Welcome to Simpel Techlabs

Employee Registration Form

Personal Information

First Name *

Middle Name

Last Name *

Salutation *

T-shirt Size *

Gender *

Date of Birth *

Date of Joining *

Attachments

PAN Card *

Aadhaar Card *

Bank Details *

10th Marksheet *

12th Marksheet *

Higher Marksheet *

Older Experience Letter

Salary Slip

Resume *

Address & Contacts

Mobile Number *

Personal Email *

Current Address *

</div>

<div class="field-group">
    <label for="permanentAddress">Permanent Address <span style="color: red;">*</span></label>
    <textarea type="text" id="permanentAddress" name="permanentAddress" required rows="5" cols="60">
  </div>
</div>

<h2>Guardian Contact Details</h2>
<hr>

<div class="name-fields">
  <div class="field-group">
    <label for="guardianName">Guardian Name <span style="color: red;">*</span></label>
    <input type="text" id="guardianName" name="guardianName" required placeholder="Full name">
  </div>

<div class="field-group">
    <label for="guardianMobile">Guardian Mobile Number <span style="color: red;">*</span></label>
    <input type="tel" id="guardianMobile" name="guardianMobile" required pattern="[0-9]{10}" placeholder="10-digit number">
  </div>

<div class="field-group">
    <label for="guardianRelation">Relation <span style="color: red;">*</span></label>
    <input type="text" id="guardianRelation" name="guardianRelation" required placeholder="e.g., Father, Mother, Guardian">
  </div>
</div>

<h2>Bank Details</h2>
<hr>

<div class="name-fields">
  <div class="field-group">
    <label for="salaryMode">Salary Mode</label>
    <input type="text" id="salaryMode" name="salaryMode" value="Bank" readonly>
  </div>

</div>

<div class="field-group">
    <label for="branchName">Branch Name <span style="color: red;">*</span></label>
    <input type="text" id="branchName" name="branchName" required placeholder="Branch name">
  </div>

<div class="field-group">
    <label for="panNumber">PAN Number <span style="color: red;">*</span></label>
    <input type="text" id="panNumber" name="panNumber" required pattern="[A-Z]{5}[0-9]{4}[A-Z]{1}" placeholder="ABCDE1234F">
  </div>
</div>

</div>

<h2>Personal Details</h2>
<hr>

<div class="name-fields">
  <div class="field-group">
    <label for="maritalStatus">Marital Status <span style="color: red;">*</span></label>
    <select id="maritalStatus" name="maritalStatus" required>
      <option value="">Select</option>
      <option value="Single">Single</option>
      <option value="Married">Married</option>
      <option value="Divorced">Divorced</option>
      <option value="Widowed">Widowed</option>
    </select>

</div>

<div class="field-group">
    <label for="bloodGroup">Blood Group <span style="color: red;">*</span></label>
    <select id="bloodGroup" name="bloodGroup" required>
      <option value="">Select</option>
      <option value="A+">A+</option>
      <option value="A-">A-</option>
      <option value="B+">B+</option>
      <option value="B-">B-</option>
      <option value="O+">O+</option>
      <option value="O-">O-</option>
      <option value="AB+">AB+</option>
      <option value="AB-">AB-</option>
    </select>
  </div>
</div>
<div class="name-fields">
  <div class="field-group">
    <label for="custom_employee_name_as_per_aadhar_card_">Employee Name as per Aadhaar Card <span style="color: red;">*</span></label>
    <input type="text" id="custom_employee_name_as_per_aadhar_card_" name="custom_employee_name_as_per_aadhar_card_" required placeholder="As per Aadhaar">
  </div>
  <div class="field-group">
    <label for="custom_previous_uan_no">Previous UAN No.</label>
    <input type="text" id="custom_previous_uan_no" name="custom_previous_uan_no" placeholder="UAN Number">
  </div>
  <div class="field-group">
    <label for="custom_previous_esic_ip_no">Previous ESIC IP No.</label>
    <input type="text" id="custom_previous_esic_ip_no" name="custom_previous_esic_ip_no" placeholder="ESIC IP Number">
  </div>
</div>

<h2>Family Details</h2>
<hr>
<div class="name-fields">
  <div class="field-group">
    <label for="custom_fathers_name">Father's Name <span style="color: red;">*</span></label>
    <input type="text" id="custom_fathers_name" name="custom_fathers_name" required placeholder="Father's Name">
  </div>
  <div class="field-group">
    <label for="custom_fathers_dob">Father's Date of Birth</label>
    <input type="date" id="custom_fathers_dob" name="custom_fathers_dob">
  </div>
  <div class="field-group">
    <label for="custom_mothers_name">Mother's Name <span style="color: red;">*</span></label>
    <input type="text" id="custom_mothers_name" name="custom_mothers_name" required placeholder="Mother's Name">
  </div>
</div>
<div class="name-fields">
  <div class="field-group">
    <label for="custom_mothers_dob">Mother's Date of Birth</label>
    <input type="date" id="custom_mothers_dob" name="custom_mothers_dob">
  </div>
  <div class="field-group">
    <label for="custom_spouse_name">Spouse Name</label>
    <input type="text" id="custom_spouse_name" name="custom_spouse_name" placeholder="Spouse Name">
  </div>
  <div class="field-group">
    <label for="custom_spouse_dob">Spouse Date of Birth</label>
    <input type="date" id="custom_spouse_dob" name="custom_spouse_dob">
  </div>
</div>
<div class="name-fields">
  <div class="field-group">
    <label for="custom_are_you_disabled">Are you disabled? <span style="color: red;">*</span></label>
    <select id="custom_are_you_disabled" name="custom_are_you_disabled" required onchange="toggleDisabilityFields()">
      <option value="">Select</option>
      <option value="No">No</option>
      <option value="Yes">Yes</option>
    </select>
  </div>
  <div class="field-group" id="disabilityDetails" style="display: none;">
    <label for="custom_if_yes_what_type_of_disability">If Yes, what type of disability?</label>
    <input type="text" id="custom_if_yes_what_type_of_disability" name="custom_if_yes_what_type_of_disability" placeholder="Type of Disability">
    <label for="custom_percentage_of_disability">Percentage of Disability</label>
    <input type="number" id="custom_percentage_of_disability" name="custom_percentage_of_disability" min="0" max="100" placeholder="%">
  </div>
</div>

<h2>Children Details</h2>
<hr>
<table id="childrenTable" border="1" cellpadding="8" cellspacing="0" style="border-collapse: collapse; width: 100%;">
  <thead>
    <tr>
      <th>No.</th>
      <th>Child Name</th>
      <th>Child Date of Birth</th>
      <th>Action</th>
    </tr>
  </thead>
  <tbody>
    <tr>
      <td style="text-align: center;">1</td>
      <td><input type="text" name="child_name1" style="border: none;"></td>
      <td><input type="date" name="child_dob1" style="border: none;"></td>
      <td style="text-align: center;"><button type="button" class="delete-row-btn" onclick="deleteChildRow(this)" style="border: none;"><i class="fas fa-trash-alt"></i></button></td>
    </tr>
  </tbody>
</table>
<br>
<button type="button" onclick="addChildRow()" class="add-row-btn">Add Child</button>

<div class="name-fields">
  <div class="field-group">
    <label for="familyBackground">Family Background <span style="color: red;">*</span></label>
    <textarea id="familyBackground" name="familyBackground" rows="5" cols="60" required placeholder="Brief description...">

Health Details *

Profile

Educational Qualifications

No.	School/University *	Qualification *	Level *	Year of Passing *
1

Previous Work Experience

No.	Company	Designation	Salary	Address	Action
No Data