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<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Client Registration | PESO Registry</title>
<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/css/bootstrap.min.css" rel="stylesheet">
<script src="https://cdn.jsdelivr.net/npm/feather-icons/dist/feather.min.js"></script>
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</head>
<body class="bg-light">
<div class="container py-5">
<div class="row justify-content-center">
<div class="col-lg-8">
<div class="registration-card p-4 p-md-5 mb-4">
<div class="text-center mb-4 position-relative">
<h2 class="fw-bold" style="background: linear-gradient(45deg, var(--mint-green), var(--mint-dark)); -webkit-background-clip: text; -webkit-text-fill-color: transparent; display: inline-block;">Client Registration</h2>
<p class="text-muted">Complete the form to register as a PESO client</p>
<div class="position-absolute top-0 end-0 m-3">
<span class="badge bg-mint text-dark rounded-pill px-3 py-2 shadow-sm pulse-animation">NEW</span>
</div>
</div>
<div class="progress mb-4" style="height: 12px; border-radius: 10px; box-shadow: inset 0 1px 3px rgba(0,0,0,0.1);">
<div class="progress-bar progress-bar-striped progress-bar-animated" role="progressbar" style="width: 25%; border-radius: 10px;" id="progressBar"></div>
</div>
<form id="registrationForm">
<!-- Personal Information -->
<div class="form-section active" id="section1">
<h5 class="mb-4">Personal Information</h5>
<div class="row g-3">
<div class="col-md-4">
<label for="lastName" class="form-label">Last Name</label>
<input type="text" class="form-control" id="lastName" required>
</div>
<div class="col-md-4">
<label for="firstName" class="form-label">First Name</label>
<input type="text" class="form-control" id="firstName" required>
</div>
<div class="col-md-4">
<label for="middleName" class="form-label">Middle Name</label>
<input type="text" class="form-control" id="middleName">
</div>
<div class="col-md-3">
<label for="age" class="form-label">Age</label>
<input type="number" class="form-control" id="age" required>
</div>
<div class="col-md-5">
<label for="birthdate" class="form-label">Birthdate</label>
<input type="date" class="form-control" id="birthdate" required>
</div>
<div class="col-md-4">
<label for="sex" class="form-label">Sex</label>
<select class="form-select" id="sex" required>
<option value="" selected disabled>Select...</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
</select>
</div>
<div class="col-md-4">
<label for="maritalStatus" class="form-label">Marital Status</label>
<select class="form-select" id="maritalStatus" required>
<option value="" selected disabled>Select...</option>
<option value="Single">Single</option>
<option value="Married">Married</option>
<option value="Separated">Separated</option>
<option value="Widowed">Widowed</option>
</select>
</div>
<div class="col-md-8">
<label for="educationalBg" class="form-label">Educational Background</label>
<select class="form-select" id="educationalBg" required>
<option value="" selected disabled>Select...</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="Post Graduate">Post Graduate</option>
</select>
</div>
</div>
<div class="d-flex justify-content-between mt-4">
<button type="button" class="btn btn-outline-secondary disabled">
<i data-feather="chevron-left" class="me-1"></i> Previous
</button>
<button type="button" class="btn btn-mint next-section">
Next <i data-feather="chevron-right" class="ms-1"></i>
</button>
</div>
</div>
<!-- Contact Information -->
<div class="form-section" id="section2">
<h5 class="mb-4">Contact Information</h5>
<div class="row g-3">
<div class="col-md-6">
<label for="email" class="form-label">Email</label>
<input type="email" class="form-control" id="email" required>
</div>
<div class="col-md-6">
<label for="phone" class="form-label">Phone Number</label>
<input type="tel" class="form-control" id="phone" required>
</div>
<div class="col-md-6">
<label for="barangay" class="form-label">Barangay</label>
<select class="form-select" id="barangay" required>
<option value="" selected disabled>Select Barangay</option>
<option value="Alapang">Alapang</option>
<option value="Alno">Alno</option>
<option value="Ambiong">Ambiong</option>
<option value="Bahong">Bahong</option>
<option value="Balili">Balili</option>
<option value="Beckel">Beckel</option>
<option value="Betag">Betag</option>
<option value="Bineng">Bineng</option>
<option value="Cruz">Cruz</option>
<option value="Lubas">Lubas</option>
<option value="Pico">Pico</option>
<option value="Poblacion">Poblacion</option>
<option value="Puguis">Puguis</option>
<option value="Shilan">Shilan</option>
<option value="Tawang">Tawang</option>
<option value="Wangal">Wangal</option>
</select>
</div>
<div class="col-md-6">
<label for="address" class="form-label">Complete Address</label>
