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Server : Apache/2.2.2 (Fedora) System : Linux App1.pathumtani.go.th 2.6.20-1.2320.fc5smp #1 SMP Tue Jun 12 19:40:16 EDT 2007 i686 User : apache ( 48) PHP Version : 5.2.9 Disable Function : NONE Directory : /home/pathumthani_integration/integration/application/labor/ |
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<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td align="center"><table width="900" border="0" cellpadding="3" cellspacing="0">
<tr>
<td height="24" align="left" valign="top"><input name="hdismissal_id" type="hidden" id="hdismissal_id" value="<?=$hdismissal_id?>" />
<input name="hid_card" type="hidden" id="hid_card" value="<?=$hid_card?>" /></td>
<td align="left"> </td>
</tr>
<tr>
<td width="30%" height="24" align="left" valign="middle"><strong>เลขประจำตัวประชาชน</strong> <span class="style1">*</span></td>
<td width="70%" align="left"><input name="id_card" type="text" id="id_card" onblur="chgPin(this.value, 'chg_pin');getVal(this.value);" onKeyPress="return isNumber(this, event);" value="<?=pinFormat($hid_card)?>" size="17" maxlength="17" onfocus="this.select()" onkeyup="chgPin(this.value, 'chg_pin');"/> <img src="../../images/dash_icon/icon_search.gif" width="16" height="16" align="middle" /> <span id="chg_pin"></span></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>ชื่อ - นามสกุล</strong> <span class="style1">*</span></td>
<td align="left"><select name="prename" id="prename" style="width:100px">
<option value="" <?=( !$prename ) ? "Selected" : "";?>>...</option>
<?
$strSQL = "SELECT id,prename_th FROM tbl_prename ORDER BY priority ASC";
$rsConn = mysql_query($strSQL);
while( $Result = mysql_fetch_array($rsConn) ) {
$Slted = ( $Result['id'] == $prename ) ? "Selected" : "";
?>
<option value="<?=$Result['id']?>" <?=$Slted?>><?=$Result['prename_th']?></option>
<?
}
?>
</select>
<input name="fname" type="text" id="fname" size="30" value="<?=$fname?>" />
<input name="lname" type="text" id="lname" size="30" value="<?=$lname?>" /></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>ออกให้ ณ </strong><span class="style1"></span></td>
<td align="left"><input name="id_card_source" type="text" id="id_card_source" value="<?=$id_card_source?>" />
วันออกบัตร
<input name="id_card_begindate" type="text" id="id_card_begindate" value="<?=( $id_card_begindate != "0000-00-00" && $id_card_begindate ) ? dateFormat($id_card_begindate, 'engthai_slash') : "";?>" size="10" maxlength="10" onkeypress="return fmtDate(this, event);"/>
<img src="js/calendar/calendar2.gif" align="top" border="0" onclick="popUpCalendar(this, form1.id_card_begindate, 'dd/mm/yyyy')" title="วัน เดือน ปี" style="cursor:pointer;" /> วันหมดอายุ
<input name="id_card_expiredate" type="text" id="id_card_expiredate" value="<?=( $id_card_expiredate != "0000-00-00" && $id_card_expiredate ) ? dateFormat($id_card_expiredate, 'engthai_slash') : "";?>" size="10" maxlength="10" onkeypress="return fmtDate(this, event);"/>
<img src="js/calendar/calendar2.gif" align="top" border="0" onclick="popUpCalendar(this, form1.id_card_expiredate, 'dd/mm/yyyy')" title="วัน เดือน ปี" style="cursor:pointer;" /> </td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>สัญชาติ</strong></td>
<td align="left"><select name="nationality" id="nationality" style="width:200px">
<option value="" <?=( !$nationality ) ? "Selected" : "";?>>...</option>
<?
$strSQL = "SELECT id, nationality_th FROM tbl_nationality ORDER BY priority, id ASC";
$rsConn = mysql_query($strSQL);
while( $Result = mysql_fetch_array($rsConn) ) {
$Slted = ( $Result['id'] == $nationality ) ? "Selected" : "";
?>
<option value="<?=$Result['id']?>" <?=$Slted?>><?=$Result['nationality_th']?></option>
<?
}
?>
</select> หมายเลขใบอนุญาตทำงาน (ถ้ามี)
<input name="work_permit_no" type="text" id="work_permit_no" value="<?=$work_permit_no?>" /></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>วัน เดือน ปี เกิด</strong> </td>
<td align="left"><select name="Dd" id="Dd">
<option value="00" <? if ( substr($birthdate, 8, 2) == "00" || !$birthdate ) echo "selected"; ?>>วันที่</option>
<?
for ( $intA = 1; $intA <=31; $intA++ ) {
?>
<option value="<?=sprintf("%02d", $intA)?>" <? if ( substr($birthdate, 8, 2) == sprintf("%02d", $intA) ) echo "selected"; ?>>
<?=sprintf("%02d", $intA)?>
</option>
<?
