@extends('layouts.app')
@section('style')
    <style>
        .flatpickr-wrapper {
            width: 100% !important;
        }
    </style>
@endsection
@section('content')
<div class="col-12">

</div>
<div class="col-12">
    <div class="card">
        <div class="card-header pl-5">
            <h5 class="title ">New Personnel</h5>
            <nav aria-label="breadcrumb">
                <ol class="breadcrumb"style="background-color: white; padding-left: 2px">
                    <li class="breadcrumb-item"><a href="{{ route('home') }}">Home</a></li>
                    <li class="breadcrumb-item"><a href="{{ route('personnel') }}">Personnel</a></li>
                    <li class="breadcrumb-item active" aria-current="page">New</li>
                </ol>
            </nav>
        </div>
        <div class="card-body">
            <form method="POST" action="{{ route('personnel.store') }}" enctype="multipart/form-data" onsubmit="formSubmit()">
                @csrf
                <div class="row">
                    @foreach ($errors->all() as $error)
                <li>{{ $error }}</li>
            @endforeach
                </div>
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Personnel Information</p>
                        <div class="row">
                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>First Name <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('first_name')) is-invalid @endif" placeholder="required" name="first_name" value="{{ old('first_name') }}">
                                    @if ($errors->has('first_name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('first_name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Middle Name</label>
                                    <input type="text" class="form-control @if ($errors->has('middle_name')) is-invalid @endif" placeholder="optional" name="middle_name" value="{{ old('middle_name') }}">
                                    @if ($errors->has('middle_name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('middle_name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Last Name  <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('last_name')) is-invalid @endif" placeholder="required" name="last_name" value="{{ old('last_name') }}">
                                    @if ($errors->has('last_name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('last_name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12  col-md-3">
                                <div class="form-group">
                                    <label>Suffix</label>
                                    <input type="text" class="form-control @if ($errors->has('suffix')) is-invalid @endif" placeholder="optional" name="suffix" value="{{ old('suffix') }}">
                                    @if ($errors->has('suffix'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('suffix') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Personnel Type <span class="text-danger">*</span></label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('personnel_type')) is-invalid @endif" placeholder="required" name="personnel_type" value="{{ old('personnel_type') }}">
                                        <option value="Security Guard">Security Guard</option>
                                        <option value="Employee">Employee</option>
                                    </select>
                                    @if ($errors->has('personnel_type'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('personnel_type') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Sex <span class="text-danger">*</span></label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('sex')) is-invalid @endif" placeholder="required" name="sex" value="{{ old('sex') }}">
                                        <option value="Male">Male</option>
                                        <option value="Female">Female</option>
                                    </select>
                                    @if ($errors->has('sex'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('sex') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Civil Status <span class="text-danger">*</span></label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('civil_status')) is-invalid @endif" placeholder="required" name="civil_status" value="{{ old('civil_status') }}">
                                        <option value="Single">Single</option>
                                        <option value="Married">Married</option>
                                        <option value="Separated">Separated</option>
                                        <option value="Widowed">Widowed</option>
                                    </select>
                                    @if ($errors->has('civil_status'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('civil_status') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Date of Birth  <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control selector @if ($errors->has('date_of_birth')) is-invalid @endif" placeholder="required" name="date_of_birth" value="{{ old('date_of_birth') }}">
                                    @if ($errors->has('date_of_birth'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('date_of_birth') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Birthplace <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('birthplace')) is-invalid @endif" placeholder="required" name="birthplace" value="{{ old('birthplace') }}">
                                    @if ($errors->has('birthplace'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('birthplace') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Contact No. <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('contact_no')) is-invalid @endif" placeholder="required" name="contact_no" value="{{ old('contact_no') }}">
                                    @if ($errors->has('contact_no'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('contact_no') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Email</label>
                                    <input type="text" class="form-control @if ($errors->has('email')) is-invalid @endif" placeholder="optional" name="email" value="{{ old('email') }}">
                                    @if ($errors->has('email'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('email') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Height (cm) <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('height')) is-invalid @endif" placeholder="required" name="height" value="{{ old('height') }}">
                                    @if ($errors->has('height'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('height') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Weight (kg) <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('weight')) is-invalid @endif" placeholder="required" name="weight" value="{{ old('weight') }}">
                                    @if ($errors->has('weight'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('weight') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Blood Type <span class="text-danger">*</span></label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('blood_type')) is-invalid @endif" placeholder="optional" name="blood_type" value="{{ old('blood_type') }}">
                                        <option value="O positive">O positive</option>
                                        <option value="O negative">O negative</option>
                                        <option value="A positive">A positive</option>
                                        <option value="A negative">A negative</option>
                                        <option value="B positive">B positive</option>
                                        <option value="B negative">B negative</option>
                                        <option value="AB positive">AB positive</option>
                                        <option value="AB negative">AB negative</option>
                                    </select>
                                    @if ($errors->has('blood_type'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('blood_type') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Citizenship <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('citizenship')) is-invalid @endif" placeholder="required" name="citizenship" value="{{ old('citizenship', 'Filipino') }}">
                                    @if ($errors->has('citizenship'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('citizenship') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Current Address <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('current_address')) is-invalid @endif" placeholder="required" name="current_address" value="{{ old('current_address') }}">
                                    @if ($errors->has('current_address'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('current_address') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Permanent Address <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('permanent_address')) is-invalid @endif" placeholder="required" name="permanent_address" value="{{ old('permanent_address') }}">
                                    @if ($errors->has('permanent_address'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('permanent_address') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6 mb-3">
                                <div class="">
                                    <label>Photo <span class="text-danger">*</span></label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="photo">
                                    @if ($errors->has('photo'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('photo') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6 mb-3">
                                <div class="">
                                    <label>Home Sketch <span class="text-danger">*</span></label>
                                    <input type="file" class="form-control-file" accept="image/x-png,image/gif,image/jpeg" name="sketch">
                                    @if ($errors->has('sketch'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('sketch') }}</strong>
                                        </div>
                                    @endif

