<?php
if (session_status() == PHP_SESSION_NONE) 
{
  session_start();
  $unicid =  session_id() ;
  //echo $unicid ;
  
  $_SESSION['unik'] = $unicid ;
}
include('include/dbcon.php') ;
include('include/class.user.php');
include('include/functions.php');
include('include/memberid.php');
$member = new USER();

if(isset($_POST['submit']))
{
if(!isset($_SESSION['appid'])) 
{
	$_SESSION['appid'] = getnewid() ;
	
	//$erromsg = "Please fill all the section of the form approprietly" ;
}
//

$Destination = 'uploads';
    if(!isset($_FILES['file']) || !is_uploaded_file($_FILES['file']['tmp_name']))
    {
      $erromsg = 'Please Browse and Select the picture Before Uploading' ;
	
    }
	
	// Check file size

    $RandomNum   = rand(0, 9999999999);
    
    $ImageName      = str_replace(' ','-',strtolower($_FILES['file']['name']));
    $ImageType      = $_FILES['file']['type']; //"image/png", image/jpeg etc.

    $ImageExt = substr($ImageName, strrpos($ImageName, '.'));
    $ImageExt = str_replace('.','',$ImageExt);

    $ImageName      = preg_replace("/\.[^.\s]{3,4}$/", "", $ImageName);
     
    //Create new image name (with random number added).
    $NewImageName = $ImageName.'-'.$RandomNum.'.'.$ImageExt;
	
if(empty($erromsg))
{
	//$sql = mysql_query("update students set avatar = '$NewImageName' where regno = '$reg'") ;
    move_uploaded_file($_FILES['file']['tmp_name'], "$Destination/$NewImageName");
	$_SESSION['imgname'] = $NewImageName ;
	
//$NewImageName = 'nill' ;
 $appid = $_SESSION['appid'] ;
 $name = sanitizeString($_POST['names']) ;
  $posi = sanitizeString($_POST['posi']) ;
   $drive = sanitizeString($_POST['drive']) ;
    $location = sanitizeString($_POST['location']) ;
	$img =  $NewImageName;
	$sql1 = $DBcon->prepare("insert into hca_app1(app_id,names,pos,dv,location,image) values(:a,:b,:c,:d,:e,:f)") ;
	$sql1->bindparam(":a",$appid) ;
	$sql1->bindparam(":b",$name) ;
	$sql1->bindparam(":c",$posi) ;
	$sql1->bindparam(":d",$drive) ;
	$sql1->bindparam(":e",$location) ;
	$sql1->bindparam(":f",$img) ;
	if($sql1->execute())
	//2ndtable variable
	{
	$apply = sanitizeString($_POST['apply']) ;
	$title = sanitizeString($_POST['title']) ;
	$fname = sanitizeString($_POST['fname']) ;
	$sname = sanitizeString($_POST['sname']) ;
	$prname = sanitizeString($_POST['pname']) ;
	$psname = sanitizeString($_POST['psname']) ;
	$add = sanitizeString($_POST['address']) ;
	$hphone = sanitizeString($_POST['hphone']) ;
	$wphone = sanitizeString($_POST['wphone']) ;
	$mobile = sanitizeString($_POST['mobile']) ;
	$emails = sanitizeString($_POST['email']) ;
	$nation = sanitizeString($_POST['nation']) ;
	$nin = sanitizeString($_POST['nin']) ;
	$dob = sanitizeString($_POST['dob']) ;
	$ct = sanitizeString($_POST['contact']) ;
	
	$sql2 = $DBcon->prepare("insert into hca_app2(app_id,apply,title,fname,sname,pname,psname,address,hphone,wphone,mobile,emails,nation,nin,dob,ct) values(:a,:b,:c,:d,:e,:f,:g,:h,:i,:j,:k,:l,:m,:n,:o,:p)") ;
	$sql2->bindparam(":a",$appid) ;
	$sql2->bindparam(":b",$apply) ;
	$sql2->bindparam(":c",$title) ;
	$sql2->bindparam(":d",$fname) ;
	$sql2->bindparam(":e",$sname) ;
	$sql2->bindparam(":f",$prname) ;
	$sql2->bindparam(":g",$psname) ;
	$sql2->bindparam(":h",$add) ;
	$sql2->bindparam(":i",$hphone) ;
	$sql2->bindparam(":j",$wphone) ;
	$sql2->bindparam(":k",$mobile) ;
	$sql2->bindparam(":l",$emails) ;
	$sql2->bindparam(":m",$nation) ;
	$sql2->bindparam(":n",$nin) ;
	$sql2->bindparam(":o",$dob) ;
	$sql2->bindparam(":p",$ct) ;
	if($sql2->execute()) 
	{
	//another
	$nks = sanitizeString($_POST['nks']) ;
	$nkf = sanitizeString($_POST['nkf']) ;
	$nkaddress = sanitizeString($_POST['nkaddress']) ;
	$nkhphone = sanitizeString($_POST['nkhphone']) ;
	$nkwphone = sanitizeString($_POST['nkwphone']) ;
	$nkmobile = sanitizeString($_POST['nkmobile']) ;
	$nr = sanitizeString($_POST['nr']) ;
	$nkpcode = sanitizeString($_POST['nkpcode']) ;
	$nname = $nks."".$nkf ;
	$sql3 = $DBcon->prepare("insert into nextkin(app_id,names,hphone,wphone,mob,address,postcode,relationship) values(:a,:b,:c,:d,:e,:f,:g,:h)") ;
	$sql3->bindparam(":a",$appid) ;
	$sql3->bindparam(":b",$nname) ;
	$sql3->bindparam(":c",$nkhphone) ;
	$sql3->bindparam(":d",$nkwphone) ;
	$sql3->bindparam(":e",$nkmobile) ;
	$sql3->bindparam(":f",$nkaddress) ;
	$sql3->bindparam(":g",$nkpcode) ;
	$sql3->bindparam(":h",$nr) ;
	if($sql3->execute())
	{
	//
	$convict = sanitizeString($_POST['nc']) ;
	$rs = sanitizeString($_POST['cyes']) ;
	$rsdetail= sanitizeString($_POST['dec']) ;
	$sql4 = $DBcon->prepare("insert into bcodes(app_id,convict,reason,rsdetails) values(:a,:b,:c,:d)") ;
	$sql4->bindparam(":a",$appid) ;
	$sql4->bindparam(":b",$convict) ;
	$sql4->bindparam(":c",$rs) ;
	$sql4->bindparam(":d",$rsdetail) ;
	
