@extends('layout')

@section('title', 'Apprenticeship/Employment Training Registration')

@section('content')
    <div class="main-card mb-3 card">
        <div class="card-body">
            <form method="post" action="{{ route('ioa.update', $ioa->id) }}">
                @csrf
                @method('PUT')
                <div class="mb-3 card card-body text-center">
                    <h1>Apprenticeship/Employment Training Registration</h1>
                </div>

                <div class="form-row">
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="last_name">
                                <span class="text-danger">*</span> Last Name
                            </label>
                            <input name="last_name" id="last_name" type="text" class="form-control"
                                   value="{{ $ioa->last_name }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="first_name">
                                <span class="text-danger">*</span> First Name
                            </label>
                            <input name="first_name" id="first_name" type="text"
                                   class="form-control"
                                   value="{{ $ioa->first_name }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="middle">
                                Middle
                            </label>
                            <input name="middle" id="middle" type="text" class="form-control"
                                   value="{{ $ioa->middle }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="street_address">
                                <span class="text-danger">*</span> Street Address
                            </label>
                            <input name="street_address" id="street_address" type="text"
                                   class="form-control" value="{{ $ioa->street_address }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="city">
                                <span class="text-danger">*</span> City
                            </label>
                            <input name="city" id="city" type="text"
                                   class="form-control" value="{{ $ioa->city }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="state">
                                <span class="text-danger">*</span> State
                            </label>
                            <input name="state" id="state" type="text"
                                   class="form-control" value="{{ $ioa->state }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="zip">
                                <span class="text-danger">*</span> Zip
                            </label>
                            <input name="zip" id="zip" type="text"
                                   class="form-control" value="{{ $ioa->zip }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="home_phone">
                                Home Phone
                            </label>
                            <input name="home_phone" id="home_phone" type="text"
                                   class="form-control"
                                   value="{{ $ioa->home_phone }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="cell_phone">
                                <span class="text-danger">*</span> Cell Phone
                            </label>
                            <input name="cell_phone" id="cell_phone" type="text"
                                   class="form-control"
                                   value="{{ $ioa->cell_phone }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="email">
                                <span class="text-danger">*</span> Email
                            </label>
                            <input name="email" id="email" type="email" class="form-control"
                                   value="{{ $ioa->email }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="gender">
                                <span class="text-danger">*</span> Gender
                            </label>
                            <select id="gender" name="gender" required class="form-control">
                                <option value="">Choose option</option>
                                <option value="F" {{ (($ioa->gender == 'F') ? 'selected' : '') }}>F</option>
                                <option value="M" {{ (($ioa->gender == 'M') ? 'selected' : '') }}>M</option>
                                <option value="Other" {{ (($ioa->gender == 'Other') ? 'selected' : '') }}>Other</option>
                            </select>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ss_number">
                                <span class="text-danger">*</span> SS #
                            </label>
                            <input name="ss_number" id="ss_number" type="text" class="form-control"
                                   value="{{ $ioa->ss_number }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ethnicity">
                                <span class="text-danger">*</span> Ethnicity
                            </label>
                            <input name="ethnicity" id="ethnicity" type="text" class="form-control"
                                   value="{{ $ioa->ethnicity }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="dob">
                                <span class="text-danger">*</span> Date of Birth
                            </label>
                            <input name="dob" id="dob" type="date" class="form-control"
                                    value="{{ $ioa->dob }}">
                        </div>
                    </div>
                    <div class="col-md-12 card card-body" style="margin-bottom: 20px;">
                        <h3>Assessment</h3>
                    </div>
                    <div class="col-md-12">
                        <h5>Communication Skills</h5>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <p>
                                <span class="text-danger">*</span> Speak English?
                            </p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="speak_english" type="radio" value="1" class="form-check-input" {{ $ioa->speak_english == '1' ? 'checked' : '' }}> Yes
                            </label>
                            <label class="form-check-label">
                                <input name="speak_english" type="radio" value="0" class="form-check-input" {{ $ioa->speak_english == '0' ? 'checked' : '' }}> No
                            </label>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <p>
                                <span class="text-danger">*</span> Read English?
                            </p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="read_english" type="radio" value="1" class="form-check-input" {{ $ioa->read_english == '1' ? 'checked' : '' }}> Yes
                            </label>
                            <label class="form-check-label">
                                <input name="read_english" type="radio" value="0" class="form-check-input" {{ $ioa->read_english == '0' ? 'checked' : '' }}> No
                            </label>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <p>
                                <span class="text-danger">*</span> Write English?