                                </div>

                            </div>

                            <div class="col-12 col-md-6 text-right">
                                <div class="form-group text-left">
                                    <label>Language Spoken</label>
                                    <input type="text" class="form-control" placeholder="optional" name="language_spoken[0]" value="{{ old('language_spoken.0') }}">
                                </div>
                                <div class="form-group text-left" id="divLanguage" >
                                </div>
                                <button class="btn btn-sm btn-success ml-auto mt-0" type="button" style="font-size: 14px !important" id="btnAddLanguage">
                                    <i class="now-ui-icons ui-1_simple-add"></i>
                                </button>

                            </div>

                            <div class="col-12 col-md-6 text-right">
                                <div class="form-group text-left">
                                    <label>Special Skills</label>
                                    <input type="text" class="form-control @if ($errors->has('special skills')) is-invalid @endif" placeholder="optional" name="special_skills[0]" value="{{ old('special_skills.0') }}">
                                </div>
                                <div class="form-group text-left" id="divSkills" >
                                </div>
                                <button class="btn btn-sm btn-success ml-auto mt-0" type="button" style="font-size: 14px !important" id="btnAddSkills">
                                    <i class="now-ui-icons ui-1_simple-add"></i>
                                </button>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Account Information --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Account Information</p>
                        <div class="row">
                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Employment Date <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control selector @if ($errors->has('employment_date')) is-invalid @endif" placeholder="required" name="employment_date" value="{{ old('employment_date') }}">
                                    @if ($errors->has('employment_date'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('employment_date') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Employment Status <span class="text-danger">*</span></label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('employment_status')) is-invalid @endif" placeholder="optional" name="employment_status" value="{{ old('employment_status') }}">
                                        <option value="Active">Active</option>
                                        <option value="Reserve">Reserve</option>
                                        <option value="Terminated">Terminated</option>
                                        <option value="Resigned">Resigned</option>
                                    </select>
                                    @if ($errors->has('employment_status'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('employment_status') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Personnel Status <span class="text-danger">*</span></label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('personnel_status')) is-invalid @endif" placeholder="optional" name="personnel_status" value="{{ old('personnel_status') }}">
                                        <option value="Internal">Internal</option>
                                        <option value="External">External</option>
                                    </select>
                                    @if ($errors->has('personnel_status'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('personnel_status') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Security License Number --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Security License Number</p>
                        <div class="row">
                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>License Number <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('license_number')) is-invalid @endif" placeholder="required" name="license_number" value="{{ old('license_number') }}">
                                    @if ($errors->has('license_number'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('license_number') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Issued Date <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control selector @if ($errors->has('issued_date')) is-invalid @endif" placeholder="required" name="issued_date" value="{{ old('issued_date') }}">
                                    @if ($errors->has('issued_date'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('issued_date') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Expiration Date <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control selector @if ($errors->has('expiration_date')) is-invalid @endif" placeholder="required" name="expiration_date" value="{{ old('expiration_date') }}">
                                    @if ($errors->has('expiration_date'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('expiration_date') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Issued At <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('issued_at')) is-invalid @endif" placeholder="required" name="issued_at" value="{{ old('issued_at') }}">
                                    @if ($errors->has('issued_at'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('issued_at') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- SSS --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">SSS Information</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>SSS No.</label>
                                    <input type="text" class="form-control @if ($errors->has('sss_no')) is-invalid @endif" placeholder="optional" name="sss_no" value="{{ old('sss_no') }}">
                                    @if ($errors->has('sss_no'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('sss_no') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6 mb-3">
                                <div class="">
                                    <label>E1 File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="e1_file">
                                    @if ($errors->has('e1_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('e1_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- TIN --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">TIN Information</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>TIN No.</label>
                                    <input type="text" class="form-control @if ($errors->has('tin_no')) is-invalid @endif" placeholder="optional" name="tin_no" value="{{ old('tin_no') }}">
                                    @if ($errors->has('tin_no'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('tin_no') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6 mb-3">
                                <div class="">
                                    <label>1902 File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="tin_file">
                                    @if ($errors->has('tin_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('tin_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- PhilHealth --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">PhilHealth Information</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>PhilHealth No.</label>
                                    <input type="text" class="form-control @if ($errors->has('philhealth_no')) is-invalid @endif" placeholder="optional" name="philhealth_no" value="{{ old('philhealth_no') }}">
                                    @if ($errors->has('philhealth_no'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('philhealth_no') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6 mb-3">
                                <div class="">
                                    <label>MDR File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="mdr_file">
                                    @if ($errors->has('mdr_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('mdr_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Pag-Ibig --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Pag-Ibig Information</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Pag-Ibig No.</label>
                                    <input type="text" class="form-control @if ($errors->has('pag_ibig_no')) is-invalid @endif" placeholder="optional" name="pag_ibig_no" value="{{ old('pag_ibig_no') }}">
                                    @if ($errors->has('pag_ibig_no'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('pag_ibig_no') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6 mb-3">
                                <div class="">
                                    <label>MDF File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="mdf_file">
                                    @if ($errors->has('mdf_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('mdf_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- NBI --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">NBI Information</p>
                        <div class="row">
                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>NBI No.</label>
                                    <input type="text" class="form-control @if ($errors->has('nbi_no')) is-invalid @endif" placeholder="optional" name="nbi_no" value="{{ old('nbi_no') }}">
                                    @if ($errors->has('nbi_no'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('nbi_no') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Issued At</label>
                                    <input type="text" class="form-control @if ($errors->has('nbi_issued_at')) is-invalid @endif" placeholder="optional" name="nbi_issued_at" value="{{ old('nbi_issued_at') }}">
                                    @if ($errors->has('nbi_issued_at'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('nbi_issued_at') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Expiration Date</label>
                                    <input type="text" class="form-control selector @if ($errors->has('nbi_expiration_date')) is-invalid @endif" placeholder="optional" name="nbi_expiration_date" value="{{ old('nbi_expiration_date') }}">
                                    @if ($errors->has('nbi_expiration_date'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('nbi_expiration_date') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3 mb-3">
                                <div class="">
                                    <label>NBI Clearance File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="nbi_clearance_file">
                                    @if ($errors->has('nbi_clearance_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('nbi_clearance_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                        </div>
                    </div>
                </div>