	if($sql4->execute()) 
	{
	//update edu qualifications
	$sql5 = $DBcon->prepare("update app_education set app_id = '$appid' where unikid = '$unicid'") ;
	if($sql5->execute())
	{
	//update employment history
	$sql6 = $DBcon->prepare("update employment_history set app_id = '$appid' where unikid = '$unicid'") ;
	if($sql6->execute())
	{
		//update training history
	$sql7 = $DBcon->prepare("update training set app_id = '$appid' where unikid = '$unicid'") ;
	if($sql7->execute())
	{
		//update training history
	$sql8 = $DBcon->prepare("update reference set app_id = '$appid' where unikid = '$unicid'") ;
	if($sql8->execute())
	{
$message = "
				
<html>
<head>
</head>
<body>
<table>
<tr>
<td><img src='www.crystalbloomltd.co.uk/header.jpg'  width='100%' /></td>

</tr>
<tr>
<td align=center>
	Hello ADMIN,
		<br/><br />
		NEW APPLICANT!<br/>
						A new Application was submitted now, login to the Admin panel to view the Application
						<br/><br />
						CLICK THE LINK BELOW TO LOGIN TO THE ADMIN PANEL
						<br/><br />
	<a href='https://crystalbloomltd.co.uk/panel/index.php?app=$appid' style='background-color:#0631B9; color:#FFFFFF; padding:15px; width:60%; height:50px; font-size:16px;'>LOGIN TO ADMIN</a>
						<br/>
						
						<br/>
						CRYSTAL BLOOM  MANAGEMENT
</td>

</tr>
<tr>
<td><img src='www.crystalbloomltd.co.uk/footer.jpg'  width='100%' /></td>

</tr>
</table>
</body>
</html>

";

	$ademails = 'admin@crystalbloomltd.co.uk' ;      			
	$subject = "NEW APPLICATION";	
	
	//
	 // To send HTML mail, the Content-type header must be set
            $headers = "MIME-Version: 1.0\r\n";
            $headers .= "Content-type: text/html; charset=UTF-8\r\n";
            $headers .= "From: noreply@yourwebsite.com\r\n";
            $headers .= "Reply-To: support@yourwebsite.com\r\n";
            $headers .= "X-Mailer: PHP/" . phpversion();
            
            if (mail($ademails, $subject, $message, $headers)) {
                header("location: success.php") ;
            }else{
				?>
                <script>
				alert("Some thing went wrong") ;
				</script>
                <?php
			}
	
	//			
	//$member->send_mail($ademails,$message,$subject);	
	
	
	
	        }
	       }
	      }
	     }
	    }
	   }
	 }
  }

//
}
else
{
$NewImageName = 'nill' ;
 $appid = $_SESSION['appid'] ;
 $name = sanitizeString($_POST['names']) ;
  $posi = sanitizeString($_POST['posi']) ;
   $drive = sanitizeString($_POST['drive']) ;
    $location = sanitizeString($_POST['location']) ;
	$img =  $NewImageName;
	$sql1 = $DBcon->prepare("insert into hca_app1(app_id,names,pos,dv,location,image) values(:a,:b,:c,:d,:e,:f)") ;
	$sql1->bindparam(":a",$appid) ;
	$sql1->bindparam(":b",$name) ;
	$sql1->bindparam(":c",$posi) ;
	$sql1->bindparam(":d",$drive) ;
	$sql1->bindparam(":e",$location) ;
	$sql1->bindparam(":f",$img) ;
	if($sql1->execute())
	//2ndtable variable
	{
	$apply = sanitizeString($_POST['apply']) ;
	$title = sanitizeString($_POST['title']) ;
	$fname = sanitizeString($_POST['fname']) ;
	$sname = sanitizeString($_POST['sname']) ;
	$prname = sanitizeString($_POST['pname']) ;
	$psname = sanitizeString($_POST['psname']) ;
	$add = sanitizeString($_POST['address']) ;
	$hphone = sanitizeString($_POST['hphone']) ;
	$wphone = sanitizeString($_POST['wphone']) ;
	$mobile = sanitizeString($_POST['mobile']) ;
	$emails = sanitizeString($_POST['email']) ;
	$nation = sanitizeString($_POST['nation']) ;
	$nin = sanitizeString($_POST['nin']) ;
	$dob = sanitizeString($_POST['dob']) ;
	$ct = sanitizeString($_POST['contact']) ;
	