                            </p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="write_english" type="radio" value="1" class="form-check-input" {{ $ioa->write_english == '1' ? 'checked' : '' }}> Yes
                            </label>
                            <label class="form-check-label">
                                <input name="write_english" type="radio" value="0" class="form-check-input" {{ $ioa->write_english == '0' ? 'checked' : '' }}> No
                            </label>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <p>
                                <span class="text-danger">*</span> English Second Language?
                            </p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="english_second_language" type="radio" value="1" class="form-check-input" {{ $ioa->english_second_language == '1' ? 'checked' : '' }}> Yes
                            </label>
                            <label class="form-check-label">
                                <input name="english_second_language" type="radio" value="0" class="form-check-input" {{ $ioa->english_second_language == '0' ? 'checked' : '' }}> No
                            </label>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="primary_language">
                                <span class="text-danger">*</span> Primary Language
                            </label>
                            <select name="primary_language" id="primary_language" class="form-control" required>
                                <option value="">--Select--</option>
                                <option value="Afghani" {{ $ioa->primary_language == "Afghani" ? 'selected' : '' }}>Afghani</option>
                                <option value="American" {{ $ioa->primary_language == "American" ? 'selected' : '' }}>American</option>
                                <option value="Sign Language" {{ $ioa->primary_language == "Sign Language" ? 'selected' : '' }}>Sign Language</option>
                                <option value="Amharic" {{ $ioa->primary_language == "Amharic" ? 'selected' : '' }}>Amharic</option>
                                <option value="Arabic" {{ $ioa->primary_language == "Arabic" ? 'selected' : '' }}>Arabic</option>
                                <option value="Armenian" {{ $ioa->primary_language == "Armenian" ? 'selected' : '' }}>Armenian</option>
                                <option value="Bosnian" {{ $ioa->primary_language == "Bosnian" ? 'selected' : '' }}>Bosnian</option>
                                <option value="Cantonese" {{ $ioa->primary_language == "Cantonese" ? 'selected' : '' }}>Cantonese</option>
                                <option value="Combodian" {{ $ioa->primary_language == "Combodian" ? 'selected' : '' }}>Combodian</option>
                                <option value="English" {{ $ioa->primary_language == "English" ? 'selected' : '' }}>English</option>
                                <option value="Ethiopian" {{ $ioa->primary_language == "Ethiopian" ? 'selected' : '' }}>Ethiopian</option>
                                <option value="Farsi" {{ $ioa->primary_language == "Farsi" ? 'selected' : '' }}>Farsi</option>
                                <option value="French" {{ $ioa->primary_language == "French" ? 'selected' : '' }}>French</option>
                                <option value="German" {{ $ioa->primary_language == "German" ? 'selected' : '' }}>German</option>
                                <option value="Hebrew" {{ $ioa->primary_language == "Hebrew" ? 'selected' : '' }}>Hebrew</option>
                                <option value="Hmong" {{ $ioa->primary_language == "Hmong" ? 'selected' : '' }}>Hmong</option>
                                <option value="Ilcano" {{ $ioa->primary_language == "Ilcano" ? 'selected' : '' }}>Ilcano</option>
                                <option value="Italian" {{ $ioa->primary_language == "Italian" ? 'selected' : '' }}>Italian</option>
                                <option value="Japanese" {{ $ioa->primary_language == "Japanese" ? 'selected' : '' }}>Japanese</option>
                                <option value="Korean" {{ $ioa->primary_language == "Korean" ? 'selected' : '' }}>Korean</option>
                                <option value="Lao" {{ $ioa->primary_language == "Lao" ? 'selected' : '' }}>Lao</option>
                                <option value="Mandarin" {{ $ioa->primary_language == "Mandarin" ? 'selected' : '' }}>Mandarin</option>
                                <option value="Mien" {{ $ioa->primary_language == "Mien" ? 'selected' : '' }}>Mien</option>
                                <option value="Oromo" {{ $ioa->primary_language == "Oromo" ? 'selected' : '' }}>Oromo</option>
                                <option value="Polish" {{ $ioa->primary_language == "Polish" ? 'selected' : '' }}>Polish</option>
                                <option value="Portuguese" {{ $ioa->primary_language == "Portuguese" ? 'selected' : '' }}>Portuguese</option>
                                <option value="Romanian" {{ $ioa->primary_language == "Romanian" ? 'selected' : '' }}>Romanian</option>
                                <option value="Russian" {{ $ioa->primary_language == "Russian" ? 'selected' : '' }}>Russian</option>
                                <option value="Samoan" {{ $ioa->primary_language == "Samoan" ? 'selected' : '' }}>Samoan</option>
                                <option value="Serbo-Croatian" {{ $ioa->primary_language == "Serbo-Croatian" ? 'selected' : '' }}>Serbo-Croatian</option>
                                <option value="Somali" {{ $ioa->primary_language == "Somali" ? 'selected' : '' }}>Somali</option>
                                <option value="Spanish" {{ $ioa->primary_language == "Spanish" ? 'selected' : '' }}>Spanish</option>
                                <option value="Swahili" {{ $ioa->primary_language == "Swahili" ? 'selected' : '' }}>Swahili</option>
                                <option value="Tagalog" {{ $ioa->primary_language == "Tagalog" ? 'selected' : '' }}>Tagalog</option>
                                <option value="Thai" {{ $ioa->primary_language == "Thai" ? 'selected' : '' }}>Thai</option>
                                <option value="Tigrigna" {{ $ioa->primary_language == "Tigrigna" ? 'selected' : '' }}>Tigrigna</option>