}
?>
</select>
<select name="Mm" id="Mm">
<option value="00" <? if ( substr($birthdate, 8, 2) == "00" || !$birthdate ) echo "selected"; ?>>เดือน</option>
<?
$Month = array("", "มกราคม", "กุมภาพันธ์", "มีนาคม", "เมษายน", "พฤษภาคม", "มิถุนายน", "กรกฎาคม", "สิงหาคม", "กันยายน", "ตุลาคม", "พฤศจิกายน", "ธันวาคม");
for ( $intA = 1; $intA <=12; $intA++ ) {
?>
<option value="<?=sprintf("%02d", $intA)?>" <? if ( substr($birthdate, 5, 2) == sprintf("%02d", $intA) ) echo "selected"; ?>>
<?=$Month[$intA]?>
</option>
<?
}
?>
</select>
<select name="Yy" id="Yy">
<option value="0000" <? if ( substr($birthdate, 8, 2) == "0000" || !$birthdate ) echo "selected"; ?>>ปี พ.ศ.</option>
<?
$ThisYear = date("Y");
for ( $intA = $ThisYear; $intA >= $ThisYear - 100; $intA-- ) {
?>
<option value="<?=$intA?>" <? if ( substr($birthdate, 0, 4) == $intA ) echo "selected"; ?>>
<?=$intA+543?>
</option>
<?
}
?>
</select></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"> </td>
<td align="left"> </td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>ปัจจุบันอยู่บ้านเลขที่</strong></td>
<td align="left"><input name="p_no" type="text" id="p_no" value="<?=$p_no?>" size="8" />
ถนน
<input name="p_soi" type="text" id="p_soi" value="<?=$p_soi?>" /></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">จังหวัด</td>
<td align="left"><select name="p_province_id" id="p_province_id" style="width:200px" onchange="getAmphur(this.value, 'p_ampur_id', 'p_tambol_id', 'p_moo_id', '')">
<option value="" <?=( !$p_province_id ) ? "Selected" : "";?>>...</option>
<?php
$strSQL = "SELECT * FROM ccaa WHERE ccType='Changwat' ORDER BY ccName";
$Fetch = mysql_query($strSQL);
while ( $Result = mysql_fetch_object($Fetch) ) {
$Slted = ( $Result->ccDigi == $p_province_id ) ? "selected" : "";
echo "<option value=\"".$Result->ccDigi."\" $Slted>".str_replace("จังหวัด", "", $Result->ccName)."</option>";
}
?>
</select></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">อำเภอ</td>
<td align="left"><label id="lbl_p_ampur_id" style="width:200px"><?
if ( $p_province_id ) {
$strSEL = "<select name=\"p_ampur_id\" id=\"p_ampur_id\" style=\"width:200px\" onchange=\"getTambol(this.value, 'p_tambol_id', 'p_moo_id', '')\"><option value=\"\">...</option>";
$strSQL = "SELECT * FROM ccaa WHERE ccDigi LIKE '".substr($p_province_id, 0, 2)."%' AND ccType='Aumpur' ORDER BY ccDigi";
$Fetch = mysql_query($strSQL);
while ( $Result = mysql_fetch_object($Fetch) ) {
$Slted = ( $Result->ccDigi == $p_ampur_id ) ? "selected" : "";
$strSEL .= "<option value='".$Result->ccDigi."' $Slted>".$Result->ccName."</option>";
}
$strSEL .= "</select>";
echo $strSEL;
} else {
echo "(กรุณาเลือกจังหวัดก่อน)";
}
?></label></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">ตำบล</td>
<td align="left"><label id="lbl_p_tambol_id" style="width:200px"><?
if ( $p_ampur_id ) {
$strSEL = "<select name=\"p_tambol_id\" id=\"p_tambol_id\" style=\"width:200px\" onchange=\"getMoo(this.value, 'p_moo_id', '')\"><option value=\"\">...</option>";
$strSQL = "SELECT * FROM ccaa WHERE ccDigi LIKE '".substr($p_ampur_id, 0, 4)."%' AND ccType='Tamboon' ORDER BY ccDigi";
$Fetch = mysql_query($strSQL);
while ( $Result = mysql_fetch_object($Fetch) ) {
$Slted = ( $Result->ccDigi == $p_tambol_id ) ? "selected" : "";
$strSEL .= "<option value='".$Result->ccDigi."' $Slted>".$Result->ccName."</option>";
}
$strSEL .= "</select>";
echo $strSEL;
} else {
echo "(กรุณาเลือกอำเภอก่อน)";
}
?></label></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">หมู่บ้าน</td>
<td align="left"><label id="lbl_p_moo_id" style="width:200px"><?