	$sql2 = $DBcon->prepare("insert into hca_app2(app_id,apply,title,fname,sname,pname,psname,address,hphone,wphone,mobile,emails,nation,nin,dob,ct) values(:a,:b,:c,:d,:e,:f,:g,:h,:i,:j,:k,:l,:m,:n,:o,:p)") ;
	$sql2->bindparam(":a",$appid) ;
	$sql2->bindparam(":b",$apply) ;
	$sql2->bindparam(":c",$title) ;
	$sql2->bindparam(":d",$fname) ;
	$sql2->bindparam(":e",$sname) ;
	$sql2->bindparam(":f",$prname) ;
	$sql2->bindparam(":g",$psname) ;
	$sql2->bindparam(":h",$add) ;
	$sql2->bindparam(":i",$hphone) ;
	$sql2->bindparam(":j",$wphone) ;
	$sql2->bindparam(":k",$mobile) ;
	$sql2->bindparam(":l",$emails) ;
	$sql2->bindparam(":m",$nation) ;
	$sql2->bindparam(":n",$nin) ;
	$sql2->bindparam(":o",$dob) ;
	$sql2->bindparam(":p",$ct) ;
	if($sql2->execute()) 
	{
	//another
	$nks = sanitizeString($_POST['nks']) ;
	$nkf = sanitizeString($_POST['nkf']) ;
	$nkaddress = sanitizeString($_POST['nkaddress']) ;
	$nkhphone = sanitizeString($_POST['nkhphone']) ;
	$nkwphone = sanitizeString($_POST['nkwphone']) ;
	$nkmobile = sanitizeString($_POST['nkmobile']) ;
	$nr = sanitizeString($_POST['nr']) ;
	$nkpcode = sanitizeString($_POST['nkpcode']) ;
	$nname = $nks."".$nkf ;
	$sql3 = $DBcon->prepare("insert into nextkin(app_id,names,hphone,wphone,mob,address,postcode,relationship) values(:a,:b,:c,:d,:e,:f,:g,:h)") ;
	$sql3->bindparam(":a",$appid) ;
	$sql3->bindparam(":b",$nname) ;
	$sql3->bindparam(":c",$nkhphone) ;
	$sql3->bindparam(":d",$nkwphone) ;
	$sql3->bindparam(":e",$nkmobile) ;
	$sql3->bindparam(":f",$nkaddress) ;
	$sql3->bindparam(":g",$nkpcode) ;
	$sql3->bindparam(":h",$nr) ;
	if($sql3->execute())
	{
	//
	$convict = sanitizeString($_POST['nc']) ;
	$rs = sanitizeString($_POST['cyes']) ;
	$rsdetail= sanitizeString($_POST['dec']) ;
	$sql4 = $DBcon->prepare("insert into bcodes(app_id,convict,reason,rsdetails) values(:a,:b,:c,:d)") ;
	$sql4->bindparam(":a",$appid) ;
	$sql4->bindparam(":b",$convict) ;
	$sql4->bindparam(":c",$rs) ;
	$sql4->bindparam(":d",$rsdetail) ;
	
	if($sql4->execute()) 
	{
	//update edu qualifications
	$sql5 = $DBcon->prepare("update app_education set app_id = '$appid' where unikid = '$unicid'") ;
	if($sql5->execute())
	{
	//update employment history
	$sql6 = $DBcon->prepare("update employment_history set app_id = '$appid' where unikid = '$unicid'") ;
	if($sql6->execute())
	{
		//update training history
	$sql7 = $DBcon->prepare("update training set app_id = '$appid' where unikid = '$unicid'") ;
	if($sql7->execute())
	{
		//update training history
	$sql8 = $DBcon->prepare("update reference set app_id = '$appid' where unikid = '$unicid'") ;
	if($sql8->execute())
	{
$message = "
				
<html>
<head>
</head>
<body>
<table>
<tr>
<td><img src='www.crystalbloomltd.co.uk/header.jpg'  width='100%' /></td>

</tr>
<tr>
<td align=center>
	Hello ADMIN,
		<br/><br />
		NEW APPLICANT!<br/>
						A new Application was submitted now, login to the Admin panel to view the Application
						<br/><br />
						CLICK THE LINK BELOW TO LOGIN TO THE ADMIN PANEL
						<br/><br />
	<a href='https://crystalbloomltd.co.uk/panel/index.php?app=$appid' style='background-color:#0631B9; color:#FFFFFF; padding:15px; width:60%; height:50px; font-size:16px;'>LOGIN TO ADMIN</a>
						<br/>
						
						<br/>
						CRYSTAL BLOOM  MANAGEMENT
</td>

</tr>
<tr>
<td><img src='www.crystalbloomltd.co.uk/footer.jpg'  width='100%' /></td>

</tr>
</table>
</body>
</html>

";

	$ademails = 'admin@crystalbloomltd.co.uk' ;      			
	$subject = "NEW APPLICATION";	
	
	//
	 // To send HTML mail, the Content-type header must be set
            $headers = "MIME-Version: 1.0\r\n";
            $headers .= "Content-type: text/html; charset=UTF-8\r\n";
            $headers .= "From: noreply@yourwebsite.com\r\n";
            $headers .= "Reply-To: support@yourwebsite.com\r\n";
            $headers .= "X-Mailer: PHP/" . phpversion();
            
            if (mail($ademails, $subject, $message, $headers)) {
                header("location: success.php") ;
            }else{
				?>
                <script>
				alert("Some thing went wrong") ;
				</script>
                <?php
			}
	
	//			
	//$member->send_mail($ademails,$message,$subject);	
	
	
	
	        }
	       }
	      }
	     }
	    }
	   }
	 }
  }
}

}

?>
<!DOCTYPE html>
<html lang="zxx">

<head>
        
        <meta charset="utf-8">
        <meta name="viewport" content="width=device-width, initial-scale=1">
        <!-- Link of CSS files -->
        <link rel="stylesheet" href="assets/css/bootstrap.min.css">
        <link rel="stylesheet" href="assets/css/flaticon.css">
        <link rel="stylesheet" href="assets/css/remixicon.css">
        <link rel="stylesheet" href="assets/css/owl.carousel.min.css">
        <link rel="stylesheet" href="assets/css/odometer.min.css">
        <link rel="stylesheet" href="assets/css/fancybox.css">
         <script src="assets/js/jquery.min.js"></script>
        
  <script src="assets/js/popper.min.js"></script>
  <script src="assets/js/bootstrap.min.js"></script>
  <link href="https://unpkg.com/tailwindcss@^1.0/dist/tailwind.min.css" rel="stylesheet">

