">
    
      </div>
  
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Citizenship No.">Citizenship No.</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-sticky-note-o"></i>
        
       </div>
   <input id="Citizenship No." name="Citizenship No." type="text" placeholder="Citizenship No." class="form-control input-md">
    
      </div>
 
    
  </div>
</div>

<!-- Multiple Checkboxes -->
<div class="form-group">
  <label class="col-md-4 control-label" for="Languages Known">Languages Known</label>
  <div class="col-md-4">
  <div class="checkbox">
    <label for="Languages Known-0">
      <input type="checkbox" name="Languages Known" id="Languages Known-0" value="1">
      Nepali
    </label>
    </div>
  <div class="checkbox">
    <label for="Languages Known-1">
      <input type="checkbox" name="Languages Known" id="Languages Known-1" value="2">
      Newari
    </label>
    </div>
  <div class="checkbox">
    <label for="Languages Known-2">
      <input type="checkbox" name="Languages Known" id="Languages Known-2" value="3">
      English
    </label>
    </div>
  <div class="checkbox">
    <label for="Languages Known-3">
      <input type="checkbox" name="Languages Known" id="Languages Known-3" value="4">
      Hindi
    </label>
    </div>

<div class="othertop">
    <label for="Languages Known-4">
    
     
  
    </label>

     <input type="input" name="LanguagesKnown" id="Languages Known-4"  placeholder="Other Language">
    </div>
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="License No.">License No.</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-sticky-note-o"></i>
        
       </div>
   <input id="License No." name="License No." type="text" placeholder="License No." class="form-control input-md">
    
      </div>
 
    
  </div>
</div>

<!-- Multiple Radios -->
<div class="form-group">
  <label class="col-md-4 control-label" for="Owns Vehicle">Owns Vehicle?</label>
  <div class="col-md-4">
  <div class="checkbox">
    <label for="Owns Vehicle-0">
      <input type="checkbox" name="Owns Vehicle" id="Owns Vehicle-0" value="1">
      4 wheeler
    </label>
    </div>
  <div class="checkbox">
    <label for="Owns Vehicle-1">
      <input type="checkbox" name="Owns Vehicle" id="Owns Vehicle-1" value="2">
     Bike
    </label>
    </div>
  <div class="checkbox">
    <label for="Owns Vehicle-2">
      <input type="checkbox" name="Owns Vehicle" id="Owns Vehicle-2" value="3">
      Bicycle
    </label>
    </div>
  </div>
</div>


<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="Working Experience (time period)">Working Experience (time period)</label>  
  <div class="col-md-4">
  <div class="input-group">
       <div class="input-group-addon">
     <i class="fa fa-clock-o"></i>
        
       </div>
    <input id="Working Experience (time period)" name="Working Experience" type="text" placeholder="Enter time period " class="form-control input-md">
    
    
      </div>
 
  </div>
</div>

<!-- Textarea -->
<div class="form-group">
  <label class="col-md-4 control-label" for="Overview (max 200 words)">Overview (max 200 words)</label>
  <div class="col-md-4">                     
    <textarea class="form-control" rows="10"  id="Overview (max 200 words)" name="Overview (max 200 words)">Overview</textarea>
  </div>
</div>


<div class="form-group">
  <label class="col-md-4 control-label" ></label>  
  <div class="col-md-4">
  <a href="#" class="btn btn-success"><span class="glyphicon glyphicon-thumbs-up"></span> Guardar</a>
  <a href="#" class="btn btn-danger" value=""><span class="glyphicon glyphicon-remove-sign"></span> Cancelar</a>
    
  </div>
</div>

</fieldset>
</form>
</div>
<div class="col-md-2 hidden-xs">
<img src="http://websamplenow.com/30/userprofile/images/avatar.jpg" class="img-responsive img-thumbnail ">
  </div>


</div>
   </div>

@endsection