                {{-- Police Clearance --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Police Clearance Information</p>
                        <div class="row">
                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Police Clearance No.</label>
                                    <input type="text" class="form-control @if ($errors->has('police_clearance_no')) is-invalid @endif" placeholder="optional" name="police_clearance_no" value="{{ old('police_clearance_no') }}">
                                    @if ($errors->has('police_clearance_no'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('police_clearance_no') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Issued At</label>
                                    <input type="text" class="form-control @if ($errors->has('clearance_issued_at')) is-invalid @endif" placeholder="optional" name="clearance_issued_at" value="{{ old('clearance_issued_at') }}">
                                    @if ($errors->has('clearance_issued_at'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('clearance_issued_at') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Expiration Date</label>
                                    <input type="text" class="form-control selector @if ($errors->has('clearance_expiration_date')) is-invalid @endif" placeholder="optional" name="clearance_expiration_date" value="{{ old('clearance_expiration_date') }}">
                                    @if ($errors->has('clearance_expiration_date'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('clearance_expiration_date') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3 mb-3">
                                <div class="">
                                    <label>Police Clearance File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="police_clearance_file">
                                    @if ($errors->has('police_clearance_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('police_clearance_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Medical Certificate --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Medical Certificate Information</p>
                        <div class="row">
                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Medical Cert. No.</label>
                                    <input type="text" class="form-control @if ($errors->has('medical_cert_no')) is-invalid @endif" placeholder="optional" name="medical_cert_no" value="{{ old('medical_cert_no') }}">
                                    @if ($errors->has('medical_cert_no'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('medical_cert_no') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Issued At</label>
                                    <input type="text" class="form-control selector @if ($errors->has('certificate_issued_at')) is-invalid @endif" placeholder="optional" name="certificate_issued_at" value="{{ old('certificate_issued_at') }}">
                                    @if ($errors->has('certificate_issued_at'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('certificate_issued_at') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Expiration Date</label>
                                    <input type="text" class="form-control selector @if ($errors->has('certificate_expiration_date')) is-invalid @endif" placeholder="optional" name="certificate_expiration_date" value="{{ old('certificate_expiration_date') }}">
                                    @if ($errors->has('certificate_expiration_date'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('certificate_expiration_date') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3 mb-3">
                                <div class="">
                                    <label>Medical Cert. File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="medical_certificate_file">
                                    @if ($errors->has('medical_certificate_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('medical_certificate_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Neurological Exam Information --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Neurological Exam Information</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Neurological Exam Status</label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('neurological_exam')) is-invalid @endif" placeholder="optional" name="neurological_exam" value="{{ old('neurological_exam') }}">
                                        <option value=""></option>
                                        <option value="NP Granted">NP Granted</option>
                                        <option value="Not Granted">Not Granted</option>
                                    </select>
                                    @if ($errors->has('neurological_exam'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('neurological_exam') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Remarks</label>
                                    <input type="text" class="form-control @if ($errors->has('exam_remarks')) is-invalid @endif" placeholder="optional" name="exam_remarks" value="{{ old('exam_remarks') }}">
                                    @if ($errors->has('exam_remarks'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('exam_remarks') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Issued At</label>
                                    <input type="text" class="form-control @if ($errors->has('exam_issued_at')) is-invalid @endif" placeholder="optional" name="exam_issued_at" value="{{ old('exam_issued_at') }}">
                                    @if ($errors->has('exam_issued_at'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('exam_issued_at') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Expiration Date <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control selector @if ($errors->has('exam_expiration_date')) is-invalid @endif" placeholder="required" name="exam_expiration_date" value="{{ old('exam_expiration_date') }}">
                                    @if ($errors->has('exam_expiration_date'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('exam_expiration_date') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3 mb-3">
                                <div class="">
                                    <label>Result File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="neurological_exam_file">
                                    @if ($errors->has('neurological_exam_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('neurological_exam_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Drug Test Information --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Drug Test Information</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Drug Test Status</label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('neurological_exam')) is-invalid @endif" placeholder="optional" name="neurological_exam" value="{{ old('neurological_exam') }}">
                                        <option value=""></option>
                                        <option value="Positive">Positive</option>
                                        <option value="Negative">Negative</option>
                                    </select>
                                    @if ($errors->has('neurological_exam'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('neurological_exam') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Remarks</label>
                                    <input type="text" class="form-control @if ($errors->has('test_remarks')) is-invalid @endif" placeholder="optional" name="test_remarks" value="{{ old('test_remarks') }}">
                                    @if ($errors->has('test_remarks'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('test_remarks') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Issued At</label>
                                    <input type="text" class="form-control @if ($errors->has('test_issued_at')) is-invalid @endif" placeholder="optional" name="test_issued_at" value="{{ old('test_issued_at') }}">
                                    @if ($errors->has('test_issued_at'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('test_issued_at') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-3">
                                <div class="form-group">
                                    <label>Expiration Date <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control selector @if ($errors->has('test_expiration_date')) is-invalid @endif" placeholder="required" name="test_expiration_date" value="{{ old('test_expiration_date') }}">
                                    @if ($errors->has('test_expiration_date'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('test_expiration_date') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-6 mb-3">
                                <div class="">
                                    <label>Result File</label>
                                    <input type="file" class="form-control-file"  accept="image/x-png,image/gif,image/jpeg" name="drug_result_file">
                                    @if ($errors->has('drug_result_file'))
                                        <div class="invalid-feedback" style="display:block;">
                                            <strong>{{ $errors->first('drug_result_file') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Family Background --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Family Background</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Name <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('family_member.0.fullname')) is-invalid @endif" placeholder="required" name="family_member[0][fullname]" value="{{ old('family_member.0.fullname') }}">
                                    @if ($errors->has('family_member.0.fullname'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('family_member.0.fullname') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Occupation <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('family_member.0.occupation')) is-invalid @endif" placeholder="required" name="family_member[0][occupation]" value="{{ old('family_member.0.occupation') }}">
                                    @if ($errors->has('family_member.0.occupation'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('family_member.0.occupation') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Contact Number <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('family_member.0.contact_number')) is-invalid @endif" placeholder="required" name="family_member[0][contact_number]" value="{{ old('family_member.0.contact_number') }}">
                                    @if ($errors->has('family_member.0.contact_number'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('family_member.0.contact_number') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Date of Birth <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control selector @if ($errors->has('family_member.0.date_of_birth')) is-invalid @endif" placeholder="required" name="family_member[0][date_of_birth]" value="{{ old('family_member.0.date_of_birth') }}" placeholder="required" >
                                    @if ($errors->has('family_member.0.date_of_birth'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('family_member.0.date_of_birth') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Relationship <span class="text-danger">*</span></label>
                                    <select type="text" class="form-control @if ($errors->has('family_member.0.relationship')) is-invalid @endif  js-example-basic-single @if ($errors->has('relationship')) is-invalid @endif" placeholder="required" name="relationship" value="{{ old('relationship') }}">
                                        <option value="Spouse">Spouse</option>
                                        <option value="Mother">Mother</option>
                                        <option value="Father">Father</option>
                                        <option value="Sibling">Sibling</option>
                                    </select>
                                    @if ($errors->has('relationship'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('relationship') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Address (current) <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('address')) is-invalid @endif" placeholder="required" name="address" value="{{ old('address') }}">
                                    @if ($errors->has('address'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('address') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4 mt-3">
                                <div class="form-check form-check-inline border w-100 px-3 py-1">
                                    <input class="form-check-input" type="radio" name="emergency_contact" id="inlineRadio1"  style="height:35px; width:35px; height: 2em;" checked="checked">
                                    <label class="form-check-label ml-0" for="inlineRadio1">Set as Emergency Contact</label>
                                  </div>
                            </div>