        <!-- <link rel="stylesheet" href="assets/css/aos.css"> -->
        <link rel="stylesheet" href="assets/css/style.css">
        <link rel="stylesheet" href="assets/css/responsive.css">
        <link rel="stylesheet" href="assets/css/dark-theme.css">
        <title>Crystal Bloom ltd</title>
        <link rel="icon" type="image/png" href="assets/favicon.png">
         <script>
	function addedu() {
	document.getElementById("adedu").innerHTML	= "Please Wait...." ;
		
	var postObj = { 
    //id: Math.random(), 
   school: document.querySelector('#school').value, 
   begindate: document.querySelector('#bdate').value,
	enddate: document.querySelector('#edate').value,
	qualification: document.querySelector('#course').value,
	grade: document.querySelector('#grade').value,
	
}
 
var post = JSON.stringify(postObj)
 
const url = "qua.php"
var xhr = new XMLHttpRequest()
 
xhr.open('POST', url, true)
xhr.setRequestHeader('Content-type', 'application/json; charset=UTF-8')
xhr.send(post);
 
xhr.onreadystatechange = function() {
   if (this.readyState == 4 && this.status == 200) {
     // Response
   var response = this.responseText;
   if(response == "ALL FILED MUST BE FILL")
	{
	 document.getElementById("quadisplay").innerHTML = this.responseText;
	}
	else 
	{
	 document.getElementById("quadisplay").innerHTML = this.responseText;
	  document.querySelector('#school').value = "" ;
	 document.querySelector('#bdate').value = "" ;
	 document.querySelector('#edate').value ="" ;
	  document.querySelector('#course').value ="" ;
	   document.querySelector('#grade').value ="" ;
     document.getElementById("adedu").innerHTML	= "ADD" ;	
	}
 
	
}
	}
	}
	
	function reffs() {
	//document.getElementById("chk").innerHTML	= "Please Wait...." ;
		
	var postObj = { 
    // odate: document.querySelector('#bdate').value, 
   // customer: document.querySelector('#cus').value,
	//orderno: document.querySelector('#bkorder').value
	 school: document.querySelector('#school').value
	//menus: document.querySelector('#menus').value,
	//items: document.querySelector('#items').value,
	//qty: document.querySelector('#quantity').value,
	//ucost: document.querySelector('#uc').value,
	//id: Math.random(), 
   
}
 
var post = JSON.stringify(postObj)
 
const url = "reff.php"
var xhr = new XMLHttpRequest()
 
xhr.open('POST', url, true)
xhr.setRequestHeader('Content-type', 'application/json; charset=UTF-8')
xhr.send(post);
 
xhr.onreadystatechange = function() {
   if (this.readyState == 4 && this.status == 200) {
     // Response
     var response = this.responseText;
	document.getElementById("quadisplay").innerHTML = this.responseText;
	 //window.alert('Room is Available') ;
     //window.location.href='adm.php?success';
	//document.getElementById("chk").innerHTML = "Check Available Rooms";
}
	}
	}
	
    function empreffs() {
	//document.getElementById("chk").innerHTML	= "Please Wait...." ;
		
	var postObj = { 
    // odate: document.querySelector('#bdate').value, 
   // customer: document.querySelector('#cus').value,
	//orderno: document.querySelector('#bkorder').value
	 empoyer: document.querySelector('#emp').value
	//menus: document.querySelector('#menus').value,
	//items: document.querySelector('#items').value,
	//qty: document.querySelector('#quantity').value,
	//ucost: document.querySelector('#uc').value,
	//id: Math.random(), 
   
}
 
var post = JSON.stringify(postObj)
 
const url = "empreff.php"
var xhr = new XMLHttpRequest()
 
xhr.open('POST', url, true)
xhr.setRequestHeader('Content-type', 'application/json; charset=UTF-8')
xhr.send(post);
 
xhr.onreadystatechange = function() {
   if (this.readyState == 4 && this.status == 200) {
     // Response
     var response = this.responseText;
	document.getElementById("empdisplay").innerHTML = this.responseText;
	 //window.alert('Room is Available') ;
     //window.location.href='adm.php?success';
	//document.getElementById("chk").innerHTML = "Check Available Rooms";
}
	}
	}
	
	function addemp() {
	document.getElementById("ademp").innerHTML	= "Please Wait...." ;
		
	var postObj = { 
    //id: Math.random(), 
   employer: document.querySelector('#emp').value, 
   begindate: document.querySelector('#empdate1').value,
	enddate: document.querySelector('#empdate2').value,
	position: document.querySelector('#posh').value,
	reason: document.querySelector('#reason').value,
	
}
 
var post = JSON.stringify(postObj)
 
const url = "emp.php"
var xhr = new XMLHttpRequest()
 
xhr.open('POST', url, true)
xhr.setRequestHeader('Content-type', 'application/json; charset=UTF-8')
xhr.send(post);
 
xhr.onreadystatechange = function() {
   if (this.readyState == 4 && this.status == 200) {
     // Response
   var response = this.responseText;
   if(response == "ALL FILED MUST BE FILL")
	{
	 document.getElementById("empdisplay").innerHTML = this.responseText;
	}
	else 
	{
	 document.getElementById("empdisplay").innerHTML = this.responseText;
	  document.querySelector('#emp').value = "" ;
	 document.querySelector('#empdate1').value = "" ;
	 document.querySelector('#empdate2').value ="" ;
	  document.querySelector('#posh').value ="" ;
	   document.querySelector('#reason').value ="" ;
     document.getElementById("ademp").innerHTML	= "ADD" ;	
	}
 
	
}
	}
	}
	
	function addtrain() {
	document.getElementById("adt").innerHTML	= "Please Wait...." ;
		
	var postObj = { 
    //id: Math.random(), 
   organiser: document.querySelector('#org').value, 
   begindate: document.querySelector('#tdate1').value,
	enddate: document.querySelector('#tdate2').value,
	course: document.querySelector('#cs').value,
	attain: document.querySelector('#attain').value,
	
