{{-- <style>
    h4 { font-size: 23px; }
    label, p, ol, ol li { font-size: 15px; }
    .modal-lg { width:975px; }
  </style> --}}

  @if(Auth::check() && !isset($job_detail))
  <h4><u>Interview Questionaire</u></h4>
    <div class="row">
      <div class="col-sm-4">
        <div class="form-group">
          {!! Form::label('date_of_application',trans('messages.date_of').' '.trans('messages.application'),['class'=>'required']) !!}
          <input type="text" class="form-control datepicker" name="date_of_application" placeholder="{{trans('messages.date_of').' '.trans('messages.application')}}" value="{{isset($job_application) ? $job_application->date_of_application : ''}}">
        </div>
      </div>
      <div class="col-sm-4">
        <div class="form-group">
          {!! Form::label('assignment','Intended Workplace',[]) !!}
          {!! Form::select('assignment',$locations,isset($job_application) ? $job_application->applicant_site : '',['class'=>'form-control show-tick','title'=>trans('messages.select_one')]) !!}
        </div>
      </div>
      <div class="col-sm-4">
        <div class="form-group">
          {!! Form::label('source',trans('messages.application').' '.trans('messages.source'),[]) !!}
          {!! Form::select('source',config('lists.job_application_source'),isset($job_application) ? $job_application->source : 'Portal',['class'=>'form-control show-tick','title'=>trans('messages.select_one')]) !!}
        </div>
      </div>
      {!! Form::hidden('job_id',isset($job) ? $job->id : '') !!}
    </div>

    {{-- Get custom fields ONLY for edit --}}
    @if(config('config.enable_custom_field'))
      {{ getCustomFields('job-application-edit-form',$custom_edit_values) }}
    @endif
    <hr>
  @else
    @if(in_array(env('COMPANY_ID'), config('constant.custom_job_application')))
      {!! Form::hidden('job_id',isset($job) ? $job->id : '') !!}
    @else
      <div class="form-group">
        {!! Form::label('job_id',trans('messages.job').' '.trans('messages.title'),['class'=>'required']) !!}
        {!! Form::select('job_id',$jobs,isset($job_application) ? $job_application->job_id : (isset($job) ? $job->id : ''),['class'=>'form-control show-tick','title'=>trans('messages.select_one')]) !!}
      </div>
    @endif
  @endif

  @if(!isset($job_detail))
    <h4><u>Personal Details</u></h4>
    <div class="row">
      <div class="col-sm-9">
        <div class="form-group">
          {!! Form::label('first_name',trans('messages.name'),['class'=>'required']) !!}
          <input type="text" class="form-control text-input" name="first_name" placeholder="{{trans('messages.name')}}" value="{{isset($job_application) ? $job_application->first_name : ''}}">
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('gender',trans('messages.gender'),['class'=>'required']) !!}
          <div class="checkbox">
            @foreach(config('lists.gender') as $gender)
              <input type="radio" class="form-control icheck" name="gender" value="{{$gender}}" {{(isset($job_application) && $job_application->gender == $gender) ? 'checked' : ''}}> {{trans('messages.'.$gender)}} &nbsp
            @endforeach
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-9">
        <div class="form-group">
          {!! Form::label('email',trans('messages.email'),[]) !!}
          <input type="email" class="form-control text-input" name="email" placeholder="{{trans('messages.email')}}" value="{{isset($job_application) ? $job_application->email : ''}}">
        </div>
      </div>
      <div class="col-sm-3">
      <div class="form-group">
      		{!! Form::label('date_of_birth',trans('messages.date_of').' '.trans('messages.birth'),['class'=>'required']) !!}
          <div style="display:flex;">
            {!! Form::selectRange('date_of_birth_day',1,31,isset($job_application->date_of_birth) ? (int) Carbon::parse($job_application->date_of_birth)->format('d') : '',['class' => 'form-control', 'placeholder' => '-- Day --']) !!} &nbsp;
            {!! Form::selectMonth('date_of_birth_mth',isset($job_application->date_of_birth) ? getMonthNumber(Carbon::parse($job_application->date_of_birth)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('date_of_birth_yr',1940,Carbon::now()->year,isset($job_application->date_of_birth) ? Carbon::parse($job_application->date_of_birth)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('date_of_birth','') !!}
          </div>
        </div>
    	</div>
    </div>
    <div class="row">
      <div class="col-sm-6">
  			<div class="form-group">
  				{!! Form::label('address_line_1',trans('messages.address'),['class'=>'required']) !!}
  				{!! Form::input('text','address_line_1',isset($job_application) ? $job_application->address_line_1 : '',['class'=>'form-control','placeholder'=>trans('messages.address')]) !!}
  			</div>
  		</div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('zipcode',trans('messages.zipcode'),['class'=>'required']) !!}
          {!! Form::input('text','zipcode',isset($job_application) ? $job_application->zipcode : '',['class'=>'form-control','placeholder'=>trans('messages.zipcode')]) !!}
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('primary_contact_number','Hp No.',['class'=>'required']) !!}
          <input type="text" class="form-control text-input" name="primary_contact_number" placeholder="Hp No." value="{{isset($job_application) ? $job_application->primary_contact_number : ''}}">
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('secondary_contact_number','Home Tel No.',[]) !!}
          <input type="text" class="form-control text-input" name="secondary_contact_number" placeholder="Home Tel No." value="{{isset($job_application) ? $job_application->secondary_contact_number : ''}}">
        </div>
      </div>
    </div>
    @if(Auth::check() && isset($job_application))
    <div class="row">
      <div class="col-sm-6">
  			<div class="form-group">
  				{!! Form::label('designation',trans('messages.applying_for'),['class'=>'required'])!!}
  				{!! Form::select('designation_id',isset($job->department_id) ? App\Designation::whereIn('id',[8,9,10,11,12])->pluck('name','id')->all() : [], isset($job_application) ? $job_application->designation_id : '',['class'=>'form-control show-tick','title' => trans('messages.select_one')]) !!}
  			</div>
  		</div>
    </div>
    @endif