                            <div id="divFamily" >
                            </div>

                            <div class="col-12 text-right">
                                <hr>
                                <button class="btn btn-sm btn-success ml-auto mt-0" type="button" style="font-size: 14px !important" id="btnAddFamily">
                                    <i class="now-ui-icons ui-1_simple-add"></i>
                                </button>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Educational Background --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Educational Background</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Educational Level <span class="text-danger">*</span></label>
                                    <select type="text" class="form-control js-example-basic-single @if ($errors->has('educational_level')) is-invalid @endif" placeholder="required" name="educational_level" value="{{ old('educational_level') }}">
                                        <option></option>
                                        <option value="Elementary">Elementary</option>
                                        <option value="High School">High School</option>
                                        <option value="Vocational">Vocational</option>
                                        <option value="College">College</option>
                                        <option value="University">University</option>
                                    </select>
                                    @if ($errors->has('educational_level'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('educational_level') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>School Name <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('school_name')) is-invalid @endif" placeholder="required" name="school_name" value="{{ old('school_name') }}">
                                    @if ($errors->has('school_name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('school_name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Course/Program</label>
                                    <input type="text" class="form-control @if ($errors->has('course')) is-invalid @endif" placeholder="optional" name="course" value="{{ old('course') }}">
                                    @if ($errors->has('course'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('course') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Year</label>
                                    <input type="text" class="form-control @if ($errors->has('year')) is-invalid @endif" placeholder="optional" name="year" value="{{ old('year') }}">
                                    @if ($errors->has('year'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('year') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>


                            <div class="col-12 col-md-4 mt-3">
                                <div class="form-check form-check-inline pt-2">
                                    <input class="form-check-input" type="checkbox" id="inlineCheckbox1" value="option1" style="height:35px; width:35px; height: 2em; opacity: 1 !important; visibility: visible !important" >
                                    <label class="form-check-label ml-3" for="inlineCheckbox1">Graduated</label>
                                </div>
                            </div>