}
 
var post = JSON.stringify(postObj)
 
const url = "train.php"
var xhr = new XMLHttpRequest()
 
xhr.open('POST', url, true)
xhr.setRequestHeader('Content-type', 'application/json; charset=UTF-8')
xhr.send(post); 
xhr.onreadystatechange = function() {
   if (this.readyState == 4 && this.status == 200) {
     // Response
   var response = this.responseText;
   if(response == "ALL FILED MUST BE FILL")
	{
	 document.getElementById("tdisplay").innerHTML = this.responseText;
	}
	else 
	{
	 document.getElementById("tdisplay").innerHTML = this.responseText;
	  document.querySelector('#org').value = "" ;
	 document.querySelector('#tdate1').value = "" ;
	 document.querySelector('#tdate2').value ="" ;
	  document.querySelector('#course').value ="" ;
	   document.querySelector('#attain').value ="" ;
     document.getElementById("adt").innerHTML	= "ADD" ;	
	}
 
	
}
	}
	}
	
	function treff() {
	//document.getElementById("chk").innerHTML	= "Please Wait...." ;
		
	var postObj = { 
    // odate: document.querySelector('#bdate').value, 
   // customer: document.querySelector('#cus').value,
	//orderno: document.querySelector('#bkorder').value
	 organiser: document.querySelector('#org').value
	//menus: document.querySelector('#menus').value,
	//items: document.querySelector('#items').value,
	//qty: document.querySelector('#quantity').value,
	//ucost: document.querySelector('#uc').value,
	//id: Math.random(), 
   
}
 
var post = JSON.stringify(postObj)
 
const url = "treff.php"
var xhr = new XMLHttpRequest()
 
xhr.open('POST', url, true)
xhr.setRequestHeader('Content-type', 'application/json; charset=UTF-8')
xhr.send(post);
 
xhr.onreadystatechange = function() {
   if (this.readyState == 4 && this.status == 200) {
     // Response
     var response = this.responseText;
	document.getElementById("tdisplay").innerHTML = this.responseText;
	 //window.alert('Room is Available') ;
     //window.location.href='adm.php?success';
	//document.getElementById("chk").innerHTML = "Check Available Rooms";
}
	}
	}
	
	function addnext() {
	document.getElementById("adn").innerHTML	= "Please Wait...." ;
		
	var postObj = { 
    //id: Math.random(), 
   firstname: document.querySelector('#nf').value, 
   surname: document.querySelector('#ns').value,
	address: document.querySelector('#na').value,
	postalcode: document.querySelector('#np').value,
	phone: document.querySelector('#nphone').value,
	position: document.querySelector('#npos').value,
	relation: document.querySelector('#nrelation').value,
	contact: document.querySelector('#ncontact').value,
	
}
 
var post = JSON.stringify(postObj)
 
const url = "next.php"
var xhr = new XMLHttpRequest()
 
xhr.open('POST', url, true)
xhr.setRequestHeader('Content-type', 'application/json; charset=UTF-8')
xhr.send(post); 
xhr.onreadystatechange = function() {
   if (this.readyState == 4 && this.status == 200) {
     // Response
   var response = this.responseText;
   if(response == "ALL FILED MUST BE FILL")
	{
	 document.getElementById("ndisplay").innerHTML = this.responseText;
	}
	else 
	{
	 document.getElementById("ndisplay").innerHTML = this.responseText;
	 document.querySelector('#nf').value = "" ;
     document.querySelector('#ns').value = "" ;
	 document.querySelector('#na').value = "" ;
	 document.querySelector('#np').value = "" ;
	 document.querySelector('#nphone').value = "" ;
	 document.querySelector('#npos').value = "" ;
	 document.querySelector('#nrelation').value = "" ;
	 document.querySelector('#ncontact').value = "" ;
     document.getElementById("adn").innerHTML	= "ADD" ;	
	}
 
	
}
	}
	}
	
	function nreff() {
	//document.getElementById("chk").innerHTML	= "Please Wait...." ;
		
	var postObj = { 
    // odate: document.querySelector('#bdate').value, 
   // customer: document.querySelector('#cus').value,
	//orderno: document.querySelector('#bkorder').value
	 firstname: document.querySelector('#nfname').value
	//menus: document.querySelector('#menus').value,
	//items: document.querySelector('#items').value,
	//qty: document.querySelector('#quantity').value,
	//ucost: document.querySelector('#uc').value,
	//id: Math.random(), 
   
}
 
var post = JSON.stringify(postObj)
 
const url = "nextreff.php"
var xhr = new XMLHttpRequest()
 
xhr.open('POST', url, true)
xhr.setRequestHeader('Content-type', 'application/json; charset=UTF-8')
xhr.send(post);
 
xhr.onreadystatechange = function() {
   if (this.readyState == 4 && this.status == 200) {
     // Response
     var response = this.responseText;
	document.getElementById("ndisplay").innerHTML = this.responseText;
	 //window.alert('Room is Available') ;
     //window.location.href='adm.php?success';
	//document.getElementById("chk").innerHTML = "Check Available Rooms";
}
	}
	}
	
	function autorefs() {
	
          reffs()
		  empreffs()
		  treff()
		  nreff()

	}
	</script>
      <style>
  .img-thumbnail {
	width:150px;
    height: 150px;
    border: 1px solid #000;
    margin: 10px 5px 0 0;
  }
</style>
    </head>

    <body style="">
      <!--Preloader starts-->
        <div class="loader js-preloader">
            <div class="absCenter">
                <div class="loaderPill">
                    <div class="loaderPill-anim">
                        <div class="loaderPill-anim-bounce">
                            <div class="loaderPill-anim-flop">
                                <div class="loaderPill-pill"></div>
                            </div>
                        </div>
                    </div>
                    <div class="loaderPill-floor">
                        <div class="loaderPill-floor-shadow"></div>
                    </div>
                </div>
            </div>
        </div>
        <!--Preloader ends-->

