Create web Form: i have a list of fields about 40, i need a web form created
máx $5 USD
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: |
Nº del proyecto: #2778906