                            <div class="col-12 col-md-12 text-right">
                                <div class="form-group text-left">
                                    <label>Awards</label>
                                    <input type="text" class="form-control @if ($errors->has('awards')) is-invalid @endif" placeholder="optional" name="awards" value="{{ old('awards') }}">
                                    @if ($errors->has('awards'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('awards') }}</strong>
                                        </div>
                                    @endif
                                </div>
                                <div class="form-group text-left" id="divAwards" >
                                </div>
                                <button class="btn btn-sm btn-success ml-auto mt-0" type="button" style="font-size: 14px !important" id="btnAddAwards">
                                    <i class="now-ui-icons ui-1_simple-add"></i>
                                </button>
                            </div>
                            <div id="divEducation" class="w-100">
                            </div>

                            <div class="col-12 text-right">
                                <hr>
                                <button class="btn btn-sm btn-success ml-auto mt-0" type="button" style="font-size: 14px !important" id="btnAddEducation">
                                    <i class="now-ui-icons ui-1_simple-add"></i>
                                </button>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Employment History --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Employment History</p>
                        <div class="row">
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Company Name <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('company_name')) is-invalid @endif" placeholder="required" name="company_name" value="{{ old('company_name') }}">
                                    @if ($errors->has('company_name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('company_name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Designation / Postion <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('position')) is-invalid @endif" placeholder="required" name="position" value="{{ old('position') }}">
                                    @if ($errors->has('position'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('position') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>From <span class="text-danger">*</span></label>
                                    <br />
                                    <input type="text" class="form-control yearRange @if ($errors->has('from')) is-invalid @endif" placeholder="required" name="from" value="{{ old('from') }}" style="width: 100% !important">
                                    @if ($errors->has('from'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('from') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>To <span class="text-danger">*</span></label>
                                    <br />
                                    <input type="text" class="form-control yearRange @if ($errors->has('to')) is-invalid @endif" placeholder="required" name="to" value="{{ old('to') }}" style="width: 100% !important">
                                    @if ($errors->has('to'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('to') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-12">
                                <div class="form-group">
                                    <label>Reasons for Leaving <span class="text-danger">*</span></label>
                                    <br />
                                    <textarea type="text" class="form-control @if ($errors->has('reasons_for_leaving')) is-invalid @endif" placeholder="required" name="reasons_for_leaving" value="{{ old('reasons_for_leaving') }}" style="border: 1px solid #E3E3E3"></textarea>
                                    @if ($errors->has('reasons_for_leaving'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('reasons_for_leaving') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div id="divEmployment" class="w-100">
                            </div>

                            <div class="col-12 text-right">
                                <hr>
                                <button class="btn btn-sm btn-success ml-auto mt-0" type="button" style="font-size: 14px !important" id="btnAddEmployment">
                                    <i class="now-ui-icons ui-1_simple-add"></i>
                                </button>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Character Reference --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Character Reference</p>
                        <div class="row">
                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Name <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('name')) is-invalid @endif" placeholder="required" name="name" value="{{ old('name') }}">
                                    @if ($errors->has('name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Contact No. <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('name')) is-invalid @endif" placeholder="required" name="name" value="{{ old('name') }}">
                                    @if ($errors->has('name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Designation / Position <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('name')) is-invalid @endif" placeholder="required" name="name" value="{{ old('name') }}">
                                    @if ($errors->has('name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Company <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('name')) is-invalid @endif" placeholder="required" name="name" value="{{ old('name') }}">
                                    @if ($errors->has('name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>
                            <div class="col-12 col-md-6">
                                <div class="form-group">
                                    <label>Company Address<span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('name')) is-invalid @endif" placeholder="required" name="name" value="{{ old('name') }}">
                                    @if ($errors->has('name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div id="divReference" class="w-100">
                            </div>

                            <div class="col-12 text-right">
                                <hr>
                                <button class="btn btn-sm btn-success ml-auto mt-0" type="button" style="font-size: 14px !important" id="btnAddReference">
                                    <i class="now-ui-icons ui-1_simple-add"></i>
                                </button>
                            </div>
                        </div>
                    </div>
                </div>

                {{-- Banking Information --}}
                <div class="row pr-5 pl-5">
                    <div class="card p-3">
                        <p class=" mt-3 text-info">Banking Informaion</p>
                        <div class="row">
                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Bank Name <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('name')) is-invalid @endif" placeholder="required" name="name" value="{{ old('name') }}">
                                    @if ($errors->has('name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Account Name <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('name')) is-invalid @endif" placeholder="required" name="name" value="{{ old('name') }}">
                                    @if ($errors->has('name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div class="col-12 col-md-4">
                                <div class="form-group">
                                    <label>Account Number <span class="text-danger">*</span></label>
                                    <input type="text" class="form-control @if ($errors->has('name')) is-invalid @endif" placeholder="required" name="name" value="{{ old('name') }}">
                                    @if ($errors->has('name'))
                                        <div class="invalid-feedback">
                                            <strong>{{ $errors->first('name') }}</strong>
                                        </div>
                                    @endif
                                </div>
                            </div>

                            <div id="divBank" class="w-100">
                            </div>

                            <div class="col-12 text-right">
                                <hr>
                                <button class="btn btn-sm btn-success ml-auto mt-0" type="button" style="font-size: 14px !important" id="btnAddBank">
                                    <i class="now-ui-icons ui-1_simple-add"></i>
                                </button>
                            </div>
                        </div>
                    </div>
                </div>