    <hr>

    @if(config('config.enable_custom_field'))
      {{ getCustomFields('job-application-form',$custom_field_values) }}
      <hr>
    @endif

    <h4><u>Education & Professional Training</u></h4>
    {{-- Row 1 --}}
    <div class="row">
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('edu_from_1',trans('messages.from'),['class'=>'required']) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('edu_from_1_mth',!empty($past_education[0]->from) ? getMonthNumber(\Carbon\Carbon::parse($past_education[0]->from)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('edu_from_1_yr',1940,\Carbon\Carbon::now()->year,!empty($past_education[0]->from) ? \Carbon\Carbon::parse($past_education[0]->from)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('edu_from_1','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('edu_to_1',trans('messages.to'),['class'=>'required']) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('edu_to_1_mth',!empty($past_education[0]->to) ? getMonthNumber(\Carbon\Carbon::parse($past_education[0]->to)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('edu_to_1_yr',1940,\Carbon\Carbon::now()->year,!empty($past_education[0]->to) ? \Carbon\Carbon::parse($past_education[0]->to)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('edu_to_1','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('institute_1',trans('messages.institute').' '.trans('messages.name'),['class'=>'required']) !!}
          {!! Form::input('text','institute_1',isset($past_education[0]->institution) ? $past_education[0]->institution : '',['class'=>'form-control','placeholder'=>trans('messages.institute').' '.trans('messages.name')]) !!}
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('education_level_1',trans('messages.education').' '.trans('messages.level'),['class'=>'required']) !!}
  				{!! Form::select('education_level_1',$education_levels,isset($past_education[0]->level) ? $past_education[0]->level : '',['class'=>'form-control input-xlarge show-tick','title' => trans('messages.select_one')]) !!}
        </div>
      </div>
    </div>
    {{-- Row 2 --}}
    <div class="row">
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('edu_from_2',trans('messages.from'),[]) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('edu_from_2_mth',!empty($past_education[1]->from) ? getMonthNumber(\Carbon\Carbon::parse($past_education[1]->from)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('edu_from_2_yr',1940,\Carbon\Carbon::now()->year,!empty($past_education[1]->from) ? \Carbon\Carbon::parse($past_education[1]->from)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('edu_from_2','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('edu_to_2',trans('messages.to'),[]) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('edu_to_2_mth',!empty($past_education[1]->to) ? getMonthNumber(\Carbon\Carbon::parse($past_education[1]->to)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('edu_to_2_yr',1940,\Carbon\Carbon::now()->year,!empty($past_education[1]->to) ? \Carbon\Carbon::parse($past_education[1]->to)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('edu_to_2','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('institute_2',trans('messages.institute').' '.trans('messages.name')) !!}
          {!! Form::input('text','institute_2',isset($past_education[1]->institution) ? $past_education[1]->institution : '',['class'=>'form-control','placeholder'=>trans('messages.institute').' '.trans('messages.name')]) !!}
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('education_level_2',trans('messages.education').' '.trans('messages.level'),[]) !!}
  				{!! Form::select('education_level_2',$education_levels,isset($past_education[1]->level) ? $past_education[1]->level : '',['class'=>'form-control input-xlarge show-tick','title' => trans('messages.select_one')]) !!}
        </div>
      </div>
    </div>