if ( $p_tambol_id ) {
$strSEL = "<select name=\"p_moo_id\" id=\"p_moo_id\" style=\"width:200px\"><option value=\"\">...</option>";
$strSQL = "SELECT * FROM ccaa_village WHERE ccDigi LIKE '".substr($p_tambol_id, 0, 6)."%' AND ccType='Village' ORDER BY ccDigi";
$Fetch = mysql_query($strSQL);
while ( $Result = mysql_fetch_object($Fetch) ) {
$Slted = ( $Result->ccDigi == $p_moo_id ) ? "selected" : "";
$strSEL .= "<option value='".$Result->ccDigi."' $Slted>".$Result->ccName."</option>";
}
$strSEL .= "</select>";
echo $strSEL;
} else {
echo "(กรุณาเลือกตำบลก่อน)";
}
?></label>
รหัสไปรษณีย์
<input name="p_zipcode" type="text" id="p_zipcode" value="<?=$p_zipcode?>" size="5" maxlength="5" onKeyPress="return fmtNumber(this, event);"/></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">โทรศัพท์</td>
<td align="left"><input name="p_tel_h" type="text" id="p_tel_h" value="<?=$p_tel_h?>" /></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"> </td>
<td align="left"> </td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>ภูมิลำเนาตามทะเบียนบ้านอยู่บ้านเลขที่</strong></td>
<td align="left"><input name="d_no" type="text" id="d_no" value="<?=$d_no?>" size="8" />
ถนน
<input name="d_soi" type="text" id="d_soi" value="<?=$d_soi?>" /></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">จังหวัด</td>
<td align="left"><select name="d_province_id" id="d_province_id" style="width:200px" onchange="getAmphur(this.value, 'd_ampur_id', 'd_tambol_id', 'd_moo_id', '')">
<option value="" <?=( !$d_province_id ) ? "Selected" : "";?>>...</option>
<?php
$strSQL = "SELECT * FROM ccaa WHERE ccType='Changwat' ORDER BY ccName";
$Fetch = mysql_query($strSQL);
while ( $Result = mysql_fetch_object($Fetch) ) {
$Slted = ( $Result->ccDigi == $d_province_id ) ? "selected" : "";
echo "<option value=\"".$Result->ccDigi."\" $Slted>".str_replace("จังหวัด", "", $Result->ccName)."</option>";
}
?>
</select></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">อำเภอ</td>
<td align="left"><label id="lbl_d_ampur_id" style="width:200px"><?
if ( $d_province_id ) {
$strSEL = "<select name=\"d_ampur_id\" id=\"d_ampur_id\" style=\"width:200px\" onchange=\"getTambol(this.value, 'd_tambol_id', 'd_moo_id', '')\"><option value=\"\">...</option>";
$strSQL = "SELECT * FROM ccaa WHERE ccDigi LIKE '".substr($d_province_id, 0, 2)."%' AND ccType='Aumpur' ORDER BY ccDigi";
$Fetch = mysql_query($strSQL);
while ( $Result = mysql_fetch_object($Fetch) ) {
$Slted = ( $Result->ccDigi == $d_ampur_id ) ? "selected" : "";
$strSEL .= "<option value='".$Result->ccDigi."' $Slted>".$Result->ccName."</option>";
}
$strSEL .= "</select>";
echo $strSEL;
} else {
echo "(กรุณาเลือกจังหวัดก่อน)";
}
?></label></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">ตำบล</td>
<td align="left"><label id="lbl_d_tambol_id" style="width:200px"><?
if ( $d_ampur_id ) {
$strSEL = "<select name=\"d_tambol_id\" id=\"d_tambol_id\" style=\"width:200px\" onchange=\"getMoo(this.value, 'd_moo_id', '')\"><option value=\"\">...</option>";
$strSQL = "SELECT * FROM ccaa WHERE ccDigi LIKE '".substr($d_ampur_id, 0, 4)."%' AND ccType='Tamboon' ORDER BY ccDigi";
$Fetch = mysql_query($strSQL);
while ( $Result = mysql_fetch_object($Fetch) ) {
$Slted = ( $Result->ccDigi == $d_tambol_id ) ? "selected" : "";
$strSEL .= "<option value='".$Result->ccDigi."' $Slted>".$Result->ccName."</option>";
}
$strSEL .= "</select>";
echo $strSEL;
} else {
echo "(กรุณาเลือกอำเภอก่อน)";
}
?></label></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">หมู่บ้าน</td>
<td align="left"><label id="lbl_d_moo_id" style="width:200px"><?