                <div class="row pr-5 pl-5">
                    <div class="col-12">
                        <button type="submit" class="d-block d-md-none ml-auto btn btn-md btn-primary btn-block">
                            <span class="icon text-white-50">
                                <i class="fas fa-save"></i>
                            </span>
                            &nbsp;Save
                        </button>
                        <button type="submit" class="d-none d-md-block ml-auto btn btn-md btn-primary btn-block" style="width: 155px">
                            <span class="icon text-white-50">
                                <i class="fas fa-save"></i>
                            </span>
                            &nbsp;Save
                        </button>
                    </div>
                </div>
            </form>
        </div>
    </div>
</div>
@section('script')
<script src="https://cdn.jsdelivr.net/npm/flatpickr@latest/dist/plugins/monthSelect/index.js"></script>
    <script>
        $(document).ready(function() {
            function formSubmit() {
                loader();
                return true;
            }

            notif = {
                misc: {
                navbar_menu_visible: 0
                },

                showNotification: function(from, align, color, msg) {

                $.notify({
                    icon: "now-ui-icons ui-1_bell-53",
                    message: msg

                }, {
                    type: color,
                    timer: 8000,
                    placement: {
                    from: from,
                    align: align
                    }
                });
                }
            };
            @if(session()->has('message.level'))
                notif.showNotification('top','right', '{{ session('message.level') }}', '{{ session('message.content') }}')
            @endif

            $(".yearRange").flatpickr({
                static: true,
                altInput: true,
                plugins: [new monthSelectPlugin({shorthand: false, dateFormat: "Y-m-d", altFormat: "M Y"})]
            });



            let language = 1;
            let skills = 1;
            let awards = 0;

            @if(old('language_spoken'))
                @foreach (old('language_spoken') as $v)
                    @if($loop->index != 0)
                        addLanguage('{{ $v }}');
                    @endif
                @endforeach
            @endif


            $('#btnAddLanguage').click(function() {
                addLanguage('');
            });

            function addLanguage(val) {
                $('#divLanguage').append(
                    '<div style="display: flex;" id="lng' + language + '">' +
                        '<input type="text" class="form-control" placeholder="optional" style="height:37px" name="language_spoken[' + language + ']" value="' + val + '" />' +
                        '<button class="btn btn-sm btn-danger mt-0 btnLang" id="btl' + language + '" type="button" style="font-size: 20px !important;">' +
                            '<span class="icon text-white-50">' +
                                '<i class="fas fa-times"></i>' +
                            '</span>' +
                        '</button>' +
                    '</div>'
                );
                language++;

                $('.btnLang').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $('#lng' + id ).remove();
                });
            }

            @if(old('special_skills'))
                @foreach (old('special_skills') as $v)
                    @if($loop->index != 0)
                        addSkills('{{ $v }}');
                    @endif
                @endforeach
            @endif

            $('#btnAddSkills').click(function() {
                addSkills('');
            });

            function addSkills(val) {
                $('#divSkills').append(
                    '<div style="display: flex;" id="skl' + skills + '">' +
                        '<input type="text" class="form-control" placeholder="optional" style="height:37px" name="special_skills[' + skills + ']" value="' + val + '">' +
                        '<button class="btn btn-sm btn-danger mt-0 btnSkl" id="skl' + skills + '" type="button" style="font-size: 20px !important;">' +
                            '<span class="icon text-white-50">' +
                                '<i class="fas fa-times"></i>' +
                            '</span>' +
                        '</button>' +
                    '</div>'
                );
                skills++;

                $('.btnSkl').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $('#skl' + id ).remove();
                });
            }

            let famCtr = 1;
            $('#btnAddFamily').click(function() {
                let fullname = {
                    'val': "",
                    'error' : "",
                    'danger' : ""
                }
                let occupation = {
                    'val': "",
                    'error' : "",
                    'danger' : ""
                }
                let contact_number = {
                    'val': "",
                    'error' : "",
                    'danger' : ""
                }
                let date_of_birth = {
                    'val': "",
                    'error' : "",
                    'danger' : ""
                }
                addFamily(fullname, occupation, contact_number, date_of_birth);
            });

            @if(old('family_member'))
                @foreach(old('family_member', []) as $i => $name_progress)
                    @if($i > 0)

                        fullname = {
                            'val' : "{{ old('family_member')[$i]['fullname'] }}",
                            @if($errors->has('family_member.' . $i . '.fullname'))
                                'error' :'{{ $errors->first('family_member.' . $i . '.fullname') }}',
                                'danger' :  'is-invalid'
                            @else
                                'error' : '',
                                'danger' : ''
                            @endif
                        }

                        occupation = {
                            'val' : "{{ old('family_member')[$i]['occupation'] }}",
                            @if($errors->has('family_member.' . $i . '.occupation'))
                                'error' :'{{ $errors->first('family_member.' . $i . '.occupation') }}',
                                'danger' :  'is-invalid'
                            @else
                                'error' : '',
                                'danger' : ''
                            @endif
                        }

                        contact_number = {
                            'val' : "{{ old('family_member')[$i]['contact_number'] }}",
                            @if($errors->has('family_member.' . $i . '.contact_number'))
                                'error' :'{{ $errors->first('family_member.' . $i . '.contact_number') }}',
                                'danger' :  'is-invalid'
                            @else
                                'error' : '',
                                'danger' : ''
                            @endif
                        }

                        date_of_birth = {
                            'val' : "{{ old('family_member')[$i]['date_of_birth'] }}",
                            @if($errors->has('family_member.' . $i . '.date_of_birth'))
                                'error' :'{{ $errors->first('family_member.' . $i . '.date_of_birth') }}',
                                'danger' :  'is-invalid'
                            @else
                                'error' : '',
                                'danger' : ''
                            @endif
                        }

