@extends('app')

@section('title', ucwords(__('edit profile')))

@section('head')
<link href="{{ url('resources/assets/admin') }}/css/bootstrap-datepicker.css" rel="stylesheet">
<style>
    .datepicker-days th{
        font-size: 18px;
    }
    .datepicker-days td{
        font-size: 16px;
        color: #000;
    }
    .datepicker-months th{
        font-size: 18px;
    }
    .datepicker-months td{
        font-size: 16px;
        color: #000;
    }
    .datepicker-years th{
        font-size: 18px;
    }
    .datepicker-years td{
        font-size: 16px;
        color: #000;
    }
</style>
@endsection

@section('content')
<!-- Topbar bottom Border Ends--->

<!-- Page Banner Area --->

<div class="container-fluid">

    <div class="row">

        <div class="col-md-12 nlrp">

            <img src="{{ url('resources/assets') }}/images/enroll-banner.jpg" class="img-responsive">

        </div>

    </div>

</div>

<!-- Page Banner Area Ends--->

<!-- Enroll Form Area --->

<div class="container">


    <div class="row"><div class="col-md-12 page-heading"><h2>{!!strtoupper(__('enrollment <span>form</span>'))!!}</h2></div></div>

    <div class="row form-section">

        <div class="col-md-12 form-box">
            {!! Form::open([ 'url' => '/profile/edit-profile', 'class' => '']) !!}

            <div class="row">

                <div class="col-md-12 form-heading"><h3>{!!strtoupper(__('<span>student</span> information'))!!}</h3></div>

                @include("includes/front_alerts")
            </div>

            <div class="row enroll-form">
                <div class="form-horizontal" >
                    <div class="form-group">
                        <div class="col-sm-3">
                            {{ Form::text('first_name', $profile->first_name ,['class' => 'form-control','id'=>'first_name' ,'placeholder'=>ucwords(__('first name'))]) }}
                        </div>
                        <div class="col-sm-3">
                            {{ Form::text('middle_name', $profile->middle_name ,['class' => 'form-control','id'=>'middle_name' ,'placeholder'=>ucwords(__('middle name'))]) }}
                        </div>
                        <div class="col-sm-3">
                            {{ Form::text('last_name', $profile->last_name ,['class' => 'form-control','id'=>'last_name' ,'placeholder'=>ucwords(__('last name'))]) }}
                        </div>
                        {{--<div class="col-sm-3">
                            {{ Form::text('suffix', $profile->suffix ,['class' => 'form-control','id'=>'suffix' ,'placeholder'=>'Suffix(Jr.,Sr.,III.,IV.,Etc.)']) }}
                        </div>--}}
                    </div>
                    <div class="form-group">
                        <div class="col-sm-3">
                            {{ Form::email('email', $profile->email ,['class' => 'form-control','id'=>'email' ,'placeholder'=>ucwords(__('email address')), 'readonly'=>'readonly']) }}
                        </div>
                        <div class="col-sm-3">
                            {{ Form::email('confirm_email', $profile->email ,['class' => 'form-control','id'=>'confirm_email' , 'readonly'=>'readonly','placeholder'=>ucwords(__('confirm email address'))]) }}
                        </div>
                    </div>
                    <div class="form-group">
                        <div class="col-sm-3">
                            {{ Form::text('address', $profile->address ,['class' => 'form-control','id'=>'address' ,'placeholder'=>ucwords(__('street address'))]) }}
                        </div>
                        <div class="col-sm-3">
                            {{ Form::text('city', $profile->city ,['class' => 'form-control','id'=>'city' ,'placeholder'=>ucwords(__('city'))]) }}
                        </div>
                        <div class="col-sm-3">
                            {{ Form::text('state', $profile->state ,['class' => 'form-control','id'=>'state' ,'placeholder'=>ucwords(__('state'))]) }}
                        </div>
                        <div class="col-sm-3">
                            {{ Form::text('zip', $profile->zip ,['class' => 'form-control','id'=>'zip' ,'placeholder'=>ucwords(__('zip'))]) }}
                        </div>
                    </div>
                    <div class="form-group">
                        <div class="col-sm-3">
                            <label>{{ucwords(__('phone number'))}}</label>
                            {{ Form::text('contact', $profile->contact ,['class' => 'form-control','id'=>'contact' ,'placeholder'=>'EX: 255-232-2525']) }}
                        </div>
                        <div class="col-sm-3">
                            <label>{{ucwords(__('date of birth'))}}</label>
                            {{ Form::text('dob', $profile->dob ,['class' => 'form-control','id'=>'dob' ,'placeholder'=>ucwords(__('date of birth'))]) }}
                        </div>
                        @if(!$hide_ssn)
                        <div class="col-sm-3">
                            <label>{{ucwords(__('social security number'))}}</label>
                            {{ Form::text('ssn', $profile->ssn ,['class' => 'form-control','id'=>'ssn' ,'placeholder'=>'EX: 123-45-6789']) }}
                        </div>
                        @endif
                    </div>

                </div>
            </div>



            <div class="row">

                <div class="col-md-12 form-heading"><h3><span>{{strtoupper(__('employer'))}} </span> ({{strtoupper(__('optional'))}})</h3></div>

            </div>

            <div class="row enroll-form">
                <div class="form-horizontal" >



                    <div class="form-group">
                        <div class="col-sm-4">
                            <div class="form-group">

                                <label for="sel1">{{ucwords(__('employer on file'))}}:</label>
                                {{ Form::text('eof', $profile->eof ,['class' => 'form-control','id'=>'eof' ,'placeholder'=>ucwords(__('employer on file'))]) }}
                            </div>
                        </div>                        
                        <div class="col-sm-3">
                            <label>{{ucwords(__('your title'))}}:</label>
                            {{ Form::text('title', $profile->title ,['class' => 'form-control','id'=>'title' ,'placeholder'=>ucwords(__('your title'))]) }}

                        </div>
                    </div>

                </div>

            </div>




            <div class="row enroll-form">
                <div class="form-group">        

                    <div class="col-sm-12 enroll-btn">
                        <button type="submit" class="btn btn-default">{{ucfirst(__('change'))}}</button>
                    </div>
                </div>
            </div>
            {!! FORM::close() !!}   


        </div>

    </div>


</div>

<!-- Enroll Form Area Ends --->


@endsection


@section('foot')
<script type="text/javascript" src="{{ url('resources/assets') }}/js/bootstrap.min.js"></script>
<script type="text/javascript" src="{{ url('resources/assets') }}/js/profile.js"></script>
<script src="{{ url('resources/assets/admin') }}/plugins/bootstrap-datepicker.js"></script>
<script >var Globals =