                                <option value="Turkish" {{ $ioa->primary_language == "Turkish" ? 'selected' : '' }}>Turkish</option>
                                <option value="Vietnamese" {{ $ioa->primary_language == "Vietnamese" ? 'selected' : '' }}>Vietnamese</option>
                                <option value="Other Chinese Language" {{ $ioa->primary_language == "Other Chinese Language" ? 'selected' : '' }}>Other Chinese Language</option>
                                <option value="Other Non-English" {{ $ioa->primary_language == "Other Non-English" ? 'selected' : '' }}>Other Non-English</option>
                                <option value="Other Sign Language" {{ $ioa->primary_language == "Other Sign Language" ? 'selected' : '' }}>Other Sign Language</option>
                            </select>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="education_completed">
                                <span class="text-danger">*</span> Highest level of education completed?
                            </label>
                            <select name="education_completed" id="education_completed" class="form-control" required>
                                <option value="">--Select--</option>
                                <option value="No Formal Education" {{ $ioa->education_completed == "No Formal Education" ? 'selected' : '' }}>No Formal Education</option>
                                <option value="Less Than 9th Grade" {{ $ioa->education_completed == "Less Than 9th Grade" ? 'selected' : '' }}>Less Than 9th Grade</option>
                                <option value="High School Dropout" {{ $ioa->education_completed == "High School Dropout" ? 'selected' : '' }}>High School Dropout</option>
                                <option value="Attending High School, Trade Or Ged High School" {{ $ioa->education_completed == "Attending High School, Trade Or Ged High School" ? 'selected' : '' }}>Attending High School, Trade Or Ged High School</option>
                                <option value="Grad GED Grad" {{ $ioa->education_completed == "Grad GED Grad" ? 'selected' : '' }}>Grad GED Grad</option>
                                <option value="Trade School Grad" {{ $ioa->education_completed == "Trade School Grad" ? 'selected' : '' }}>Trade School Grad</option>
                                <option value="Attending College" {{ $ioa->education_completed == "Attending College" ? 'selected' : '' }}>Attending College</option>
                                <option value="Undergraduate College Graduate" {{ $ioa->education_completed == "Undergraduate College Graduate" ? 'selected' : '' }}>Undergraduate College Graduate</option>
                                <option value="Post-Graduate Degree" {{ $ioa->education_completed == "Post-Graduate Degree" ? 'selected' : '' }}>Post-Graduate Degree</option>
                                <option value="Unknown" {{ $ioa->education_completed == "Unknown" ? 'selected' : '' }}>Unknown</option>
                            </select>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="school">
                                School
                            </label>
                            <input name="school" id="school" type="text" class="form-control" value="{{ $ioa->school }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="major_program">
                                Major/Program
                            </label>
                            <input name="major_program" id="major_program" type="text" class="form-control" value="{{ $ioa->major_program }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="industry_focus">
                                Workforce Pathway Interest
                            </label>
                            <select name="industry_focus" id="industry_focus" class="form-control">
                                <option value="">--Select--</option>
                                <option value="software_app_dev" {{ $ioa->industry_focus == "software_app_dev" ? 'selected' : '' }}>Software/Application Dev</option>
                                <option value="cybersecurity" {{ $ioa->industry_focus == "cybersecurity" ? 'selected' : '' }}>Cybersecurity</option>
                                <option value="it_project_manager" {{ $ioa->industry_focus == "it_project_manager" ? 'selected' : '' }}>IT Project Manager</option>
                                <option value="info_assurance" {{ $ioa->industry_focus == "info_assurance" ? 'selected' : '' }}>Information Assurance</option>
                                <option value="helpdesk_tech" {{ $ioa->industry_focus == "helpdesk_tech" ? 'selected' : '' }}>Helpdesk Technician</option>
                                <option value="ecommerce_specialist" {{ $ioa->industry_focus == "ecommerce_specialist" ? 'selected' : '' }}>E-Commerce Specialist</option>
                                <option value="health_it_specialists" {{ $ioa->industry_focus == "health_it_specialists" ? 'selected' : '' }}>Health IT Specialists</option>
                                <option value="health_it_data_analyst" {{ $ioa->industry_focus == "health_it_data_analyst" ? 'selected' : '' }}>Health IT Data Analyst</option>
                                <option value="health_it_management_business_analyst" {{ $ioa->industry_focus == "health_it_management_business_analyst" ? 'selected' : '' }}>Health IT Management Business Analyst</option>
                                <option value="health_it_coder" {{ $ioa->industry_focus == "health_it_coder" ? 'selected' : '' }}>Health IT Coder</option>
                                <option value="clinical_documentation_specialist" {{ $ioa->industry_focus == "clinical_documentation_specialist" ? 'selected' : '' }}>Clinical Documentation Specialist</option>
                                <option value="eLearning_instructional_designer" {{ $ioa->industry_focus == "eLearning_instructional_designer" ? 'selected' : '' }}>eLearning Instructional Designer</option>
                            </select>
                        </div>
                    </div>
                    <div class="col-md-12">
                        <h5>Employment History</h5>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="last_job">
                                <span class="text-danger">*</span> Last Job/Occupation?
