Create web Form: i have a list of fields about 40, i need a web form created

Completado Publicado Sep 21, 2012 Pagado a la entrega
Completado Pagado a la entrega

Hello All Dev's, I have a simple webform i need to create. i basically need a nicely laid out form that will email me the input.

basic html page:

nice looking:

there are fields and selection items i need

All Fields in the Detail Section: *Note the selection items

here are some of the basic fields:

<colgroup> <col /></colgroup>

| Name: |

| Address: |

| ID Number: |

| Rank: |

| Select One: |

| Active |

| Retired |

| Resigned |

| If retired or resigned, please note the date of retirement or resignation: |

| Highest Level of Education (select one): |

| High School |

| Associate's |

| Bachelor's |

| Master's |

| Doctorate |

## Deliverables

All Fields:

<colgroup> <col /></colgroup>

| Name: |

| Address: |

| ID Number: |

| Rank: |

| Select One: |

| Active |

| Retired |

| Resigned |

| If retired or resigned, please note the date of retirement or resignation: |

| Highest Level of Education (select one): |

| High School |

| Associate's |

| Bachelor's |

| Master's |

| Doctorate |

| JD |

| Mail Station: |

| Assignment: |

| Home Phone: |

| Cell Phone: |

| Personal E-mail Address (Non-PD): |

| Veteran (Y or N): |

| Branch of Service (If you have served in the military, please select one of the options): |

| Army |

| USAF |

| USN |

| USCG |

| USMC |

| Army National Guard |

| Air National Guard |

| Active Reserve (circle one): |

| Army |

| USAF |

| USN |

| USCG |

| USMC |

| Army National Guard |

| Air National Guard |

| Date of Birth: |

| Date of Hire: |

| Joined POA (date): |

| Academy: |

| Break in Service (if applicable): |

| From: |

| To: |

| Blood Type: |

| If another officer is in need of a bone marrow transplant, would you be willing to be tested to see if you could be a donor? (Y or N): |

| Beneficiary: |

| Relationship: |

| Electronic Signature: |

| Date: |

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