<input type="text" class="form-control" id="address" required>
</div>
</div>
<div class="d-flex justify-content-between mt-4">
<button type="button" class="btn btn-outline-secondary prev-section">Previous</button>
<button type="button" class="btn btn-mint next-section">Next</button>
</div>
</div>
<!-- Beneficiary Category -->
<div class="form-section" id="section3">
<h5 class="mb-4">Beneficiary Category</h5>
<div class="mb-3">
<label class="form-label">Please select your status (check all that apply):</label>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="employed" name="beneficiaryCategory">
<label class="form-check-label" for="employed">Employed</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="selfEmployed" name="beneficiaryCategory">
<label class="form-check-label" for="selfEmployed">Self-Employed</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="unemployed" name="beneficiaryCategory">
<label class="form-check-label" for="unemployed">Unemployed</label>
</div>
</div>
<div class="d-flex justify-content-between mt-4">
<button type="button" class="btn btn-outline-secondary prev-section">Previous</button>
<button type="button" class="btn btn-mint next-section">Next</button>
</div>
</div>
<!-- Services -->
<div class="form-section" id="section4">
<h5 class="mb-4">Services</h5>
<div class="mb-3">
<label class="form-label">Please select services you're interested in:</label>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="spes" name="services">
<label class="form-check-label" for="spes">SPES (Special Program of Employment for Students)</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="tupad" name="services">
<label class="form-check-label" for="tupad">TUPAD (Tulong Para Sa Disadvantaged Workers)</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="leep" name="services">
<label class="form-check-label" for="leep">LEEP (Local Emergency Employment Program)</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="jobStart" name="services">
<label class="form-check-label" for="jobStart">Job Start</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="gip" name="services">
<label class="form-check-label" for="gip">GIP</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="livelihood" name="services">
<label class="form-check-label" for="livelihood">Livelihood</label>
<div class="mt-2 ms-4" id="livelihoodOptions" style="display: none;">
<div class="form-check">
<input class="form-check-input" type="radio" name="livelihoodType" id="individual" value="individual">
<label class="form-check-label" for="individual">Individual</label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="livelihoodType" id="association" value="association">
<label class="form-check-label" for="association">Association</label>
<input type="text" class="form-control mt-2" id="associationAddress" placeholder="Association Address" style="display: none;">
</div>
</div>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" id="jobSeeker" name="services">
<label class="form-check-label" for="jobSeeker">Job Seeker</label>
<div class="mt-2 ms-4" id="jobSeekerOptions" style="display: none;">
<div class="form-check">
<input class="form-check-input" type="radio" name="jobReferral" id="local" value="local">
<label class="form-check-label" for="local">Local</label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="jobReferral" id="overseas" value="overseas">
<label class="form-check-label" for="overseas">Overseas</label>
</div>
<div class="mt-2">
<label for="jobLookingFor" class="form-label">What job are you looking for?</label>
<input type="text" class="form-control" id="jobLookingFor">
</div>
</div>
</div>
</div>
<div class="d-flex justify-content-between mt-4">
<button type="button" class="btn btn-outline-secondary prev-section">Previous</button>
<button type="button" class="btn btn-mint next-section">Next</button>
</div>
</div>
<!-- Documents Upload -->
<div class="form-section" id="section5">
<h5 class="mb-4">Documents Upload</h5>
<div class="mb-3">
<label for="cvUpload" class="form-label">Upload CV/Resume/Biodata</label>
<input class="form-control" type="file" id="cvUpload" accept=".pdf,.doc,.docx">
<div class="form-text">File types: .pdf, .doc, .docx (Max 5MB)</div>
</div>
<div class="mb-3">
<label for="otherDocs" class="form-label">Other Supporting Documents (Optional)</label>
<input class="form-control" type="file" id="otherDocs" multiple>
<div class="form-text">You can upload multiple files</div>
</div>
<div class="d-flex justify-content-between mt-4">
<button type="button" class="btn btn-outline-secondary prev-section">Previous</button>
<button type="submit" class="btn btn-mint">Submit Registration</button>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
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