                            </label>
                            <select name="last_job" id="last_job" class="form-control" required>
                                <option value="">--Select--</option>
                                <option value="Administrative" {{ $ioa->last_job == "Administrative" ? 'selected' : '' }}>Administrative</option>
                                <option value="Secretarial Architecture" {{ $ioa->last_job == "Secretarial Architecture" ? 'selected' : '' }}>Secretarial Architecture</option>
                                <option value="Interior design Artistic" {{ $ioa->last_job == "Interior design Artistic" ? 'selected' : '' }}>Interior design Artistic</option>
                                <option value="Creative" {{ $ioa->last_job == "Creative" ? 'selected' : '' }}>Creative</option>
                                <option value="Performance Education" {{ $ioa->last_job == "Performance Education" ? 'selected' : '' }}>Performance Education</option>
                                <option value="Teacher" {{ $ioa->last_job == "Teacher" ? 'selected' : '' }}>Teacher</option>
                                <option value="Professor Executive" {{ $ioa->last_job == "Professor Executive" ? 'selected' : '' }}>Professor Executive</option>
                                <option value="Management Fashion" {{ $ioa->last_job == "Management Fashion" ? 'selected' : '' }}>Management Fashion</option>
                                <option value="Model" {{ $ioa->last_job == "Model" ? 'selected' : '' }}>Model</option>
                                <option value="Beauty Financial" {{ $ioa->last_job == "Beauty Financial" ? 'selected' : '' }}>Beauty Financial</option>
                                <option value="Accounting" {{ $ioa->last_job == "Accounting" ? 'selected' : '' }}>Accounting</option>
                                <option value="Real Estate Labor" {{ $ioa->last_job == "Real Estate Labor" ? 'selected' : '' }}>Real Estate Labor</option>
                                <option value="Construction Law enforcement" {{ $ioa->last_job == "Construction Law enforcement" ? 'selected' : '' }}>Construction Law enforcement</option>
                                <option value="Security" {{ $ioa->last_job == "Security" ? 'selected' : '' }}>Security</option>
                                <option value="Military Legal Medical" {{ $ioa->last_job == "Military Legal Medical" ? 'selected' : '' }}>Military Legal Medical</option>
                                <option value="Dental" {{ $ioa->last_job == "Dental" ? 'selected' : '' }}>Dental</option>
                                <option value="Veterinary" {{ $ioa->last_job == "Veterinary" ? 'selected' : '' }}>Veterinary</option>
                                <option value="Fitness None Nonprofit" {{ $ioa->last_job == "Fitness None Nonprofit" ? 'selected' : '' }}>Fitness None Nonprofit</option>
                                <option value="Volunteer" {{ $ioa->last_job == "Volunteer" ? 'selected' : '' }}>Volunteer</option>
                                <option value="Activist Political" {{ $ioa->last_job == "Activist Political" ? 'selected' : '' }}>Activist Political</option>
                                <option value="Govt" {{ $ioa->last_job == "Govt" ? 'selected' : '' }}>Govt</option>
                                <option value="Civil Service" {{ $ioa->last_job == "Civil Service" ? 'selected' : '' }}>Civil Service</option>
                                <option value="Military Retail" {{ $ioa->last_job == "Military Retail" ? 'selected' : '' }}>Military Retail</option>
                                <option value="Food services Retired Sales" {{ $ioa->last_job == "Food services Retired Sales" ? 'selected' : '' }}>Food services Retired Sales</option>
                                <option value="Marketing Self-Employed" {{ $ioa->last_job == "Marketing Self-Employed" ? 'selected' : '' }}>Marketing Self-Employed</option>
                                <option value="Entrepreneur Student Technical" {{ $ioa->last_job == "Entrepreneur Student Technical" ? 'selected' : '' }}>Entrepreneur Student Technical</option>
                                <option value="Science" {{ $ioa->last_job == "Science" ? 'selected' : '' }}>Science</option>
                                <option value="Computers" {{ $ioa->last_job == "Computers" ? 'selected' : '' }}>Computers</option>
                                <option value="Engineering Travel" {{ $ioa->last_job == "Engineering Travel" ? 'selected' : '' }}>Engineering Travel</option>
                                <option value="Hospitality" {{ $ioa->last_job == "Hospitality" ? 'selected' : '' }}>Hospitality</option>
                                <option value="Transportation Other profession" {{ $ioa->last_job == "Transportation Other profession" ? 'selected' : '' }}>Transportation Other profession</option>
                            </select>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="employer_name">
                                Employer Name
                            </label>
                            <input name="employer_name" id="employer_name" type="text" class="form-control" value="{{ $ioa->employer_name }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="date_last_worked">
                                Date Last Worked?