    <hr>

    <h4><u>Working Experience</u></h4>
    <div class="row">
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('work_from_1',trans('messages.from'),['class'=>'required']) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('work_from_1_mth',!empty($past_work_exp[0]->from) ? getMonthNumber(\Carbon\Carbon::parse($past_work_exp[0]->from)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('work_from_1_yr',1940,\Carbon\Carbon::now()->year,!empty($past_work_exp[0]->from) ? \Carbon\Carbon::parse($past_work_exp[0]->from)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('work_from_1','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('work_to_1',trans('messages.to'),['class'=>'required']) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('work_to_1_mth',!empty($past_work_exp[0]->to) ? getMonthNumber(\Carbon\Carbon::parse($past_work_exp[0]->to)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('work_to_1_yr',1940,\Carbon\Carbon::now()->year,!empty($past_work_exp[0]->to) ? \Carbon\Carbon::parse($past_work_exp[0]->to)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('work_to_1','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('company_1',trans('messages.company'),['class'=>'required']) !!}
          {!! Form::input('text','company_1',isset($past_work_exp[0]->company) ? $past_work_exp[0]->company : '',['class'=>'form-control','placeholder'=>trans('messages.company').' '.trans('messages.name')]) !!}
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('job_title_1',trans('messages.leaving').' '.trans('messages.remarks'),['class'=>'required']) !!}
          {!! Form::input('text','job_title_1',isset($past_work_exp[0]->title) ? $past_work_exp[0]->title : '',['class'=>'form-control','placeholder'=>trans('messages.leaving').' '.trans('messages.remarks')]) !!}
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('site_1',trans('messages.salary'),['class'=>'required']) !!}
          {!! Form::input('text','site_1',isset($past_work_exp[0]->site) ? $past_work_exp[0]->site : '',['class'=>'form-control','placeholder'=>trans('messages.salary')]) !!}
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('work_from_2',trans('messages.from'),[]) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('work_from_2_mth',!empty($past_work_exp[1]->from) ? getMonthNumber(\Carbon\Carbon::parse($past_work_exp[1]->from)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('work_from_2_yr',1940,\Carbon\Carbon::now()->year,!empty($past_work_exp[1]->from) ? \Carbon\Carbon::parse($past_work_exp[1]->from)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('work_from_2','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('work_to_2',trans('messages.to'),[]) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('work_to_2_mth',!empty($past_work_exp[1]->to) ? getMonthNumber(\Carbon\Carbon::parse($past_work_exp[1]->to)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('work_to_2_yr',1940,\Carbon\Carbon::now()->year,!empty($past_work_exp[1]->to) ? \Carbon\Carbon::parse($past_work_exp[1]->to)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('work_to_2','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('company_2',trans('messages.company')) !!}
          {!! Form::input('text','company_2',isset($past_work_exp[1]->company) ? $past_work_exp[1]->company : '',['class'=>'form-control','placeholder'=>trans('messages.company').' '.trans('messages.name')]) !!}
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('job_title_2',trans('messages.leaving').' '.trans('messages.remarks'),[]) !!}
          {!! Form::input('text','job_title_2',isset($past_work_exp[1]->title) ? $past_work_exp[1]->title : '',['class'=>'form-control','placeholder'=>trans('messages.leaving').' '.trans('messages.remarks')]) !!}
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('site_2',trans('messages.salary')) !!}
          {!! Form::input('text','site_2',isset($past_work_exp[1]->site) ? $past_work_exp[1]->site : '',['class'=>'form-control','placeholder'=>trans('messages.salary')]) !!}
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('work_from_3',trans('messages.from'),[]) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('work_from_3_mth',!empty($past_work_exp[2]->from) ? getMonthNumber(\Carbon\Carbon::parse($past_work_exp[2]->from)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('work_from_3_yr',1940,\Carbon\Carbon::now()->year,!empty($past_work_exp[2]->from) ? \Carbon\Carbon::parse($past_work_exp[2]->from)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('work_from_3','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('work_to_3',trans('messages.to'),[]) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('work_to_3_mth',!empty($past_work_exp[2]->to) ? getMonthNumber(\Carbon\Carbon::parse($past_work_exp[2]->to)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('work_to_3_yr',1940,\Carbon\Carbon::now()->year,!empty($past_work_exp[2]->to) ? \Carbon\Carbon::parse($past_work_exp[2]->to)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('work_to_3','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('company_3',trans('messages.company')) !!}
          {!! Form::input('text','company_3',isset($past_work_exp[2]->company) ? $past_work_exp[2]->company : '',['class'=>'form-control','placeholder'=>trans('messages.company').' '.trans('messages.name')]) !!}
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('job_title_3',trans('messages.leaving').' '.trans('messages.remarks'),[]) !!}
          {!! Form::input('text','job_title_3',isset($past_work_exp[2]->title) ? $past_work_exp[2]->title : '',['class'=>'form-control','placeholder'=>trans('messages.leaving').' '.trans('messages.remarks')]) !!}
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('site_3',trans('messages.salary')) !!}
          {!! Form::input('text','site_3',isset($past_work_exp[2]->site) ? $past_work_exp[2]->site : '',['class'=>'form-control','placeholder'=>trans('messages.salary')]) !!}
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('work_from_4',trans('messages.from'),[]) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('work_from_4_mth',!empty($past_work_exp[3]->from) ? getMonthNumber(\Carbon\Carbon::parse($past_work_exp[3]->from)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('work_from_4_yr',1940,\Carbon\Carbon::now()->year,!empty($past_work_exp[3]->from) ? \Carbon\Carbon::parse($past_work_exp[3]->from)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('work_from_4','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('work_to_4',trans('messages.to'),[]) !!}
          <div style="display:flex;">
            {!! Form::selectMonth('work_to_4_mth',!empty($past_work_exp[3]->to) ? getMonthNumber(\Carbon\Carbon::parse($past_work_exp[3]->to)->format('F')) : '',['class' => 'form-control', 'placeholder' => '-- Month --']) !!} &nbsp;
            {!! Form::selectYear('work_to_4_yr',1940,\Carbon\Carbon::now()->year,!empty($past_work_exp[3]->to) ? \Carbon\Carbon::parse($past_work_exp[3]->to)->format('Y') : '',['class' => 'form-control', 'placeholder' => '-- Year --']) !!}
            {!! Form::hidden('work_to_4','') !!}
          </div>
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('company_4',trans('messages.company')) !!}
          {!! Form::input('text','company_4',isset($past_work_exp[3]->company) ? $past_work_exp[3]->company : '',['class'=>'form-control','placeholder'=>trans('messages.company').' '.trans('messages.name')]) !!}
        </div>
      </div>
      <div class="col-sm-3">
        <div class="form-group">
          {!! Form::label('job_title_4',trans('messages.leaving').' '.trans('messages.remarks'),[]) !!}
          {!! Form::input('text','job_title_4',isset($past_work_exp[3]->title) ? $past_work_exp[3]->title : '',['class'=>'form-control','placeholder'=>trans('messages.leaving').' '.trans('messages.remarks')]) !!}
        </div>
      </div>
      <div class="col-sm-2">
        <div class="form-group">
          {!! Form::label('site_4',trans('messages.salary')) !!}
          {!! Form::input('text','site_4',isset($past_work_exp[3]->site) ? $past_work_exp[3]->site : '',['class'=>'form-control','placeholder'=>trans('messages.salary')]) !!}
        </div>
      </div>
    </div>

