-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathDpenduduk.php
92 lines (72 loc) · 2.96 KB
/
Dpenduduk.php
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
<html>
<?php
include 'header.php';
?>
<body>
<div data-role="page" id="page1" data-theme="C">
<div data-role="header">
<h1>DATA PENDUDUK</h1>
</div>
<div data-role="content">
<form action="prosesPenduduk.php" method="POST" data-ajax="false">
<label for="nik">NIK</label>
<input type="number" name="nik" id="nik" required="true">
<label for="nama">Nama Lengkap :</label>
<input type="text" data-clear-btn="true" name="nama" id="nama" required="true">
<label for="tempat_lahir">Tempat Lahir :</label>
<input type="text" data-clear-btn="true" name="tempat_lahir" id="tempat_lahir" required="true">
<label for="tgl_lahir">Tanggal Lahir :</label>
<input type="date" name ="tgl_lahir" id="tgl_lahir" data-role="date" required="true">
<fieldset data-role="content">
<label for="jenis_kelamin">Jenis Kelamin :</label>
<select name="jenis_kelamin" id="jenis_kelamin" required="true">
<option value="">Pilih</option>
<option value="Laki-laki">Laki-laki</option>
<option value="Perempuan">Perempuan</option>
</select>
</fieldset>
<fieldset data-role="content">
<label for="agama">Agama :</label>
<select name="agama" id="agama" required="true">
<option value="">Pilih</option>
<option value="Islam">Islam</option>
<option value="Kristen Katolik">Kristen Katolik</option>
<option value="Kristen Protestan">Kristen Protestan</option>
<option value="Buddha">Buddha</option>
<option value="Hindu">Hindu</option>
</select>
</fieldset>
<fieldset data-role="content">
<label for="status">Status :</label>
<select name="status" id="status" required="true">
<option value="">Pilih</option>
<option value="Menikah">Menikah</option>
<option value="Belum Menikah">Belum Menikah</option>
</select>
</fieldset>
<fieldset data-role="content">
<label for="warga_negara">Warga Negara :</label>
<select name="warga_negara" id="warga_negara" required="true">
<option value="">Pilih</option>
<option value="Indonesia">Indonesia</option>
<option value="Asing">Asing</option>
</select>
</fieldset>
<label for="pekerjaan">Pekerjaan :</label>
<input type="text" data-clear-btn="true" name="pekerjaan" id="pekerjaan" required="true">
<label for="tempat_tinggal">Tempat Tinggal :</label>
<textarea cols="40" rows="8" name="tempat_tinggal" id="tempat_tinggal" required="true"></textarea>
<table width="100%" height="100%">
<tr>
<td width="50%"><a href="index.php" class="ui-btn ui-icon-home ui-btn-icon-right ui-corner-all ui-shadow">Home</a></td>
<td width="50%"><button type="submit" name="simpan" id="simpan" class="ui-btn ui-icon-navigation ui-btn-icon-right ui-corner-all ui-shadow">Kirim</button></td>
</tr>
</table>
</form>
</div>
<div data-role="footer" class="uir" data-position="fixed">
<h4>DESA MANDIANGIN</h4>
</div>
</div>
</body>
</html>