                            </label>
                            <input name="date_last_worked" id="date_last_worked" type="date" class="form-control" value="{{ $ioa->date_last_worked }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="hourly_wage">
                                Hourly Wage?
                            </label>
                            <input name="hourly_wage" id="hourly_wage" type="number" class="form-control" value="{{ $ioa->hourly_wage }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="job_title">
                                Job Title?
                            </label>
                            <input name="job_title" id="job_title" type="text" class="form-control" value="{{ $ioa->job_title }}">
                        </div>
                    </div>
                    <div class="col-md-12">
                        <h5>Employment Related Skills, Abilities and Interests</h5>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="skill_certificate">
                                Trade or Skill Certificate & date obtained?
                            </label>
                            <textarea name="skill_certificate" id="skill_certificate" class="form-control">{{ $ioa->skill_certificate }}</textarea>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="skill_and_abilities">
                                Skills and Abilities?
                            </label>
                            <textarea name="skill_and_abilities" id="skill_and_abilities" class="form-control">{{ $ioa->skill_and_abilities }}</textarea>
                        </div>
                    </div>
                    <div class="col-md-12">
                        <h5>Type of work seeking?</h5>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="choice_1">
                                Choice 1:
                            </label>
                            <input name="choice_1" id="choice_1" type="text" class="form-control" value="{{ $ioa->choice_1 }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="choice_2">
                                Choice 2:
                            </label>
                            <input name="choice_2" id="choice_2" type="text" class="form-control" value="{{ $ioa->choice_2 }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="choice_3">
                                Choice 3:
                            </label>
                            <input name="choice_3" id="choice_3" type="text" class="form-control" value="{{ $ioa->choice_3 }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <p>
                                <span class="text-danger">*</span> Veteran
                            </p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="veteran" type="radio" value="1" class="form-check-input" {{ $ioa->veteran == '1' ? 'checked' : '' }} required> Yes
                            </label>
                            <label class="form-check-label">
                                <input name="veteran" type="radio" value="0" class="form-check-input" {{ $ioa->veteran == '0' ? 'checked' : '' }}> No
                            </label>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <p>
                                <span class="text-danger">*</span> Disabled
                            </p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="disabled" type="radio" value="1" class="form-check-input" {{ $ioa->disabled == '1' ? 'checked' : '' }} required> Yes
                            </label>
                            <label class="form-check-label">
                                <input name="disabled" type="radio" value="0" class="form-check-input" {{ $ioa->disabled == '0' ? 'checked' : '' }}> No
                            </label>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <p>
                                <span class="text-danger">*</span> U.S. Citizen?
                            </p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="us_citizen" type="radio" value="1" class="form-check-input" {{ $ioa->us_citizen == '1' ? 'checked' : '' }} required> Yes
                            </label>
                            <label class="form-check-label">
                                <input name="us_citizen" type="radio" value="0" class="form-check-input" {{ $ioa->us_citizen == '0' ? 'checked' : '' }}> No
                            </label>
                        </div>
                    </div>
                    <div class="col-md-4" id="div_visa_status" {{ $ioa->us_citizen == '1' ? 'style="display: none;"' : '' }}>
                        <div class="position-relative form-group">
                            <label for="visa_status">
                                <span class="text-danger">*</span> Visa Status?
