{% include 'parts/flash.html.twig' %}

Personal Information

{{ form_label(form.firstName, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.firstName, {'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.firstName) }}

{{ form_label(form.lastName, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.lastName, {'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)" }}) }} {{ form_errors(form.lastName) }}

{{ form_label(form.fatherName, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.fatherName, {'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.fatherName) }}

{{ form_label(form.motherName, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.motherName, {'attr': { 'class': 'form-control','maxlength':'50', 'oninput':"this.value = this.value.replace(/[^0-9a-zA-Z ]/g, '')" }}) }} {{ form_errors(form.motherName) }}

{{ form_label(form.gender, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.gender, {'attr': { 'class': 'form-control select-dropdown' }}) }} {{ form_errors(form.gender) }}

{{ form_label(form.dob, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.dob, {'attr': { 'class': 'form-control','readonly':'true' }}) }} {{ form_errors(form.dob) }}

{{ form_label(form.localAddress, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.localAddress, {'attr': { 'class': 'form-control','maxlength':'255' }}) }} {{ form_errors(form.localAddress) }}

{{ form_label(form.permanentAddress, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.permanentAddress, {'attr': { 'class': 'form-control','maxlength':'255' }}) }} {{ form_errors(form.permanentAddress) }}

{{ form_label(form.adharNum, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.adharNum, {'attr': { 'class': 'form-control','maxlength':'12','minlength':'12', 'autocomplete':'off','oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }} {{ form_errors(form.adharNum) }}

{{ form_label(form.panNum, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.panNum, {'attr': { 'class': 'form-control','maxlength':'10', 'oninput':"this.value = this.value.replace(/[a-zA-z]{5}\d{4}[a-zA-Z]{1}/, '')" }}) }} {{ form_errors(form.panNum) }}

{{ form_label(form.email, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.email, {'attr': { 'class': 'form-control','maxlength':'30' }}) }} {{ form_errors(form.email) }}

{{ form_label(form.mobile, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.mobile, {'attr': { 'class': 'form-control','min':'8','maxlength':'10', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }} {{ form_errors(form.mobile) }}

{{ form_label(form.designation, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.designation, {'attr': { 'class': 'form-control select-dropdown' }}) }} {{ form_errors(form.designation) }}

{{ form_label(form.regNum, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.regNum, {'attr': { 'class': 'form-control','maxlength':'25', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }} {{ form_errors(form.regNum) }}

{{ form_label(form.jobType, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.jobType, {'attr': { 'class': 'form-control select-dropdown' }}) }} {{ form_errors(form.jobType) }}

{{ form_label(form.empSenNum, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.empSenNum, {'attr': { 'class': 'form-control','maxlength':'20','min':'1', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }} {{ form_errors(form.empSenNum) }}

{{ form_label(form.gpfCpfNum, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.gpfCpfNum, {'attr': { 'class': 'form-control','maxlength':'25','min':'1', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }} {{ form_errors(form.gpfCpfNum) }}

{{ form_label(form.castCategory, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.castCategory, {'attr': { 'class': 'form-control select-dropdown' }}) }} {{ form_errors(form.castCategory) }}

{{ form_label(form.quotaType, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.quotaType, {'attr': { 'class': 'form-control select-dropdown' }}) }} {{ form_errors(form.quotaType) }}

{{ form_label(form.photo, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.photo, {'attr': { 'class': 'form-control-file' }}) }} {{ form_errors(form.photo) }}

File must be .jpg,.png,.jpeg and file size 500KB

{% if not staff_profile.id %}

{{ form_label(form.service_order_1, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.service_order_1, {'attr': { 'class': 'form-control-file' }}) }} {{ form_errors(form.service_order_1) }}

File must be .pdf,.doc,.docx and file size 5MB

{{ form_label(form.service_order_2, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.service_order_2, {'attr': { 'class': 'form-control-file' }}) }} {{ form_errors(form.service_order_2) }}

File must be .pdf,.doc,.docx and file size 5MB

{{ form_label(form.service_order_3, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.service_order_3, {'attr': { 'class': 'form-control-file' }}) }} {{ form_errors(form.service_order_3) }}

File must be .pdf,.doc,.docx and file size 5MB

{{ form_label(form.service_order_4, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.service_order_4, {'attr': { 'class': 'form-control-file' }}) }} {{ form_errors(form.service_order_4) }}

File must be .pdf,.doc,.docx and file size 5MB

{% endif %}

Bank Details

{{ form_label(form.bankName, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.bankName, {'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)" }}) }} {{ form_errors(form.bankName) }}

{{ form_label(form.bankBranch, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.bankBranch, {'attr': { 'class': 'form-control' ,'maxlength':'25', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)" }}) }} {{ form_errors(form.bankBranch) }}

{{ form_label(form.bankBranchAddress, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.bankBranchAddress, {'attr': { 'class': 'form-control','maxlength':'255' }}) }} {{ form_errors(form.bankBranchAddress) }}

{{ form_label(form.bankAccountRepeat, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.bankAccountRepeat, {'attr': { 'class':'form-control','maxlength':'20','min':'1', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')"}}) }} {{ form_errors(form.bankAccountRepeat) }}

{{ form_label(form.bankAccount, '', {'label_attr': { 'class': 'col-form-label font-weight-bold'}}) }} {{ form_widget(form.bankAccount, {'attr': { 'class': 'form-control', 'maxlength':'20', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')"}}) }} {{ form_errors(form.bankAccount) }}

{{ form_label(form.bankIfsCode, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.bankIfsCode, {'attr': { 'class': 'form-control','maxlength':'20','oninput':"this.value = this.value.replace(/[^0-9a-zA-Z]/g, '')" }}) }} {{ form_errors(form.bankIfsCode) }}

System Information

{% if staff_profile.user %} Username

{% else %} {{ form_label(form.username, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.username, {'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)" }}) }} {{ form_errors(form.username) }} {% endif %}

{{ form_label(form.plainPassword, '', {'label_attr': {'minlength':'8','maxlength':'20','class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.plainPassword, {'attr': { 'class': 'form-control','data-toggle':'tooltip','title':'Password must be 8-20 character, uppercase[A-Z], lowercase[a-z], number[0-9] and special character[!,@,#,$,%,^,&,*]','id':'password','autocomplete':'off','onblur':'ValidPassword(this.value)', 'min':'8', 'maxlength':'20'}}) }} {{ form_errors(form.plainPassword) }}

{% if staff_profile.user %} Role

{% else %} {{ form_label(form.role, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.role, {'attr': { 'class': 'form-control select-dropdown' }}) }} {{ form_errors(form.role) }} {% endif %}

{% if staff_profile.user %} {% if staff_profile.user.role == 'Doctor' %}

{{ form_label(form.doctorCategory, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.doctorCategory, {'attr': { 'class': 'form-control select-dropdown' }}) }} {{ form_errors(form.doctorCategory) }}

{% elseif staff_profile.user.role in ward_roles %}

{{ form_label(form.ward, '', {'label_attr': { 'class': 'col-form-label font-weight-bold' }}) }} {{ form_widget(form.ward, {'attr': { 'class': 'form-control select-dropdown' }}) }} {{ form_errors(form.ward) }}

{% endif %} {% else %}

{% endif %}