< form class = "jotform-form" action = "http://submit.jotform.me/submit.php" method = "post" name = "form_51937699295476" id = "timeOffForm" >
< input type = "hidden" name = "formID" value = "51937699295476" />
< div class = "form-all" >
< ul class = "form-section page-section" >
< li class = "form-line jf-required" data-type = "control_fullname" >
< label class = "form-label form-label-left form-label-auto" >
Employee Name < span class = "form-required" > *</ span >
</ label >
< div class = "form-input jf-required" >
< span class = "form-sub-label-container" style = "vertical-align: top;" >
< input class = "form-textbox validate[required]" type = "text" style = "width: 200px;" name = "employeeName[first]" />
< label class = "form-sub-label" > First Name</ label >
</ span >
< span class = "form-sub-label-container" style = "vertical-align: top" >
< input class = "form-textbox validate[required]" type = "text" style = "width: 200px;" name = "employeeName[last]" />
< label class = "form-sub-label" > Last Name</ label >
</ span >
</ div >
</ li >
< li class = "form-line jf-required" data-type = "control_email" >
< label class = "form-label form-label-left form-label-auto" >
E-mail < span class = "form-required" > *</ span >
</ label >
< div class = "form-input jf-required" >
< input type = "email" class = "form-textbox validate[required, Email]" name = "email" size = "30" />
</ div >
</ li >
< li class = "form-line jf-required" data-type = "control_phone" >
< label class = "form-label form-label-left form-label-auto" >
Contact Number < span class = "form-required" > *</ span >
</ label >
< div class = "form-input jf-required" >
< span class = "form-sub-label-container" style = "vertical-align: top" >
< input class = "form-textbox validate[required]" type = "tel" name = "contactNumber[area]" style = "width: 200px;" />
< label class = "form-sub-label" > Area Code</ label >
</ span >
< span class = "form-sub-label-container" style = "vertical-align: top" >
< input class = "form-textbox validate[required]" type = "tel" name = "contactNumber[phone]" style = "width: 200px;" />
< label class = "form-sub-label" > Phone Number</ label >
</ span >
</ div >
</ li >
< li class = "form-line jf-required" data-type = "control_textbox" >
< label class = "form-label form-label-left form-label-auto" >
Start Date< span class = "form-required" > *</ span >
</ label >
< div class = "form-input jf-required" >
< input type = "text" class = "form-textbox validate[required]" data-type = "input-textbox" name = "startDate" size = "20" value = "" />
</ div >
</ li >
< li class = "form-line jf-required" data-type = "control_textbox" >
< label class = "form-label form-label-left form-label-auto" >
End Date< span class = "form-required" > *</ span >
</ label >
< div class = "form-input jf-required" >
< input type = "text" class = "form-textbox validate[required]" data-type = "input-textbox" name = "endDate" size = "20" value = "" />
</ div >
</ li >
< li class = "form-line jf-required" data-type = "control_textbox" >
< label class = "form-label form-label-left form-label-auto" >
Start to work on< span class = "form-required" > *</ span >
</ label >
< div class = "form-input jf-required" >
< input type = "text" class = "form-textbox validate[required]" data-type = "input-textbox" name = "startToWork" size = "20" value = "" />
</ div >
</ li >
< li class = "form-line jf-required" data-type = "control_dropdown" >
< label class = "form-label form-label-left form-label-auto" >
Reason < span class = "form-required" > *</ span >
</ label >
< div class = "form-input jf-required" >
< select class = "form-dropdown validate[required]" style = "width: 200px" name = "reason" >
< option value = "" ></ option >
< option value = "Vacation" > Vacation</ option >
< option value = "Personal Leave" > Personal Leave</ option >
< option value = "Sick" > Sick</ option >
< option value = "Others" > Others</ option >
</ select >
</ div >
</ li >
< li class = "form-line" data-type = "control_textarea" >
< label class = "form-label form-label-left" > Additional Comments</ label >
< div class = "form-input jf-required" >
< textarea class = "form-textarea" name = "additionalComments" cols = "30" rows = "7" ></ textarea >
</ div >
</ li >
< li class = "form-line" data-type = "control_button" >
< div class = "form-input-wide" >
< div style = "margin-left: 206px" class = "form-buttons-wrapper" >
< button type = "submit" class = "form-submit-button" > Submit</ button >
</ div >
</ div >
</ li >
</ ul >
</ div >
<!-- Generated by JotForm -->
< input type = "hidden" id = "simple_spc" name = "simple_spc" value = "51937699295476" />
< script type = "text/javascript" >
document . getElementById ( "si" + "mple" + "_spc" ). value = "51937699295476-51937699295476" ;
</ script >
</ form >
< script >
$ ( document ). ready ( function () {
$ ( '#timeOffForm' ). formValidation ({
framework : 'jotform' ,
icon : {
valid : 'fa fa-check' ,
invalid : 'fa fa-times' ,
validating : 'fa fa-refresh' ,
feedback : 'fv-control-feedback'
},
fields : {
'employeeName[first]' : {
row : '.form-sub-label-container' ,
validators : {
notEmpty : {
message : 'The first name is required'
}
}
},
'employeeName[last]' : {
row : '.form-sub-label-container' ,
validators : {
notEmpty : {
message : 'The last name is required'
}
}
},
email : {
validators : {
notEmpty : {
message : 'The email address is required'
},
emailAddress : {
message : 'The email address is not valid'
}
}
},
'contactNumber[area]' : {
row : '.form-sub-label-container' ,
validators : {
notEmpty : {
message : 'The area code is required'
},
digits : {
message : 'The area code can consist of number only'
}
}
},
'contactNumber[phone]' : {
row : '.form-sub-label-container' ,
validators : {
notEmpty : {
message : 'The phone number is required'
},
digits : {
message : 'The phone number can consist of number only'
}
}
},
startDate : {
validators : {
notEmpty : {
message : 'The start date is required'
},
date : {
format : 'YYYY-MM-DD' ,
message : 'The start date must follow YYYY-MM-DD format'
}
}
},
endDate : {
validators : {
notEmpty : {
message : 'The end date is required'
},
date : {
format : 'YYYY-MM-DD' ,
message : 'The end date must follow YYYY-MM-DD format and be later than the start date' ,
min : 'startDate'
}
}
},
startToWork : {
validators : {
notEmpty : {
message : 'The date to start working on is required'
},
date : {
format : 'YYYY-MM-DD' ,
message : 'The working date must follow YYYY-MM-DD format and be later than the end date' ,
min : 'endDate'
}
}
},
reason : {
validators : {
notEmpty : {
message : 'The reason is required'
}
}
}
}
});
});
</ script >