Source Code: (back to article)
<!DOCTYPE html>
<html>
<head>
<title>Training Application Form</title>
<link href="https://fonts.googleapis.com/css?family=Roboto:300,400,500,700" rel="stylesheet">
<link rel="stylesheet" href="https://use.fontawesome.com/releases/v5.5.0/css/all.css" integrity="sha384-B4dIYHKNBt8Bc12p+WXckhzcICo0wtJAoU8YZTY5qE0Id1GSseTk6S+L3BlXeVIU" crossorigin="anonymous">
<style>
html, body {
min-height: 100%;
}
body, div, form, input, select, p {
padding: 0;
margin: 0;
outline: none;
font-family: Roboto, Arial, sans-serif;
font-size: 14px;
color: #666;
line-height: 22px;
}
h1 {
position: absolute;
margin: 0;
font-size: 32px;
color: #fff;
z-index: 2;
}
h2 {
font-weight: 400;
}
.testbox {
display: flex;
justify-content: center;
align-items: center;
height: inherit;
padding: 20px;
}
form {
width: 100%;
padding: 20px;
border-radius: 6px;
background: #fff;
box-shadow: 0 0 20px 0 #095484;
}
.banner {
position: relative;
height: 210px;
background-image: url("/uploads/media/default/0001/01/3f0d2969f2cffeb123ab1a6fa7408bf87bd34bd3.jpeg");
background-size: cover;
display: flex;
justify-content: center;
align-items: center;
text-align: center;
}
.banner::after {
content: "";
background-color: rgba(0, 0, 0, 0.4);
position: absolute;
width: 100%;
height: 100%;
}
input, select {
margin-bottom: 10px;
border: 1px solid #ccc;
border-radius: 3px;
}
input {
width: calc(100% - 10px);
padding: 5px;
}
select {
width: 100%;
padding: 7px 0;
background: transparent;
}
.item:hover p, .item:hover i, .question:hover p, .question label:hover, input:hover::placeholder, a {
color: #095484;
}
.item input:hover, .item select:hover {
border: 1px solid transparent;
box-shadow: 0 0 6px 0 #095484;
color: #095484;
}
.item {
position: relative;
margin: 10px 0;
}
input[type="date"]::-webkit-inner-spin-button {
display: none;
}
.item i, input[type="date"]::-webkit-calendar-picker-indicator {
position: absolute;
font-size: 20px;
color: #a9a9a9;
}
.item i {
right: 2%;
top: 30px;
z-index: 1;
}
[type="date"]::-webkit-calendar-picker-indicator {
right: 1%;
z-index: 2;
opacity: 0;
cursor: pointer;
}
input[type=checkbox] {
display: none;
}
label.check {
position: relative;
display: inline-block;
margin: 5px 20px 10px 0;
cursor: pointer;
}
.question span {
margin-left: 30px;
}
span.required {
margin-left: 0;
color: red;
}
label.check:before {
content: "";
position: absolute;
top: 2px;
left: 0;
width: 16px;
height: 16px;
border-radius: 2px;
border: 1px solid #095484;
}
input[type=checkbox]:checked + .check:before {
background: #095484;
}
label.check:after {
content: "";
position: absolute;
top: 6px;
left: 4px;
width: 8px;
height: 4px;
border: 3px solid #fff;
border-top: none;
border-right: none;
transform: rotate(-45deg);
opacity: 0;
}
input[type=checkbox]:checked + label:after {
opacity: 1;
}
.btn-block {
margin-top: 10px;
text-align: center;
}
button {
width: 150px;
padding: 10px;
border: none;
border-radius: 5px;
background: #095484;
font-size: 16px;
color: #fff;
cursor: pointer;
}
button:hover {
background: #0666a3;
}
@media (min-width: 568px) {
.name-item, .city-item {
display: flex;
flex-wrap: wrap;
justify-content: space-between;
}
.name-item input, .city-item input {
width: calc(50% - 20px);
}
.city-item select {
width: calc(50% - 8px);
}
}
</style>
</head>
<body>
<div class="testbox">
<form action="/">
<div class="banner">
<h1>Training Application Form</h1>
</div>
<h2>Applicant Details</h2>
<div class="item">
<p>Name</p>
<div class="name-item">
<input type="text" name="name" placeholder="First"/>
<input type="text" name="name" placeholder="Last"/>
</div>
</div>
<div class="item">
<p>Phone</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Fax</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Email</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Company name</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Address</p>
<input type="text" name="name" placeholder="Street address" />
<input type="text" name="name" placeholder="Street address line 2" />
<div class="city-item">
<input type="text" name="name" placeholder="City" />
<input type="text" name="name" placeholder="Region" />
<input type="text" name="name" placeholder="Postal / Zip code" />
<select>
<option value="">Country</option>
<option value="1">Russia</option>
<option value="2">Germany</option>
<option value="3">France</option>
<option value="4">Armenia</option>
<option value="5">USA</option>
</select>
</div>
</div>
<h2>Course Details</h2>
<div class="item">
<p>Course Code</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Location</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Start Date</p>
<input type="date" name="bdate"/>
<i class="fas fa-calendar-alt"></i>
</div>
<h2>Distributor Details</h2>
<div class="item">
<p>Contact Name</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Distributor Name</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Distributor Address</p>
<input type="text" name="name" placeholder="Street address" />
<input type="text" name="name" placeholder="Street address line 2" />
<div class="city-item">
<input type="text" name="name" placeholder="City" />
<input type="text" name="name" placeholder="Region" />
<input type="text" name="name" placeholder="Postal / Zip code" />
<select>
<option value="">Country</option>
<option value="1">Russia</option>
<option value="2">Germany</option>
<option value="3">France</option>
<option value="4">Armenia</option>
<option value="5">USA</option>
</select>
</div>
</div>
<div class="item">
<p>Phone</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Fax</p>
<input type="text" name="name"/>
</div>
<div class="question">
<p>Privacy Policy<span class="required">*</span></p>
<div class="question-answer checkbox-item">
<div>
<input type="checkbox" value="none" id="check_1" name="check" required/>
<label for="check_1" class="check"><span>I agree to the <a href="https://www.w3docs.com/privacy-policy">privacy policy.</a></span></label>
</div>
</div>
</div>
<div class="btn-block">
<button type="submit" href="/">Send</button>
</div>
</form>
</div>
</body>
</html>