                            </label>
                            <textarea name="visa_status" id="visa_status" class="form-control">{{ $ioa->visa_status }}</textarea>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="training_schedule">
                                Choose the best training schedule that will work for you
                            </label>
                            <select name="training_schedule" id="training_schedule" class="form-control">
                                <option value="">--Select--</option>
                                <option value="9:00 AM - 12:00 NOON: Monday - Thursday" {{ $ioa->training_schedule == "9:00 AM - 12:00 NOON: Monday - Thursday" ? 'selected' : '' }}>9:00 AM - 12:00 NOON: Monday - Thursday</option>
                                <option value="1:00 PM - 4:00 PM: Monday - Thursday" {{ $ioa->training_schedule == "1:00 PM - 4:00 PM: Monday - Thursday" ? 'selected' : '' }} disabled>1:00 PM - 4:00 PM: Monday - Thursday</option>
                                <option value="9:00 AM - 3:00 PM: Friday and Saturday" {{ $ioa->training_schedule == "9:00 AM - 3:00 PM: Friday and Saturday" ? 'selected' : '' }}>9:00 AM - 3:00 PM: Friday and Saturday</option>
                            </select>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="hear_about_program">
                                <span class="text-danger">*</span> How did you hear about our program?
                            </label>
                            <input name="hear_about_program" id="hear_about_program" type="text" class="form-control" value="{{ $ioa->hear_about_program }}" required>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="job_target">
                                Job Target
                            </label>
                            <input name="job_target" id="job_target" type="text"
                                   class="form-control"
                                   value="{{ $ioa->job_target }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="special_skills">
                                Do you have any special skills, talents and/or hobbies?
                            </label>
                            <textarea name="special_skills" id="special_skills" class="form-control">{{ $ioa->special_skills }}</textarea>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="joining_reason">
                                Please tell us why you are interested in joining the program
                            </label>
                            <textarea name="joining_reason" id="joining_reason" class="form-control">{{ $ioa->joining_reason }}</textarea>
                        </div>
                    </div>
                </div>

                <div class="form-row">
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="work_authorization">
                                <span class="text-danger">*</span> YES: I am authorized to work in
                                the
                                United States with
                            </label>
                            <select name="work_authorization" id="work_authorization"
                                    class="form-control"
                                    required>
                                <option value="visa" {{ (($ioa->work_authorization == 'visa') ? 'selected' : '') }}>
                                    VISA
                                </option>
                                <option value="citizenship" {{ (($ioa->work_authorization == 'citizenship') ? 'selected' : '') }}>
                                    Citizenship
                                </option>
                            </select>
                        </div>
                    </div>
                    <div class="col-md-6">
                        <div class="position-relative form-group">
                            <label for="starting_date">
                                <span class="text-danger">*</span> Starting on this date:
                            </label>
                            <input name="starting_date" id="starting_date" type="date"
                                   class="form-control" value="{{ $ioa->starting_date }}">
                            <p>
                                <i>
                                    For the length of time required for my training.
                                    I understand that any request to change my schedule is subject
                                    to the
                                    approval, by the Program Director.
                                </i>
                            </p>
                        </div>
                    </div>
                </div>

                <div class="form-row">
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_contact">
                                <span class="text-danger">*</span> Emergency Contact Name
                            </label>
                            <input name="ec_contact" id="ec_contact" type="text"
                                   class="form-control" value="{{ $ioa->ec_contact }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_relationship">
                                Relationship
                            </label>
                            <input name="ec_relationship" id="ec_relationship" type="text"
                                   class="form-control" value="{{ $ioa->ec_relationship }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_street_address">
                                Street Address
                            </label>
                            <input name="ec_street_address" id="ec_street_address" type="text"
                                   class="form-control" value="{{ $ioa->ec_street_address }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_city">
                                <span class="text-danger">*</span> City
                            </label>
                            <input name="ec_city" id="ec_city" type="text"
                                   class="form-control" value="{{ $ioa->ec_city }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_state">
                                <span class="text-danger">*</span> State
                            </label>
                            <input name="ec_state" id="ec_state" type="text"
                                   class="form-control" value="{{ $ioa->ec_state }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_zip">
                                <span class="text-danger">*</span> Zip
                            </label>
                            <input name="ec_zip" id="ec_zip" type="text"
                                   class="form-control" value="{{ $ioa->ec_zip }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_home_phone">
                                Home Phone
                            </label>