                        addFamily(fullname, occupation, contact_number, date_of_birth)
                    @endif
                @endforeach
            @endif

            function addFamily(fullname, occupation, contact_number, date_of_birth) {
                $('#divFamily').append(
                    '<div class="row p-3" id="famRow' + famCtr + '">' +
                        '<div class="col-12 text-right">' +
                            '<hr>' +
                            '<button class="btn btn-sm btn-danger mt-0 btnRmFam" id="btn' + famCtr + '" type="button" style="font-size: 12px !important;">' +
                                '<span class="icon text-white-50">' +
                                    '<i class="fas fa-times"></i>' +
                                '</span>' +
                            '</button>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Name</label>' +
                                '<input type="text" class="form-control ' + fullname.danger + '" placeholder="required" name="family_member[' + famCtr + '][fullname]" value="' + fullname.val + '"}}">' +
                                '<div class="invalid-feedback" style="display:block">' +
                                    '<strong>' + fullname.error + '</strong>' +
                                '</div>' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Occupation</label>' +
                                '<input type="text" class="form-control ' + occupation.danger + '" name="family_member[' + famCtr + '][occupation]" placeholder="required" value="' + occupation.val + '"}}">' +
                                '<div class="invalid-feedback" style="display:block">' +
                                    '<strong>' + occupation.error + '</strong>' +
                                '</div>' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Contact Number</label>' +
                                '<input type="text" class="form-control ' + contact_number.danger + '" placeholder="required" name="family_member[' + famCtr + '][contact_number]" value="' + contact_number.val + '"}}">' +
                                '<div class="invalid-feedback" style="display:block">' +
                                    '<strong>' + contact_number.error + '</strong>' +
                                '</div>' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Date of Birth</label>' +
                                '<input type="text" class="form-control  ' + date_of_birth.danger + ' xselector" placeholder="required" name="family_member[' + famCtr + '][date_of_birth]" value="' + date_of_birth.val + '"}}">' +
                                '<div class="invalid-feedback" style="display:block">' +
                                    '<strong>' + date_of_birth.error + '</strong>' +
                                '</div>' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Relationship</label>' +
                                '<select type="text" class="form-control ss2 " placeholder="required">' +
                                    '<option value="Spouse">Spouse</option>' +
                                    '<option value="Mother">Mother</option>' +
                                    '<option value="Father">Father</option>' +
                                    '<option value="Sibling">Sibling</option>' +
                                '</select>' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Address (current)</label>' +
                                '<input type="text" class="form-control" placeholder="required" >' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4 mt-3">' +
                            '<div class="form-check form-check-inline border w-100 px-3 py-1">' +
                                '<input class="form-check-input" type="radio" name="emergency_contact" id="inlineRadio1" value="option1" style="height:35px; width:35px;height: 2em;">' +
                                '<label class="form-check-label ml-0" for="inlineRadio1">Set as Emergency Contact</label>' +
                            '</div>' +
                        '</div>' +
                    '</div>'
                );

                $('.btnRmFam').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $("#divFamily").children("#famRow" + id).remove();
                });

                $(".xselector").flatpickr();

                $('.ss2').select2({
                    theme: "bootstrap4"
                });

                famCtr++;
            }


            $('#btnAddAwards').click(function() {
                $('#divAwards').append(
                    '<div style="display: flex;" id="awd' + awards + '">' +
                        '<input type="text" class="form-control" placeholder="optional" style="height:37px">' +
                        '<button class="btn btn-sm btn-danger mt-0 btnAwrd" id="bta' + awards + '" type="button" style="font-size: 20px !important;">' +
                            '<span class="icon text-white-50">' +
                                '<i class="fas fa-times"></i>' +
                            '</span>' +
                        '</button>' +
                    '</div>'
                );
                awards++;

                $('.btnAwrd').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $('#awd' + id ).remove();
                });
            });

            let awardsBtn = 0;
            $('#btnAddEducation').click(function() {
                $('#divEducation').append(
                    '<div class="row p-3 " id="eduRow' + awardsBtn + '">' +
                        '<div class="col-12 text-right">' +
                            '<hr>' +
                            '<button class="btn btn-sm btn-danger mt-0 btnRmEduc" id="baw' + awardsBtn + '" type="button" style="font-size: 12px !important;">' +
                                '<span class="icon text-white-50">' +
                                    '<i class="fas fa-times"></i>' +
                                '</span>' +
                            '</button>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Educational Level <span class="text-danger">*</span></label>' +
                                '<select type="text" class="form-control ss2" placeholder="required">' +
                                    '<option></option>' +
                                    '<option value="Elementary">Elementary</option>' +
                                    '<option value="High School">High School</option>' +
                                    '<option value="Vocational">Vocational</option>' +
                                    '<option value="College">College</option>' +
                                    '<option value="University">University</option>' +
                                '</select>'+
                            '</div>' +
                        '</div>'+
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>School Name <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" >' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Course/Program</label>' +
                                '<input type="text" class="form-control" placeholder="optional" name="course">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Year</label>' +
                                '<input type="text" class="form-control" placeholder="optional" name="year">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4 mt-3">' +
                            '<div class="form-check form-check-inline pt-2">' +
                                '<input class="form-check-input" type="checkbox" id="cbGrad' + awardsBtn + '" style="height:35px; width:35px; height: 2em; opacity: 1 !important; visibility: visible !important" >' +
                                '<label class="form-check-label ml-3" for="cbGrad' + awardsBtn + '">Graduated</label>' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-12 text-right">' +
                            '<div class="form-group text-left">' +
                                '<label>Awards</label>' +
                                '<input type="text" class="form-control" placeholder="optional">' +
                            '</div>' +
                            '<div class="form-group text-left" id="divAwards' + awardsBtn + '" >' +
                            '</div>' +
                            '<button class="btn btn-sm btn-success ml-auto mt-0 btnDAwards" type="button" style="font-size: 14px !important" id="dxa' + awardsBtn + '">' +
                                '<i class="now-ui-icons ui-1_simple-add"></i>' +
                            '</button>' +
                        '</div>' +
                    '<div>'
                );