    <hr>

    <h4><u class="required">Declaration of Health</u></h4>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('medical_1','Are you currently undergoing any medical treatment or medication ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_1" value="No" {{(isset($medical_declaration[0]->condition) && $medical_declaration[0]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_1" value="Yes" id="medical_cbx_1" {{(isset($medical_declaration[0]->condition) && $medical_declaration[0]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="medical_text_field_1" style="display:block;">
              {!! Form::input('text','medical_text_1',isset($medical_declaration[0]->description) ? $medical_declaration[0]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_1" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_1" value="Yes" id="medical_cbx_1"> Yes &nbsp
            </div>
            <div id="medical_text_field_1" style="display:none;">
              {!! Form::input('text','medical_text_1','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('medical_2','Do you have or ever had any infirmity or physical defect ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_2" value="No" {{(isset($medical_declaration[1]->condition) && $medical_declaration[1]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_2" value="Yes" id="medical_cbx_2" {{(isset($medical_declaration[1]->condition) && $medical_declaration[1]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="medical_text_field_2" style="display:block;">
              {!! Form::input('text','medical_text_2',isset($medical_declaration[1]->description) ? $medical_declaration[1]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_2" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_2" value="Yes" id="medical_cbx_2"> Yes &nbsp
            </div>
            <div id="medical_text_field_2" style="display:none;">
              {!! Form::input('text','medical_text_2','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>

