%PDF-
%PDF-
Mini Shell
Mini Shell
<?php
$conf = new Configuracion();
$conf->conectarBD();
?>
<div class="page-content">
<form data-toggle="validator" action="agregar_personal.php" method="post" role="form" enctype="multipart/form-data">
<div class="portlet box portlet-yellow">
<div class="portlet-header">
<div class="caption">Registro de nuevo servicio de la DEFENSERIA</div>
<div class="tools"><i class="fa fa-chevron-up"></i><i class="fa fa-refresh"></i></div>
</div>
<div class="portlet-body">
<div class="row">
<div class="form-group">
<label for="InputText">
<h3>
<dt> Datos personales</dt>
</h3>
</label><br>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Nombre(s)</dt>
</label><span class='require'> *</span>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" ombre" value="" class="form-control" required />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Primer Apellido</dt>
</label><span class='require'> *</span>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pellido1" value="" class="form-control" required />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Segundo Apellido</dt>
</label><span class='require'> *</span>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="apellido2" value="" class="form-control" required />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Sexo</dt>
</label>
<select class="select2-multi-value form-control" name="genero" required>
<option selected value="">Seleccione una opción</option>
<option value="M">Masculino</option>
<option value="F">Femenino</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Edad</dt>
</label>
<div class="input-icon left"><i class="fa fa-edit"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="correo" value="" class="form-control" />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Nacionalidad</dt>
</label>
<select class="select2-multi-value form-control" name="genero" required>
<option selected value="M">Méxicana</option>
<option value="F">Extranjero</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Estado Civil</dt>
</label>
<select class="select2-multi-value form-control" name="genero" required>
<option selected value="">Seleccione una opción</option>
<option value="Casado">Casado</option>
<option value="Divorciado">Divorciado</option>
<option value="Soltero">Soltero</option>
<option value="Unión Libre">Unión Libre</option>
<option value="Viudo">Viudo</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Escolaridad</dt>
</label>
<div class="input-icon left"><i class="fa fa-edit"></i><input id="cliente" type="text" name="fecha_nac" value="" class="form-control" minlength="13" />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Idioma / Dialecto</dt>
</label>
<div class="input-icon left"><i class="fa fa-edit"></i><input id="cliente" type="text" name="fecha_nac" value="Español" class="form-control" minlength="13" />
</div>
</div>
</div>
<div class="form-group">
<label for="InputText">
<h3>
<dt> Domicilio</dt>
</h3>
</label><br>
</div>
<div class="col-md-8">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Calle</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="calle" value="<?php echo $rst2[0]["calle"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-2">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Numero exterior</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="numero" value="<?php echo $rst2[0]["numero"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-2">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Numero interior</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="numero" value="<?php echo $rst2[0]["numero"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Colonia</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="colonia" value="<?php echo $rst2[0]["colonia"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>C.P.</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="cp" value="<?php echo $rst2[0]["cp"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Municipio</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="colonia" value="<?php echo $rst2[0]["colonia"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Estado</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="colonia" value="<?php echo $rst2[0]["colonia"]; ?>" class="form-control" />
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<label for="InputText">
<h3>
<dt> Datos de Contacto</dt>
</h3>
</label><br>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Correo electrónico</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="calle" value="<?php echo $rst2[0]["calle"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Tel. Celular</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="numero" value="<?php echo $rst2[0]["numero"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Tel. Casa</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="numero" value="<?php echo $rst2[0]["numero"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Tel. Trabajo</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="colonia" value="<?php echo $rst2[0]["colonia"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Documento de identificación</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="numero" value="<?php echo $rst2[0]["numero"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Número</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="colonia" value="<?php echo $rst2[0]["colonia"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Ocupación</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="colonia" value="<?php echo $rst2[0]["colonia"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Percepción mensual $</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="colonia" value="<?php echo $rst2[0]["colonia"]; ?>" class="form-control" />
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<label for="InputText">
<h3>
<dt> Datos del asunto</dt>
</h3>
</label><br>
</div>
<div class="col-md-6">
<div class="form-group"><label for="inputName" class="control-label">
<dt>¿AUTORIZA QUE ESTA INFORMACIÓN SE HAGA PÚBLICA?:</dt>
</label>
<select class="select2-multi-value form-control" name="genero" required>
<option value="">Seleccione una opción</option>
<option value="Si">Si</option>
<option value="No">No</option>
</select>
</div>
</div>
<div class="col-md-6">
<div class="form-group"><label for="inputName" class="control-label">
<dt>¿SOLICITA LOS SERVICIOS POR OTRA PERSONA?:</dt>
</label>
<select class="select2-multi-value form-control" name="genero" required>
<option value="">Seleccione una opción</option>
<option selected value="Si">Si</option>
<option value="No">No</option>
</select>
</div>
</div>
<div class="col-md-12">
<div class="form-group"><label for="inputName" class="control-label">
<dt>SI SU RESPUESTA ES AFIRMATIVA ANOTE EL NOMBRE DE ESA PERSONA:</dt>
</label>
<div class="input-icon left"><i class="fa fa-user"></i><input id="cliente" type="text" pattern="[A-Za-z�0�8-�0�70-9�0�9�0�5@\:%/.,()+*�� _-]{1,2000}" name="numero" value="<?php echo $rst2[0]["numero"]; ?>" class="form-control" />
</div>
</div>
</div>
<div class="col-md-12">
<div class="form-group"><label for="inputName" class="control-label">
<dt>Observaciones</dt>
</label>
<div class="input-icon left"><i class="fa fa-note"></i><textarea id="cliente" name="objetivo_puesto" cols="40" rows="5" placeholder="" class="form-control"><?php echo $objetivo_puesto; ?></textarea></div>
</div>
</div>
<div class="col-md-12">
<div class="form-group"><label for="inputName" class="control-label">
<dt>CATALOGO DE SERVICIOS</dt>
</label><span class='require'> *</span>
<select class="select2-multi-value form-control" name="id_puesto">
<option value="">Seleccione una opción</option>
<?php
$consulta = "SELECT id_juridico,juridico,IF(tipo=1,'METERIA FISCAL','MATERIA ADMINISTRATIVA') as materia FROM defensoria_catalago_servicios WHERE habilitado = 1";
$rst1 = $conf->consulta($consulta);
for ($i = 0; $i < count($rst1); $i++) {
echo '<option value="' . $rst1[$i]["id_juridico"] . '">' . $rst1[$i]["juridico"].' - '. $rst1[$i]["materia"]. '</option>';
}
?>
</select>
</div>
</div>
</div>
<div class="form-actions">
<div class="col-md-offset-5 col-md-6">
<button type="submit" class="btn btn-success">Guardar Cambios</button>
<button type="button" onclick="location.href='<?php echo $_SERVER['HTTP_REFERER']; ?>'" class="btn btn-primary">Regresar <i class="fa fa-mail-reply"></i></button>
</div>
</div>
</div>
</div>
</form>
</div>
Zerion Mini Shell 1.0