                            <input name="ec_home_phone" id="ec_home_phone" type="text"
                                   class="form-control"
                                   value="{{ $ioa->ec_home_phone }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_cell_phone">
                                <span class="text-danger">*</span> Cell Phone
                            </label>
                            <input name="ec_cell_phone" id="ec_cell_phone" type="text"
                                   class="form-control"
                                   value="{{ $ioa->ec_cell_phone }}">
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="ec_email">
                                <span class="text-danger">*</span> Email
                            </label>
                            <input name="ec_email" id="ec_email" type="email" class="form-control"
                                   value="{{ $ioa->ec_email }}">
                        </div>
                    </div>
                </div>
                <hr>
                <div class="form-row">
                    <div class="col-md-12">
                        <p>I am eligible to receive</p>
                    </div>
                    <div class="col-md-12">
                        <div class="position-relative form-group">
                            <p>Unemployment</p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_unemployment" type="radio" value="yes" class="form-check-input" {{ $ioa->eligible_unemployment == 'yes' ? 'checked' : '' }}> Yes
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_unemployment" type="radio" value="no" class="form-check-input" {{ $ioa->eligible_unemployment == 'no' ? 'checked' : '' }}> No
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_unemployment" type="radio" value="not_sure" class="form-check-input" {{ $ioa->eligible_unemployment == 'not_sure' ? 'checked' : '' }}> Not sure
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_unemployment" type="radio" value="not_applicable" class="form-check-input" {{ $ioa->eligible_unemployment == 'not_applicable' ? 'checked' : '' }}> Not applicable
                            </label>
                        </div>
                    </div>
                    <div class="col-md-12">
                        <div class="position-relative form-group">
                            <p>CalFresh</p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_calfresh" type="radio" value="yes" class="form-check-input" {{ $ioa->eligible_calfresh == 'yes' ? 'checked' : '' }}> Yes
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_calfresh" type="radio" value="no" class="form-check-input" {{ $ioa->eligible_calfresh == 'no' ? 'checked' : '' }}> No
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_calfresh" type="radio" value="not_sure" class="form-check-input" {{ $ioa->eligible_calfresh == 'not_sure' ? 'checked' : '' }}> Not sure
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_calfresh" type="radio" value="not_applicable" class="form-check-input" {{ $ioa->eligible_calfresh == 'not_applicable' ? 'checked' : '' }}> Not applicable
                            </label>
                        </div>
                    </div>
                    <div class="col-md-12">
                        <div class="position-relative form-group">
                            <p>CalWorks</p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_calworks" type="radio" value="yes" class="form-check-input" {{ $ioa->eligible_calworks == 'yes' ? 'checked' : '' }}> Yes
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_calworks" type="radio" value="no" class="form-check-input" {{ $ioa->eligible_calworks == 'no' ? 'checked' : '' }}> No
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_calworks" type="radio" value="not_sure" class="form-check-input" {{ $ioa->eligible_calworks == 'not_sure' ? 'checked' : '' }}> Not sure
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_calworks" type="radio" value="not_applicable" class="form-check-input" {{ $ioa->eligible_calworks == 'not_applicable' ? 'checked' : '' }}> Not applicable
                            </label>
                        </div>
                    </div>
                    <div class="col-md-12">
                        <div class="position-relative form-group">
                            <p>WIOA</p>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_wioa" type="radio" value="yes" class="form-check-input" {{ $ioa->eligible_wioa == 'yes' ? 'checked' : '' }}> Yes
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_wioa" type="radio" value="no" class="form-check-input" {{ $ioa->eligible_wioa == 'no' ? 'checked' : '' }}> No
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_wioa" type="radio" value="not_sure" class="form-check-input" {{ $ioa->eligible_wioa == 'not_sure' ? 'checked' : '' }}> Not sure
                            </label>
                            <label class="form-check-label" style="margin-right: 50px; margin-left: 25px;">
                                <input name="eligible_wioa" type="radio" value="not_applicable" class="form-check-input" {{ $ioa->eligible_wioa == 'not_applicable' ? 'checked' : '' }}> Not applicable
                            </label>
                        </div>
                    </div>
                    <div class="col-md-12" id="div_consent" {{ (($ioa->eligible_agency_name != '') ? '' : 'style="display: none;"') }}>
                        <div class="position-relative form-group">
                            <p>CONSENT TO RELEASE PUBLIC ASSISTANCE INFORMATION FOR THE CALFRESH EMPLOYMENT &
                                TRAINING PROGRAM</p>
                            <p>RELEASE OF ELIGIBILITY INFORMATION. I understand this consent form and give my
                                permission to the County of Santa Clara Social Services Agency (SSA) to release and
                                send information relating to the status of my CalFresh eligibility to the CalFresh
                                Employment & Training (CFET) Program representative at</p>
                            <input name="eligible_agency_name" id="eligible_agency_name" type="text" placeholder="Agency Name" class="form-control" value="{{ $ioa->eligible_agency_name }}"
                                   required>
                            <p>if I am eligible for the CalFresh program.</p>
                        </div>
                    </div>
                </div>
                <div class="form-row">
                    <p>
                        <strong>
                            I acknowledge that this project is to provide me a workforce skills
                            enrichment
                            experience. There is no other compensation for my work during this work
                            experience EXCEPT for the compensation I negotiated with my employer.