    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('medical_4','During the last five (5) years, have you been absent from work due to health reasons for more than one (1) week, suffered from any serioues illness or injury, consulted any doctor or been admitted to hospital ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_4" value="No" {{(isset($medical_declaration[2]->condition) && $medical_declaration[2]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_4" value="Yes" id="medical_cbx_4" {{(isset($medical_declaration[2]->condition) && $medical_declaration[2]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="medical_text_field_4" style="display:block;">
              {!! Form::input('text','medical_text_4',isset($medical_declaration[2]->description) ? $medical_declaration[2]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_4" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_4" value="Yes" id="medical_cbx_4"> Yes &nbsp
            </div>
            <div id="medical_text_field_4" style="display:none;">
              {!! Form::input('text','medical_text_4','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('medical_5','Have you undergone or are you about to undergo any surgical operations ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_5" value="No" {{(isset($medical_declaration[3]->condition) && $medical_declaration[3]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_5" value="Yes" id="medical_cbx_5" {{(isset($medical_declaration[3]->condition) && $medical_declaration[3]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="medical_text_field_5" style="display:block;">
              {!! Form::input('text','medical_text_5',isset($medical_declaration[3]->description) ? $medical_declaration[3]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_5" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_5" value="Yes" id="medical_cbx_5"> Yes &nbsp
            </div>
            <div id="medical_text_field_5" style="display:none;">
              {!! Form::input('text','medical_text_5','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>

    <!-- 7 -->
    @foreach(config('lists.medical_123') as $index => $medical)
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('medical_'.($index+7),$medical,[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_{{$index+7}}" value="No" {{(isset($medical_declaration[$index+5]->condition) && $medical_declaration[$index+5]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_{{$index+7}}" value="Yes" id="medical_cbx_{{$index+7}}" {{(isset($medical_declaration[$index+5]->condition) && $medical_declaration[$index+5]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="medical_text_field_{{$index+7}}" style="display:block;">
              {!! Form::input('text','medical_text_'.($index+7),isset($medical_declaration[$index+5]->description) ? $medical_declaration[$index+5]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_{{$index+7}}" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_{{$index+7}}" value="Yes" id="medical_cbx_{{$index+7}}"> Yes &nbsp
            </div>
            <div id="medical_text_field_{{$index+7}}" style="display:none;">
              {!! Form::input('text','medical_text_'.($index+7),'',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>
    @endforeach

    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('medical_14','Are you an IMH Patient ? ',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_14" value="No" {{(isset($medical_declaration[12]->condition) && $medical_declaration[12]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_14" value="Yes" id="medical_cbx_14" {{(isset($medical_declaration[12]->condition) && $medical_declaration[12]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="medical_text_field_14" style="display:block;">
              {!! Form::input('text','medical_text_14',isset($medical_declaration[12]->description) ? $medical_declaration[12]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_14" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_14" value="Yes" id="medical_cbx_14"> Yes &nbsp
            </div>
            <div id="medical_text_field_14" style="display:none;">
              {!! Form::input('text','medical_text_14','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>

    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('medical_6','For woman only; Are you pregnant ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_6" value="No" {{(isset($medical_declaration[4]->condition) && $medical_declaration[4]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_6" value="Yes" id="medical_cbx_6" {{(isset($medical_declaration[4]->condition) && $medical_declaration[4]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="medical_text_field_6" style="display:block;">
              {!! Form::input('text','medical_text_6',isset($medical_declaration[4]->description) ? $medical_declaration[4]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="medical_con_6" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="medical_con_6" value="Yes" id="medical_cbx_6"> Yes &nbsp
            </div>
            <div id="medical_text_field_6" style="display:none;">
              {!! Form::input('text','medical_text_6','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>