if ( $d_tambol_id ) {
$strSEL = "<select name=\"d_moo_id\" id=\"d_moo_id\" style=\"width:200px\"><option value=\"\">...</option>";
$strSQL = "SELECT * FROM ccaa_village WHERE ccDigi LIKE '".substr($d_tambol_id, 0, 6)."%' AND ccType='Village' ORDER BY ccDigi";
$Fetch = mysql_query($strSQL);
while ( $Result = mysql_fetch_object($Fetch) ) {
$Slted = ( $Result->ccDigi == $d_moo_id ) ? "selected" : "";
$strSEL .= "<option value='".$Result->ccDigi."' $Slted>".$Result->ccName."</option>";
}
$strSEL .= "</select>";
echo $strSEL;
} else {
echo "(กรุณาเลือกตำบลก่อน)";
}
?></label>
รหัสไปรษณีย์
<input name="d_zipcode" type="text" id="d_zipcode" value="<?=$d_zipcode?>" size="5" maxlength="5" onKeyPress="return fmtNumber(this, event);"/></td>
</tr>
<tr>
<td height="24" align="left" valign="middle">โทรศัพท์</td>
<td align="left"><input name="d_tel_h" type="text" id="d_tel_h" value="<?=$d_tel_h?>" /></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"> </td>
<td align="left"> </td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>ขอยื่นคำร้องต่อพนักงานตรวจแรงงานในฐานะ</strong> <span class="style1">*</span></td>
<td align="left"><p>
<label><input type="radio" name="protest_agent" id="protest_agent_a" value="ลูกจ้าง" <?=( $protest_agent == "ลูกจ้าง" ) ? "Checked" : "" ;?>/> ลูกจ้าง</label>
<label><input type="radio" name="protest_agent" id="protest_agent_b" value="ทายาทโดยธรรมของลูกจ้าง" <?=( $protest_agent == "ทายาทโดยธรรมของลูกจ้าง" ) ? "Checked" : "" ;?>/> ทายาทโดยธรรมของลูกจ้าง</label>
<br />
</p></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>เลขประจำตัวประชาชน</strong></td>
<td align="left"><input name="d_idcard" type="text" id="d_idcard" onblur="chgPin(this.value, 'd_chg_pin');" onKeyPress="return isNumber(this, event);" value="<?=pinFormat($d_idcard)?>" size="17" maxlength="17" onfocus="this.select()" onkeyup="chgPin(this.value, 'd_chg_pin');"/> <span id="d_chg_pin"></span></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>ชื่อ - นามสกุล</strong></td>
<td align="left"><select name="d_prename" id="d_prename" style="width:100px">
<option value="" <?=( !$d_prename ) ? "Selected" : "";?>>...</option>
<?
$strSQL = "SELECT id,prename_th FROM tbl_prename ORDER BY priority ASC";
$rsConn = mysql_query($strSQL);
while( $Result = mysql_fetch_array($rsConn) ) {
$Slted = ( $Result['id'] == $d_prename ) ? "Selected" : "";
?>
<option value="<?=$Result['id']?>" <?=$Slted?>>
<?=$Result['prename_th']?>
</option>
;
<?
}
?>
</option>
</select>
<input name="d_name" type="text" id="d_name" size="30" value="<?=$d_name?>" />
<input name="d_surname" type="text" id="d_surname" size="30" value="<?=$d_surname?>"></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>ใบมรณบัตรเลขที่</strong><span class="style1"></span></td>
<td align="left"><input name="death_certificate" type="text" id="death_certificate" value="<?=$death_certificate?>" />
ออกให้ ณ
<input name="dc_source" type="text" id="dc_source" value="<?=$dc_source?>" /></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"><strong>สัญชาติ</strong></td>
<td align="left"><select name="d_nationality" id="d_nationality" style="width:200px">
<option value="" <?=( !$d_nationality ) ? "Selected" : "";?>>...</option>
<?
$strSQL = "SELECT id, nationality_th FROM tbl_nationality ORDER BY priority, id ASC";
$rsConn = mysql_query($strSQL);
while( $Result = mysql_fetch_array($rsConn) ) {
$Slted = ( $Result['id'] == $d_nationality ) ? "Selected" : "";
?>
<option value="<?=$Result['id']?>" <?=$Slted?>>
<?=$Result['nationality_th']?>
</option>
<?
}
?>
</select> หมายเลขใบอนุญาตทำงาน (ถ้ามี)
<input name="d_workpermit" type="text" id="d_workpermit" value="<?=$d_workpermit?>" /></td></tr>
<tr>
<td height="24" align="left" valign="middle"><strong>ซึ่งเกี่ยวข้องเป็น</strong></td>
<td align="left"><input name="concerned" type="text" id="concerned" value="<?=$concerned?>" size="100" /></td>
</tr>
<tr>
<td height="24" align="left" valign="middle"> </td>
<td align="left"> </td>
</tr>
</table></td>
</tr>
</table>