             <!-- Page Wrapper End -->
        <div class="page-wrapper">
        <?php include('header.php') ; ?>
       <div class="content-wrapper">
                <!-- Breadcrumb Start -->
            <div class="breadcrumb-wrap bg-f br-2" style="max-height:200px;">
                    <div class="container">
                        <div class="breadcrumb-title">
                            <h2>ONLINE APPLICATION</h2>
                            <ul class="breadcrumb-menu list-style">
                                <li><a href="index.php">Home</a></li>
                                <li>About Us</li>
                            </ul>
                        </div>
                    </div>
                </div>
                 <!-- Contact Us section Start -->
                <section class="contact-us-wrap ptb-100">
                 <center> <h2 style="font-size:24px;">CRYSTAL BLOOM LTD APPLICATION FORM</h2></center>
                  <br/> <br/>
             
                    <div class="container" style="font-family:Baskerville, 'Palatino Linotype', Palatino, 'Century Schoolbook L', 'Times New Roman', serif;">
                  
                  <div class="row gx-5" style=" margin:10px; border:1px solid #1178CC; box-shadow:8px 8px 8px 8px #9B9B9B; padding:10px; border-radius:5px;">
                   <br/> <br/>
                   <div class="alert alert-info"> <center><?php if(isset($erromsg)) echo $erromsg ; ?></center></div>
                   
                    <br/>
                    <form name="form" method="post" action="" enctype="multipart/form-data">
                    <center>
                    <label>Attach A clear Passport Photograph</label><br/>
                    <input type="file" id="file" name="file" class="btn btn-primary" style="margin-top:30px; border-radius:5px; width:70%;" />
<br/>

                 <span id="output"></span>
                      </center>
                        <fieldset ><legend>Section One</legend>
                        <div class="form-group" style="margin:10px;">
              <input type="text" class="form-control" name="posi" required id="posi" placeholder="Position Applied for" />
                        </div>
                         <div class="form-group" style="margin:10px;">
              <input type="text" class="form-control" name="names" required id="names" placeholder="Your Full Name" />
                        </div>
                         <div class="form-group" style="margin:10px;">
   <input type="text" class="form-control" name="location" id="location" required placeholder="What Part of UK do you Live ?" />
                        </div>
                        <div class="form-group" style="margin:10px;">
   <input type="text" class="form-control" name="drive" id="drive" placeholder="Do you drive ?" />
                        </div>
               </fieldset>
                      
                       <hr/> 
        <p style="margin:5px; text-align:justify; padding:15px; width:90%; margin-left:auto; margin-right:auto;">
                        
<strong>Data Protection Statement</strong>
<br/>
The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Agency to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.
<br/>
The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Agency to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.
<br/>
<strong>Equality of Opportunity Statement</strong>
<br/>
The Agency’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.
                        
                        </p>
        <center><h4>Which of the following Applied to You</h4></center>
                        
               <fieldset ><legend>Section Two</legend>        
                          <div class="form-group" style="margin:5px;">
   <select  class="form-control" name="apply" id="aplly" placeholder="" >
   <option></option>
    <option>HEALTHCARE ASSITANT</option>
    <option>QUALIFIED NURSE</option>
     <option>STUDENT NURSE</option>
      <option>QUALIFIED NURSE ABROAD (NOT IN UK)</option>
   </select>
                        </div>
           <div class="row" style="margin:5px;">
           <div class="col-md-2" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text" value="" name="title" placeholder="Title" id="title" class="form-control" />
           </div>
            <div class="col-md-5" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="fname" placeholder="First Name" id="fname" class="form-control" />
           </div>
            <div class="col-md-5" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="sname" placeholder="Surname" id="sname" class="form-control" />
           </div>
  
           </div>
           
           <div class="row" style="margin:10px;">
           
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="pname" placeholder="Previous Names" id="pname" class="form-control" />
           </div>
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="psname" placeholder="Previous Surnames" id="psname" class="form-control" />
           </div>
  
           </div>
           <div class="row" style="margin:10px;">
           
            <div class="col-md-12" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="address" placeholder="Your Address" id="address" class="form-control" />
           </div>
  
           </div>
           
           <div class="row" style="margin:10px;">
           <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text" value="" name="hphone" placeholder="Home Phone" id="hphone" class="form-control" />
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="wphone" placeholder="Work Phone" id="wphone" class="form-control" />
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
         <input type="text" value="" name="mobile" placeholder="Mobile Phone" id="mphone" class="form-control" />
           </div>
  
           </div>
           <div class="row" style="margin:10px;">
           
            <div class="col-md-7" style=" margin-top:10px; margin-bottom:10px;">
             <input type="email" value="" name="email" placeholder="Email" id="email" class="form-control" />
           </div>
            <div class="col-md-5" style=" margin-top:10px; margin-bottom:10px;">
         <input type="text" value="" name="nation" placeholder="Nationality" id="nation" class="form-control" />
           </div>
  
           </div>
           
            <div class="row" style="margin:10px;">
           
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="nin" placeholder="National Insurance Number" id="nin" class="form-control" />
           </div>
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
            <label>Date of Birth</label>
         <input type="date" value="" name="dob" placeholder="Date of Birth" id="dob" class="form-control" />
           </div>
  
           </div>
           
           <div class="row" style="margin:10px;">
           
            <div class="col-md-6"style=" margin-top:10px; margin-bottom:10px;"> <strong>Can We Contact You at Work ?</strong>
            <div class="form-group" style="margin:5px;">
   <select  class="form-control" name="contact" id="contact" >
   <option></option>
    <option>YES</option>
    <option>NO</option>
   </select>
                        </div>
           </div>
            <div class="col-md-6">
        
           </div>
  
           </div>
           </fieldset>
           <hr/>
   
                       
      <fieldset ><legend>Section Three</legend>                   
                           <center>    <h5> Name Of Next Of Kin To Be Contacted During Emergency</h5></center>
                          