    <h4><u class="required">Statutory Declaration</u></h4>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('declare_1','Have you been convicted of a criminal offence / misused of dangerous drug ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_1" value="No" {{(isset($offence_declaration[0]->condition) && $offence_declaration[0]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_1" value="Yes" id="declare_cbx_1" {{(isset($offence_declaration[0]->condition) && $offence_declaration[0]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="declare_text_field_1" style="display:block;">
              {!! Form::input('text','declare_text_1',isset($offence_declaration[0]->description) ? $offence_declaration[0]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_1" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_1" value="Yes" id="declare_cbx_1"> Yes &nbsp
            </div>
            <div id="declare_text_field_1" style="display:none;">
              {!! Form::input('text','declare_text_1','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('declare_2','Are you on any Police Probation / DRC / Warrant Of Arrest currently pending against you ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_2" value="No" {{(isset($offence_declaration[1]->condition) && $offence_declaration[1]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_2" value="Yes" id="declare_cbx_2" {{(isset($offence_declaration[1]->condition) && $offence_declaration[1]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="declare_text_field_2" style="display:block;">
              {!! Form::input('text','declare_text_2',isset($offence_declaration[1]->description) ? $offence_declaration[1]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_2" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_2" value="Yes" id="declare_cbx_2"> Yes &nbsp
            </div>
            <div id="declare_text_field_2" style="display:none;">
              {!! Form::input('text','declare_text_2','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('declare_3','Have you been convicted in the Court of Law in any country ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_3" value="No" {{(isset($offence_declaration[2]->condition) && $offence_declaration[2]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_3" value="Yes" id="declare_cbx_3" {{(isset($offence_declaration[2]->condition) && $offence_declaration[2]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="declare_text_field_3" style="display:block;">
              {!! Form::input('text','declare_text_3',isset($offence_declaration[2]->description) ? $offence_declaration[2]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_3" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_3" value="Yes" id="declare_cbx_3"> Yes &nbsp
            </div>
            <div id="declare_text_field_3" style="display:none;">
              {!! Form::input('text','declare_text_3','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('declare_4','Have you been dismissed or discharged from service from any organisation ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_4" value="No" {{(isset($offence_declaration[3]->condition) && $offence_declaration[3]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_4" value="Yes" id="declare_cbx_4" {{(isset($offence_declaration[3]->condition) && $offence_declaration[3]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="declare_text_field_4" style="display:block;">
              {!! Form::input('text','declare_text_4',isset($offence_declaration[3]->description) ? $offence_declaration[3]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_4" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_4" value="Yes" id="declare_cbx_4"> Yes &nbsp
            </div>
            <div id="declare_text_field_4" style="display:none;">
              {!! Form::input('text','declare_text_4','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('declare_5','Do you have issues performing your PWM Job functions ?',[]) !!}
          @if(Auth::check() && !isset($job_detail))
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_5" value="No" {{(isset($offence_declaration[4]->condition) && $offence_declaration[4]->condition == "No") ? 'checked' : ''}}> No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_5" value="Yes" id="declare_cbx_5" {{(isset($offence_declaration[4]->condition) && $offence_declaration[4]->condition == "Yes") ? 'checked' : ''}}> Yes &nbsp
            </div>
            <div id="declare_text_field_5" style="display:block;">
              {!! Form::input('text','declare_text_5',isset($offence_declaration[4]->description) ? $offence_declaration[4]->description : '',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @else
            <div class="checkbox">
              <input type="radio" class="form-control icheck" name="declare_con_5" value="No" required > No &nbsp
              <input type="radio" class="form-control icheck" name="declare_con_5" value="Yes" id="declare_cbx_5"> Yes &nbsp
            </div>
            <div id="declare_text_field_5" style="display:none;">
              {!! Form::input('text','declare_text_5','',['class'=>'form-control','placeholder'=>'Please Specify']) !!}
            </div>
          @endif
        </div>
      </div>
    </div>

    @if(Auth::check() && !isset($job_detail))
    @else
      <hr>
      <h4><u>Collection, Use and Disclosure of Personal Data</u></h4>
      <div class="row">
        <div class="col-sm-12">
          <p>I consent to my personal data being collected, used, disclosed and retained by <b>Westminster Investigation & Security Management Pte Ltd</b> for the purpose of :</p>
          <ol type="i">
            <li style="font-weight:bold;"><u>Collection</u></li>
            <ol type="a">
              <li>Processing, adminstering and managing my personal records</li>
              <li>Legal compliance on our part under applicable laws</li>
            </ol>
            <li style="font-weight:bold;"><u>Use</u></li>
            <p>We may, in the future, use your personal data for any purpose not prohibited by application law. This includes, but not limited to:</p>
            <ol type="a">
              <li>Verifying your identity</li>
              <li>Processing and responding to inquiries and / or feedback</li>
              <li>The purposes for which you provided the information</li>
              <li>Complying with Court order or other legal process or statutory and / or regulatory requirements of any governmental and / or regulatory authorities; and exceptional circumstances, such as national emergency or security concern</li>
            </ol>
            <li style="font-weight:bold;"><u>Disclosure</u></li>
            <p>We may share and disclose your personal data for the purposes stated above. However, before we do so, we will ensure that such third parties maintain confidentiality of your data and has reasonable security arrangements to prevent un-authorised modification, access, collection use, disclosure, copying, disposal or similar risks</p>
          </ol>
        </div>
      </div>
    @endif

