<?php
    $record = $record ?? null;
?>
<h4 class="mb-3">Personal Information</h4>
<div class="row">
    <div class="col-md-6 mb-3">
        <label class="form-label">Name of Applicant</label>
        <input type="text" name="applicant_name" class="form-control <?php $__errorArgs = ['applicant_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" value="<?php echo e(old('applicant_name', $record->applicant_name ?? '')); ?>" required>
        <?php $__errorArgs = ['applicant_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?><div class="invalid-feedback"><?php echo e($message); ?></div><?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Designation</label>
        <input type="text" name="designation" class="form-control" value="<?php echo e(old('designation', $record->designation ?? '')); ?>">
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Address: Building No/Name</label>
        <input type="text" name="building" class="form-control" value="<?php echo e(old('building', $record->building ?? '')); ?>">
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Street</label>
        <input type="text" name="street" class="form-control" value="<?php echo e(old('street', $record->street ?? '')); ?>">
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">City</label>
        <input type="text" name="city" class="form-control" value="<?php echo e(old('city', $record->city ?? '')); ?>">
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">State</label>
        <input type="text" name="state" class="form-control" value="<?php echo e(old('state', $record->state ?? '')); ?>">
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Postal code</label>
        <input type="text" name="postal_code" class="form-control" value="<?php echo e(old('postal_code', $record->postal_code ?? '')); ?>">
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Country</label>
        <input type="text" name="country" class="form-control" value="<?php echo e(old('country', $record->country ?? '')); ?>">
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Email (login)</label>
        <input type="email" name="email" class="form-control <?php $__errorArgs = ['email'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" value="<?php echo e(old('email', $record->email ?? '')); ?>" required autocomplete="email" autocapitalize="none" spellcheck="false">
        <?php $__errorArgs = ['email'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?><div class="invalid-feedback"><?php echo e($message); ?></div><?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Phone Number with Country Code</label>
        <input type="text" name="phone" class="form-control" value="<?php echo e(old('phone', $record->phone ?? '')); ?>">
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Upload Applicant Photo</label>
        <input type="file" name="photo" class="form-control <?php $__errorArgs = ['photo'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>" accept="image/*">
        <?php $__errorArgs = ['photo'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?><div class="invalid-feedback"><?php echo e($message); ?></div><?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
        <?php if(!empty($record?->photo_path)): ?>
            <small class="text-muted">Current file is already uploaded.</small>
        <?php endif; ?>
    </div>
    <div class="col-md-6 mb-3">
        <label class="form-label">Upload Applicant ID Proof</label>
        <input type="file" name="id_proof" class="form-control <?php $__errorArgs = ['id_proof'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?> is-invalid <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>">
        <?php $__errorArgs = ['id_proof'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?><div class="invalid-feedback"><?php echo e($message); ?></div><?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
        <?php if(!empty($record?->id_proof_path)): ?>
            <small class="text-muted">Current file is already uploaded.</small>
        <?php endif; ?>
    </div>
    <div class="col-md-6">
        <?php echo $__env->make('iqec.partials.password-field', [
            'name' => 'password',
            'label' => 'Password '.($record ? '(leave blank to keep)' : ''),
            'required' => ! $record,
            'autocomplete' => 'new-password',
        ], array_diff_key(get_defined_vars(), ['__data' => 1, '__path' => 1]))->render(); ?>
    </div>
    <div class="col-md-6">
        <?php echo $__env->make('iqec.partials.password-field', [
            'name' => 'password_confirmation',
            'label' => 'Confirm Password',
            'required' => ! $record,
            'autocomplete' => 'new-password',
        ], array_diff_key(get_defined_vars(), ['__data' => 1, '__path' => 1]))->render(); ?>
    </div>
</div>
<?php /**PATH /Users/fasil/Sites/iqec/admin/resources/views/iqec/partials/partner-personal-fields.blade.php ENDPATH**/ ?>