                            <div class="row" style="margin:10px;">
           
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="nkf" placeholder="Next of kin First Name" id="nkfname" class="form-control" />
           </div>
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
         <input type="text" value="" name="nks" placeholder="Next of Kin Surname" id="nksname" class="form-control" />
           </div>
  
           </div>
           <div class="row" style="margin:10px;">
           
            <div class="col-md-8" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="nkaddress" placeholder="Next of kin Address" id="nkaddress" class="form-control" />
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
         <input type="text" value="" name="nkpcode" placeholder="Next of Kin Postal Code" id="nkpcode" class="form-control" />
           </div>
  
           </div>
           <div class="row" style="margin:10px;">
           <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text" value="" name="nkhphone" placeholder="Home Phone" id="nkhphone" class="form-control" />
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
             <input type="text" value="" name="nkwphone" placeholder="Work Phone" id="nkwphone" class="form-control" />
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
         <input type="text" value="" name="nkmobile" placeholder="Mobile Phone" id="nkmphone" class="form-control" />
           </div>
  
           </div>
           <div class="row" style="margin:10px;">
           <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text" value="" name="nr" placeholder="Relationship with next of kin" id="nr" class="form-control" />
           </div>
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
        
           </div>
          
           </div>
           </fieldset>
           <hr/>
          <center><h4> Formal Education & Qualifications</h4> </center>
       <fieldset ><legend>Section Four</legend>     
           <div class="row" style="margin:10px;">
           <div class="col-md-12" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text" value="" name="school" placeholder="Name of School/college/University and location" id="school" class="form-control" />
           </div>
           </div>
            <center><h5> Date of Attendance</h5> </center>
            
           <div class="row" style="margin:10px;">
           <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           <label>Admission Date</label>
           <input type="Date" value="" name="bdate" placeholder="From Date" id="bdate" class="form-control" />
           </div>
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
            <label>Graduation Date</label>
           <input type="Date" value="" name="edate" placeholder="To Date" id="edate" class="form-control" />
           </div>
           </div> 
           <div class="row" style="margin:10px;">
           <div class="col-md-7" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text"  value="" name="course" placeholder="Course of Study/Qualification(s) gained e.g GCSE'S, "A" LEVELS, NVQ, Degree, etc" id="course" class="form-control" />
           </div>
            <div class="col-md-3" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text"  value="" name="grade" placeholder="Grade" id="grade" class="form-control" />
           </div>
            <div class="col-md-2" style=" margin-top:10px; margin-bottom:10px;">
           <input type="button"  value="ADD" name="adedu" onClick="addedu()" id="adedu" class="btn btn-dark" />
           </div>
           </div> 
           <div class="row" style="margin:10px;">
           <div class="col-md-12" style=" margin-top:10px; margin-bottom:10px;">
           <div class="table-responsive">
           <center><h4>PREVIEW</h4></center>
            <div id="quadisplay" class="alert alert-primary"></div>
   

           </div>
           </div>
           </div>
           </fieldset>
           <hr/>
           <center><h4>Employment History</h4> </center>
           <fieldset ><legend>Section Five</legend> 
           <div class="row" style="margin:10px;">
           <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           Name|Address of employer
           <input type="text" value="" name="emp" placeholder="Name|Address of employer" id="emp" class="form-control" />
           </div>
            <div class="col-md-3" style=" margin-top:10px; margin-bottom:10px;">
            <label>Date Employed</label>
           <input type="Date" value="" name="empdate1" placeholder="From Date" id="empdate1" class="form-control" />
           </div>
           <div class="col-md-3" style=" margin-top:10px; margin-bottom:10px;">
           <label>To Date</label>
           <input type="Date" value="" name="empdate2" placeholder="To Date" id="empdate2" class="form-control" />
           </div>
           </div>
           
           <div class="row" style="margin:10px;">
           <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           Position held and brief summary of duties and responsibilities
           <textarea   name="posh"  id="posh" class="form-control" placeholder="Position held and brief summary of duties and responsibilities"> </textarea>
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
            Reason for leaving and last salary received
           <textarea name="reason"  id="reason" placeholder="Reason for leaving and last 
           salary received" class="form-control" > </textarea>
           </div>
           <div class="col-md-2" style=" margin-top:10px; margin-bottom:10px;">
           <input type="button" value="ADD" name="ademp" id="ademp" onClick="addemp()" class="btn btn-dark" />
           </div>
           </div>
            <div class="row" style="margin:10px;">
           <div class="col-md-12" style=" margin-top:10px; margin-bottom:10px;">
          <div class="table-responsive">
          <center><h4>PREVIEW</h4></center>
            <div id="empdisplay" class="alert alert-primary"></div>
               </div>
             </div>
             </div>
             </fieldset>
             
              <center><h5> Training – eg. Manual handling, CPR, infection control, first aid etc, (please provide certificates)</h5></center>
              <fieldset ><legend>Section Six</legend> 
              <div class="row" style="margin:10px;">
           <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           Detail of Training, Hospital|establishment
 <input type="text" value="" name="org" placeholder="Detail of Training, Hospital|establishment" id="org" class="form-control" />
           </div>
            <div class="col-md-3" style=" margin-top:10px; margin-bottom:10px;">
           Begin Date
           <input type="Date" value="" name="tdate1" placeholder="From Date" id="tdate1" class="form-control" />
           </div>
           <div class="col-md-3" style=" margin-top:10px; margin-bottom:10px;">
           End Date
           <input type="Date" value="" name="tdate2" placeholder="To Date" id="tdate2" class="form-control" />
           </div>
           </div>
           