                        </strong>
                    </p>
                    <p>
                        I understand that during the course and scope of my work study/internship
                        with
                        Rightvarsity, I will not be covered under Rightvarsity insurance. I
                        understand and
                        agree that my sole remedy for any injury that I may sustain during the
                        course and
                        scope of my work experience at Rightvarsity shall be through my employer’s
                        Workers’
                        Compensation or self-insurance coverage. I waive any other right or remedy
                        that I
                        may have available to me from Rightvarsity Technologies, LLC. for any
                        injuries.
                    </p>
                    <p>
                        I agree to grant to Rightvarsity a non-exclusive, irrevocable, royalty free
                        license
                        to use, copy and modify any elements of the material not specifically
                        created for
                        Rightvarsity as part of the services. In respect of the material
                        specifically
                        created for Rightvarsity Technologies as part of the services, I assign the
                        full
                        title guarantee to Rightvarsity Technologies and any and all of the
                        copyright, other
                        intellectual property rights and any other data or material used or
                        subsisting in
                        the material whether finished or unfinished. If any third party intellectual
                        property rights are used in the material I shall ensure that I have secured
                        all
                        necessary consents and approvals to use such third party intellectual
                        property
                        rights. For the purposes of this document, "Material" shall mean the
                        materials,
                        in whatever form, used by me to provide the services and products, systems,
                        applications, contents, programs or processes, in whatever form, produced by
                        me
                        during this work-study.
                    </p>
                    <p>
                        <strong>I understand that Rightvarsity may photograph or videotape the
                            events or
                            activity in which I am participating.</strong> I give my permission for
                        Rightvarsity to use photographs or videotape of me for the purpose of
                        promoting
                        Rightvarsity and its services/ programs. I give my permission with the
                        following
                        understanding: <strong>No compensation of any kind will be paid to me at
                            this time
                            or in the future for the use of my likeness.</strong>
                    </p>
                    <p>
                        I certify that the information stated on this application is true, complete
                        and
                        correct to the best of my knowledge and belief and is made in good faith.
                        Any false
                        statements made by me may be used as a basis of rejection for this
                        application.
                    </p>

                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="signature">
                                <span class="text-danger">*</span> Signature of Applicant
                            </label>
                            <input name="signature" id="signature" type="text" class="form-control"
                                   value="{{ $ioa->signature }}" required>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="signature_date">
                                <span class="text-danger">*</span> Date
                            </label>
                            <input name="signature_date" id="signature_date" type="date"
                                   class="form-control" value="{{ $ioa->signature_date }}" required>
                        </div>
                    </div>
                    <div class="col-md-4">
                        <div class="position-relative form-group">
                            <label for="print_name">
                                <span class="text-danger">*</span> Print Name
                            </label>
                            <input name="print_name" id="print_name" type="text"
                                   class="form-control"
                                   value="{{ $ioa->print_name }}" required>
                        </div>
                    </div>
                </div>
                <hr/>
                @if (in_array(Auth::user()->role, array('manager', 'admin')))
                <div class="col-md-4">
                    <div class="position-relative form-group">
                        <label for="major_program">
                            Approve?
                        </label>
                        <select name="application_approved" id="application_approved" required class="form-control">
                            <option value="pending" {{ (($ioa->application_approved == 'pending') ? 'selected' : '') }}>Pending</option>
                            <option value="no" {{ (($ioa->application_approved == 'no') ? 'selected' : '') }}>No</option>
                            <option value="yes" {{ (($ioa->application_approved == 'yes') ? 'selected' : '') }}>Yes</option>
                        </select>
                    </div>
                </div>
                @endif
                <div class="col-md-12">
                    <div class="form-group text-center">
                        <button class="btn-wide btn-pill btn-shadow btn-hover-shine btn btn-primary btn-lg">
                            Update
                        </button>
                    </div>
                </div>
            </form>
        </div>
    </div>
    <p class="text-center">
        <i>
            Thank you for taking the time to complete this application. We appreciate your interest in
            using this opportunity to improve your skills with us
        </i>
    </p>
@endsection

@section('js')
    <script>
        $('input[type=radio][name=us_citizen]').change(function() {
            if (this.value == '1') {
                $('#visa_status').removeAttr("required");
                $('#div_visa_status').hide();
            }
            else if (this.value == '0') {
                $('#visa_status').prop('required', true);
                $('#div_visa_status').show();
            }
        });

        $('input[type=radio][name=eligible_calfresh]').change(function() {
            if (this.value == 'yes' || this.value == 'not_sure') {
                $('#eligible_agency_name').prop('required', true);
                $('#div_consent').show();
            }
            else {
                $('#eligible_agency_name').removeAttr("required");
                $('#eligible_agency_name').val('');
                $('#div_consent').hide();
            }
        });
    </script>
@endsection