    @if(Auth::check() && !isset($job_detail))
    @else
    <hr>
    <h4><u>Terms & Conditions</u></h4>
    <div class="row">
  		<div class="col-sm-12">
  			<p>I am currently <b><u>NOT</u></b> working as a civil servant or a Volunteer Special Constabulary (VSC) personnel. I shall immediately declare to the Company if I am working as a civil servant / VSC.
        Failing to do so, I shall be accountable for any sort of outcome thereafter.</p>
  		</div>
  	</div>
    <div class="row">
  		<div class="col-sm-12">
  			<p>I authorize the Company to make reference to all my past employers on my job performance / experience.</p>
  		</div>
  	</div>
    <div class="row">
  		<div class="col-sm-12">
  			<p>I further give consent to the Company for my personal data to be used for work purposes. E.g. sending my resume to clients, submitting my particulars to PLRD
          or to release my information to government departments (CPF, MOM, etc..) whenever requested.</p>
  		</div>
  	</div>
    <div class="row">
  		<div class="col-sm-12">
  			<p>I confirm that all the above facts in this application form are true and accurate to the best of my knowledge. I have not deliberately omitted any relevant fact.
            I understand that should any of the above information turn out to be false or inaccurate, I will be subjected to appropriate action.</p>
  		</div>
  	</div>
    @endif
  @else
    <p><b>{{trans('messages.applying_as_user',['attribute' => Auth::user()->full_name])}}</b></p>
  @endif

  {{-- Attachments --}}
  @if(Auth::check() && !isset($job_detail))
    <div class="row">
      <div class="col-sm-4">
        <div class="form-group">
          {!! Form::label('interviewer','Interviewer',[]) !!}
          {!! Form::select('interviewer',$interviewer,isset($job_application->last_name) ? $job_application->last_name : '',['class' => 'form-control show-tick', 'title' => trans('messages.select_one')]) !!}
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12">
        <div class="form-group">
          {!! Form::label('additional_information','Interviewer '.trans('messages.remarks'),[]) !!}
          {!! Form::textarea('additional_information',isset($job_application) ? $job_application->additional_information : '',['size' => '30x3', 'class' => 'form-control', 'placeholder' => trans('messages.remarks'), 'data-show-counter' => 1, 'data-limit' => config('config.textarea_limit'), 'data-autoresize' => 1]) !!}
          <span class="countdown"></span>
        </div>
      </div>
    </div>
  @else
    @if(!in_array(env('COMPANY_ID'), config('constant.custom_job_application')))
      <a href="/jobs" class="btn btn-default pull-left">{!! trans('messages.back_to').' '.trans('messages.job').' '.trans('messages.post') !!}</a>
    @endif
  @endif

  @if(!isset($job_detail))
  {{-- Backend --}}
  @include('upload.index',['module' => 'job-application-nric', 'upload_button' => trans('messages.upload').' '.trans('messages.nric').' (Front & Back)', 'module_id' => isset($job_application) ? $job_application->id : ''])
  <br>
  @include('upload.index',['module' => 'job-application-plrd', 'upload_button' => trans('messages.upload').' '.trans('messages.plrd').' (Front & Back)', 'module_id' => isset($job_application) ? $job_application->id : ''])
  <br>
  @include('upload.index',['module' => 'job-application-medical', 'upload_button' => trans('messages.upload').' '.trans('messages.medical'), 'module_id' => isset($job_application) ? $job_application->id : ''])
  <br>
  @endif

  {{-- Signature Portion --}}
  @if(Auth::check() && !isset($job_detail))
    {{-- Submit Button (Backend) --}}
    {!! Form::submit(isset($buttonText) ? $buttonText : trans('messages.submit').' '.trans('messages.application').' (Front & Back)',['id'=>'m-submit', 'class'=>'btn btn-primary pull-right']) !!}
  @else
  <br><br>
  <div class="row">
    <div class="col-sm-12">
      <div class="form-group">
        <div style="text-align:center;">Please sign below to agree with the terms and conditions before submitting your application.</div>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-sm-12">
      <div class="form-group">
        <div id="drawSign" scroll="false" style="width:100%; margin:0 auto; display: flex; justify-content: center;">
          <canvas id="cSign" style="border: 2pt solid black;"></canvas>
        </div>
      </div>
    </div>
  </div>
  <div class="row" style="display:flex; justify-content: center;">
    <div class="col-md-12" style="display:flex; justify-content: space-between; width: 100%; max-width: 600px;">
      <div class="form-group">
        <a id="clear-canvas" class="btn btn-success">{!! trans('messages.clear').' '.trans('messages.signature') !!}</a>
      </div>
      <div class="form-group">
        {{-- Submit Button (Frontend) --}}
        {!! Form::submit(isset($buttonText) ? $buttonText : trans('messages.submit').' '.trans('messages.application'),['id'=>'m-submit', 'class'=>'btn btn-primary pull-right', 'disabled'=>'true']) !!}
      </div>
    </div>
  </div>
  {!! Form::hidden('img_string','',['id' => 'signature_string'])!!}
  @endif