           <div class="row" style="margin:10px;">
           <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text"   name="cs"  id="cs" placeholder="Course Taken" class="form-control" /> 
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text"  name="attain"  id="attain" placeholder="Attainment" class="form-control" /> 
           </div>
           <div class="col-md-2" style=" margin-top:10px; margin-bottom:10px;">
           <input type="button" value="ADD" name="adt" id="adt" onClick="addtrain()" class="btn btn-dark" />
           </div>
           </div>
            <div class="row" style="margin:10px;">
           <div class="col-md-12" style=" margin-top:10px; margin-bottom:10px;">
           <div class="table-responsive">
          <center><h4>PREVIEW</h4></center>
            <div id="tdisplay"></div>
               </div>
        
             </div>
             </div>
             </fieldset>
             <hr/>
             <center>
             
<h4>References</h4> </center>
<fieldset ><legend>Section Seven</legend> 
 <p style="margin:5px; text-align:justify; padding:15px; width:70%; margin-left:auto; margin-right:auto;">
References are normally taken up for candidates selected for interview. Give details of the names/addresses of two work-related Referees. One of the Referees should be your current employer, or if presently unemployed or self-employed, your last employer
</p>
            
             
             <div class="row" style="margin:10px;">
           <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text" value="" name="nf" placeholder="First Name" id="nf" class="form-control" />
           </div>
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text" value="" name="ns" placeholder="Last Name" id="ns" class="form-control" />
           </div>
           
           </div>
           
           <div class="row" style="margin:10px;">
           <div class="col-md-8" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text"   name="na"  id="na" placeholder="Address" class="form-control" /> 
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text"  name="np"  id="np" placeholder="Postal Code" class="form-control" /> 
           </div>
         
           </div>
           
            <div class="row" style="margin:10px;">
           <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text"   name="nphone"  id="nphone" placeholder="Telephone Number" class="form-control" /> 
           </div>
            <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
           <input type="text"  name="npos"  id="npos" placeholder="Position" class="form-control" /> 
           </div>
         <div class="col-md-4" style=" margin-top:10px; margin-bottom:10px;">
       <input type="text"  name="nrelation"  id="nrelation" placeholder="Relationship" class="form-control" /> 
           </div>
           
           </div>
           <div class="row" style="margin:10px;">
           <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           <label>May We Contact The Above Person Now ?</label>
          <select type="text"   name="ncontact"  id="ncontact"  class="form-control" >
          <option>YES</option>
           <option>NO</option>
          </select> 
           </div>
            <div class="col-md-6" style=" margin-top:10px; margin-bottom:10px;">
           <input type="button" value="ADD" name="adn" id="adn" onClick="addnext()" class="btn btn-dark"  />
           </div>
                   
           </div>
            <div class="row" style="margin:10px;">
           <div class="col-md-12" style=" margin-top:10px; margin-bottom:10px;">
          <div class="table-responsive">
           <center><h4>PREVIEW</h4></center>
            <div id="ndisplay" class="alert alert-primary"></div>
           </div>
             </div>
             </div>
             </fieldset>
             <hr/>
             
<center><h5>Confidentiality Declaration</h5></center>
 
<p style="margin:5px; text-align:justify; padding:15px; width:70%; margin-left:auto; margin-right:auto;">
Registration implies acceptance of our code of confidentiality.  In the course of your duties you may have access to confidential information about your clients. On no account must  information relating to identifiable client be divulged to anyone other than the manager of the agency. You should not  disclose ANY information to your family, friends or neighbours.  If you are worried by any information you have obtained and consider that you should talk about it to someone else MAKE  AN APPOINTMENT TO SPEAK IN PRIVATE TO YOUR MANAGER.  Failure to observe these rules will be regarded as serious misconduct which could result in removal from the agency  register
 </p> 
 
 
<center><h5>Rehabilitation of Offenders Act 1</h5></center>
<p style="margin:5px; text-align:justify; padding:15px; width:70%; margin-left:auto; margin-right:auto;">
As a general rule, no-one need answer questions about spent convictions. However this general rule does not apply  to specified professions, employments and occupations. By virtue of the Rehabilitation of Offenders Act 1974  (Exceptions) (Amendment) Orders, the exemption rule does not apply to:<br/>
a) any employment or other work which is concerned with the provision of health services and which is of such  a kind as to enable the holder of that employment or the person engaged in that work to have access to  persons in receipt of such services in the course of his normal duties, or <br/>
b) any employment or other work which is concerned with the provision of care services to vulnerable adults  and which is of such a kind as to enable the holder of that employment or the person engaged in that work  to have access to vulnerable adults in receipt of such services in the course of his normal duties<br/>
One or both of the above apply to work with the Agency, and covers all occupations.  You are therefore requested to provide details of all convictions, including those which would otherwise be considered  as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply  that this employment application will be rejected. 
</p>
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<center>
<strong>Records will be checked via the Criminal Records Bureau procedures    </strong>
<br/> 
<input type="radio" value="NO"  name="nc" id="ncy" /> <label>I have no conviction</label> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  
<input type="radio" value="YES"  name="nc" id="ncy" /> <label>I have conviction</label> 
<br/><br/>

<h4>Criminal Records – Disclosure Certificate</h4>
<p style="margin:5px; text-align:justify; padding:15px; width:70%; margin-left:auto; margin-right:auto;">
Disclosure Barring Service (DBS) have issued a Code of Practice regarding Disclosure Information, a copy of  which is available upon request. A Disclosure Certificate (standard or enhanced) will be requested from DBS  which will detail all convictions, including those which would otherwise be “spent”, as well as details of cautions,  reprimands or final warnings. You will be advised of the type of certificate being requested, and asked to give your  approval to this application. The Disclosure Certificate will only be requested in the event that you are successful in  your application for employment.
</p>

<strong>Disclosure:</strong> <br/>Is there any reason why you cannot work in a regulated activity (care)
<br/>
<input type="radio" value="YES"  name="cyes" id="cy" /> <label>YES</label> 
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  
<input type="radio" value="NO"  name="cyes" id="cy" /> <label>NO</label> 
<br/><br/>
<textarea name="dec" id="dec" placeholder="if yes, please state the eason" class="form-control">
</textarea>

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