                $('.ss2').select2({
                    theme: "bootstrap4"
                });

                let dAwards = 0;

                $('.btnDAwards').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $('#divAwards' + id).append(
                        '<div style="display: flex;" id="dwd' + dAwards + '">' +
                            '<input type="text" class="form-control" placeholder="optional" style="height:37px">' +
                            '<button class="btn btn-sm btn-danger mt-0 btnAwrd' + id + '" id="bta' + dAwards + '" type="button" style="font-size: 20px !important;">' +
                                '<span class="icon text-white-50">' +
                                    '<i class="fas fa-times"></i>' +
                                '</span>' +
                            '</button>' +
                        '</div>'
                    );

                    $('.btnAwrd' + id).click(function() {
                        let id  = $(this).attr('id').substring(3);
                        $('#dwd' + id ).remove();
                    });
                    dAwards++;

                });

                $('.btnRmEduc').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $("#divEducation").children("#eduRow" + id).remove();
                });
                awardsBtn++;
            });


            let empCtr = 0;
            $('#btnAddEmployment').click(function() {
                $('#divEmployment').append(
                    '<div class="row p-3 " id="empRow' + empCtr + '" >' +
                        '<div class="col-12 text-right">' +
                            '<hr>' +
                            '<button class="btn btn-sm btn-danger mt-0 btnRmEmp" id="bem' + empCtr + '" type="button" style="font-size: 12px !important;">' +
                                '<span class="icon text-white-50">' +
                                    '<i class="fas fa-times"></i>' +
                                '</span>' +
                            '</button>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Company Name <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="company_name">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Designation / Postion <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="position">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>From <span class="text-danger">*</span></label>' +
                                '<br />' +
                                '<input type="text" class="form-control yearRange2" placeholder="required" name="from" style="width: 100% !important">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>To <span class="text-danger">*</span></label>' +
                                '<br />' +
                                '<input type="text" class="form-control yearRange2" placeholder="required" name="to" style="width: 100% !important">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-12">' +
                            '<div class="form-group">' +
                                '<label>Reasons for Leaving <span class="text-danger">*</span></label>' +
                                '<br />' +
                                '<textarea type="text" class="form-control" placeholder="required" name="reasons_for_leaving" style="border: 1px solid #E3E3E3"></textarea>' +
                            '</div>' +
                        '</div>' +
                    '</div>'
                );

                $(".yearRange2").flatpickr({
                    static: true,
                    altInput: true,
                    plugins: [new monthSelectPlugin({shorthand: false, dateFormat: "Y-m-d", altFormat: "M Y"})]
                });

                $('.btnRmEmp').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $("#divEmployment").children("#empRow" + id).remove();
                });
                empCtr++;
            })

            let refCtr = 0;
            $('#btnAddReference').click(function() {
                $('#divReference').append(
                    '<div class="row p-3" id="refRow' + refCtr + '">' +
                        '<div class="col-12 text-right">' +
                            '<hr>' +
                            '<button class="btn btn-sm btn-danger mt-0 btnRmRef" id="brt' + refCtr + '" type="button" style="font-size: 12px !important;">' +
                                '<span class="icon text-white-50">' +
                                    '<i class="fas fa-times"></i>' +
                                '</span>' +
                            '</button>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Name <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="name">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Contact No. <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="name">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Designation / Position <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="name">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Company <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="name">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-6">' +
                            '<div class="form-group">' +
                                '<label>Company Address<span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="name">' +
                            '</div>' +
                        '</div>' +
                    '</div>'
                );

                $('.btnRmRef').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $("#divReference").children("#refRow" + id).remove();
                });
                refCtr++;
            })

            let bnkCtr = 0;
            $('#btnAddBank').click(function() {
                $('#divBank').append(
                    '<div class="row p-3" id="refRow' + bnkCtr + '" >' +
                        '<div class="col-12 text-right">' +
                            '<hr>' +
                            '<button class="btn btn-sm btn-danger mt-0 btnRmBnk" id="bnk' + bnkCtr + '" type="button" style="font-size: 12px !important;">' +
                                '<span class="icon text-white-50">' +
                                    '<i class="fas fa-times"></i>' +
                                '</span>' +
                            '</button>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Bank Name <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="name">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Account Name <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="name">' +
                            '</div>' +
                        '</div>' +
                        '<div class="col-12 col-md-4">' +
                            '<div class="form-group">' +
                                '<label>Account Number <span class="text-danger">*</span></label>' +
                                '<input type="text" class="form-control" placeholder="required" name="name">' +
                            '</div>' +
                        '</div>' +
                    '</div>'
                );

                $('.btnRmBnk').click(function() {
                    let id  = $(this).attr('id').substring(3);
                    $("#divBank").children("#refRow" + id).remove();
                });
                bnkCtr++;
            })

        });
    </script>

@endsection

@endsection