  @section('css')
    @if(config('config.enable_uppercase'))
      <style>
        input[type="text"] { text-transform: uppercase; }
      </style>
    @endif
  @endsection

  @section('js')
    {!! Html::script('https://cdnjs.cloudflare.com/ajax/libs/fabric.js/1.7.22/fabric.min.js') !!}
  	<script>
      var element = document.getElementById("drawSign");
      var width = element.offsetWidth ;   // width of canvas
      var height = element.offsetHeight;  // height of canvas
      var canvas = new fabric.Canvas('cSign');

      canvas.isDrawingMode = true;
      canvas.selection = false;
      fabric.Object.prototype.selectable = false; // prevent drawing objects to be draggable or clickable
      canvas.freeDrawingBrush.width = 4;    // size of the drawing brush

      function responsive() {
        var width = 600 ;
        var height = 400;
        if (element.offsetWidth < 600) { width = element.offsetWidth; height =  width * 2/3; }
        canvas.setHeight(height);
        canvas.setWidth(width);
        canvas.setDimensions({'width':width,'height':height},{'backstoreOnly':false,'cssOnly':true});
      }
      responsive();

      // Resize canvas
      window.addEventListener('resize', function(){ responsive(); });

      var btn_clear = document.getElementById('clear-canvas');
      btn_clear.onclick = function(){
        canvas.clear();
        canvas.backgroundColor = "white";  // use this background colour to check the actual canvas size
        document.getElementById("m-submit").disabled = true;
      };

      // Event to check when something is drawn on the canvas
      canvas.on('path:created', function(event){
        document.getElementById("m-submit").disabled = false;
      });

      // Convert signature to data url upon submit
      var btn_submit = document.getElementById('m-submit');
      btn_submit.onclick = function(){
        var dataURL = canvas.toDataURL({ format: 'png', quality: 0.8 });
        var signature_field = document.getElementById('signature_string');
        signature_field.value = dataURL;
        // canvas.clear();
      };

      $('#declare_cbx_1').on('ifChecked', function () {
        document.getElementById("declare_text_field_1").style.display = "block";
      });
      $('#declare_cbx_1').on('ifUnchecked', function () {
        document.getElementById("declare_text_field_1").style.display = "none";
      });
      $('#declare_cbx_2').on('ifChecked', function () {
        document.getElementById("declare_text_field_2").style.display = "block";
      });
      $('#declare_cbx_2').on('ifUnchecked', function () {
        document.getElementById("declare_text_field_2").style.display = "none";
      });
      $('#declare_cbx_3').on('ifChecked', function () {
        document.getElementById("declare_text_field_3").style.display = "block";
      });
      $('#declare_cbx_3').on('ifUnchecked', function () {
        document.getElementById("declare_text_field_3").style.display = "none";
      });
      $('#declare_cbx_4').on('ifChecked', function () {
        document.getElementById("declare_text_field_4").style.display = "block";
      });
      $('#declare_cbx_4').on('ifUnchecked', function () {
        document.getElementById("declare_text_field_4").style.display = "none";
      });
      $('#declare_cbx_5').on('ifChecked', function () {
        document.getElementById("declare_text_field_5").style.display = "block";
      });
      $('#declare_cbx_5').on('ifUnchecked', function () {
        document.getElementById("declare_text_field_5").style.display = "none";
      });

      @foreach(range(1,14) as $index)
        $('#medical_cbx_{{$index}}').on('ifChecked', function () {
          document.getElementById("medical_text_field_{{$index}}").style.display = "block";
        });
        $('#medical_cbx_{{$index}}').on('ifUnchecked', function () {
          document.getElementById("medical_text_field_{{$index}}").style.display = "none";
        });
      @endforeach


      function showFields() {
        var position_applied = document.getElementById("position_applied").value;
        if (position_applied == "Others") {
          document.getElementById("position_others").style.display = "block";
        }
        else {
          document.getElementById("position_others").style.display = "none";
        }
      }
  	</script>
  @endsection