<style type="text/css">
  .form-control[disabled], .form-control[readonly], fieldset[disabled] .form-control {
    background-color: #FFF;
  }
</style>
</div>
  </section>
  <div class="for-fixed"></div>
  <section id="become-driver mctop75" style="">
    <div class="container">
      <div class="row driver-reg">
        <div class="col-md-12 col-sm-12 col-xs-12">
          <h2 class="text-center">Become a Driver</h2>
          <?php if($this->session->flashdata('success_msg')) { ?>
          <div class="alert alert-info text-center">
            <a href="#" class="close" data-dismiss="alert" aria-label="close">&times;</a>
            <strong><?php echo $this->session->flashdata('success_msg'); ?></strong>
          </div>
          <?php } ?>
          <?php if($this->session->flashdata('error_msg')) { ?>
          <div class="alert alert-danger text-center">
            <a href="#" class="close" data-dismiss="alert" aria-label="close">&times;</a>
            <strong><?php echo $this->session->flashdata('error_msg'); ?></strong>
          </div>
          <?php } ?>
          <?php if(validation_errors() != FALSE) { ?>
          <div class="alert alert-danger text-center">
            <a href="#" class="close" data-dismiss="alert" aria-label="close">&times;</a>
            <strong><?php echo validation_errors(); ?></strong>
          </div>
          <?php } ?>
          <?php $validator = array('role' => 'form', 'data-toggle' => 'validator'); echo form_open('applydriveronline', $validator); ?>
          <div class="col-md-6">
            <div class="form-group">
              <input type="text" class="form-control" id="driver_first_name" name="driver_first_name" placeholder="First Name"  data-error="Please enter your name" required="" value="<?=isset($driver_details['driver_first_name'])?$driver_details['driver_first_name']:''?>">
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-6">
            <div class="form-group">
              <input type="text" class="form-control" id="driver_last_name" name="driver_last_name" placeholder="Last Name" data-error="Please enter your last name" required="" value="<?=isset($driver_details['driver_last_name'])?$driver_details['driver_last_name']:''?>">
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-6">
            <div class="form-group">
              <input type="text" class="form-control" id="driver_street_address" name="driver_street_address" placeholder="Street Address" required="" data-error="Please enter your address"  value="<?=isset($driver_details['driver_street_address'])?$driver_details['driver_street_address']:''?>">
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-6">
            <div class="form-group">
              <input onkeyup="findAddressByZip(this.value, 'driver_city', 'driver_state')" pattern="^([0-9]){5}([-])([0-9]){3}$" type="text" class="form-control" id="driver_zipcode" name="driver_zipcode" placeholder="Postcode" required="" data-error="Please enter your postcode"  value="<?=isset($driver_details['driver_zipcode'])?$driver_details['driver_zipcode']:''?>">
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-6">
            <div class="form-group">
              <input value="<?=isset($driver_details['driver_city'])?$driver_details['driver_city']:''?>" name="driver_city" id="driver_city" required type="text" class="form-control generatedCity" placeholder="City (Fill out Postcode first)" data-error="Please enter City." readonly>
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-6">
            <div class="form-group">
              <input value="<?php echo set_value('driver_state', isset($data['driver_state']) ? $data['driver_state'] : ''); ?>" name="driver_state" id="driver_state" required type="text" class="form-control generatedState" placeholder="State (Fill out Postcode first)" data-error="Please enter State." readonly>
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="clearfix"></div>
          <hr>
          <div class="clearfix"></div>
          <div class="col-md-6">
            <div class="form-group">
              <input type="text" class="form-control" id="driver_mobile_number" name="driver_mobile_number" placeholder="Phone Number" required="" pattern="(?:[+][0-9]{1,3}[\s]?)?(?:(?:[(][0-9]{2}[)][\s]?)|(?:[0-9]{2}[\s]?))?(?:(?:[0-9]{1}[0-9.-]{6,8}[0-9]{1})|(?:[0-9]{1}[\s]?[0-9\.-]{6,8}[0-9]{1})){1}" data-error="Please enter your mobile number" data-pattern-error="Please enter a valid mobile number" value="<?=isset($driver_details['driver_mobile_number'])?$driver_details['driver_mobile_number']:''?>" maxlength="16">
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-6 hide" >
            <div class="form-group">
              <input type="text" class="form-control" id="driver_social_security_number" name="driver_social_security_number" placeholder="Social Security Number" data-error="Please enter your Social Security Number"  value="<?=isset($driver_details['driver_social_security_number'])?$driver_details['driver_social_security_number']:''?>">
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-6">
             <div class="form-group">
                <select class="form-control" id="driver_device" name="driver_device" data-error="Please choose your device" required="" value="<?=isset($driver_details['driver_device'])?$driver_details['driver_device']:''?>">
                  <option value="">Select Device</option>
                  <?php
                    $driver_device = isset($driver_details['driver_device'])?$driver_details['driver_device']:'';
                    foreach ($myDevices as $key => $value) {
                  ?>
                  <option value="<?=$value?>" <?=$driver_device==$value?'selected':''?> ><?=$value?></option>
                  <?php
                    }
                  ?>
                </select>
                <div class="help-block with-errors"></div>
              </div>
          </div>
          <div class="clearfix"></div>
          <hr>
          <div class="clearfix"></div>
          <div class="col-md-4">
            <div class="form-group">

              <!--<input type="text" class="form-control" id="driver_vehicle_make" name="driver_vehicle_make" placeholder="Make" data-error="Please enter your vehicle make" required="" value="<?=isset($driver_details['driver_vehicle_make'])?$driver_details['driver_vehicle_make']:''?>">-->
<!--                Bicycle, Scooter, Motorbike or Car-->
                <select class="form-control" id="driver_vehicle_make" name="driver_vehicle_make" data-error="Please choose your vehicle type" required="" value="<?=isset($driver_details['driver_vehicle_make'])?$driver_details['driver_vehicle_make']:''?>" onchange="requiredRemove(this.value);">
                    <option value="">Select Vehicle Type</option>
                    <?php
                    $driver_vehicle_make = isset($driver_details['driver_vehicle_make'])?$driver_details['driver_vehicle_make']:'';
                    foreach ($myVehicles as $key => $value) {
                        if($key == 5) continue;
                        ?>
                        <option value="<?=$value?>" <?=$driver_vehicle_make==$value?'selected':''?> ><?=$value?></option>
                        <?php
                    }
                    ?>
                </select>
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-4">
            <div class="form-group">
              <input type="text" class="form-control" id="driver_vehicle_model" name="driver_vehicle_model" placeholder="Model" data-error="Please enter your vehicle model" required="" value="<?=isset($driver_details['driver_vehicle_model'])?$driver_details['driver_vehicle_model']:''?>">
              <div class="help-block with-errors"></div>
            </div>
          </div>
          <div class="col-md-4">
            <div class="form-group">
              <input onkeypress="return only_num(event, this.value)" maxlength="4" data-minlength="4" type="text" class="form-control" id="driver_vehicle_year" name="driver_vehicle_year" placeholder="Year" data-error="Please enter your vehicle year" required="" maxlength="4" value="<?=isset($driver_details['driver_vehicle_year']) && $driver_details['driver_vehicle_year'] > 0 ?$driver_details['driver_vehicle_year']:''?>">
              <div class="help-block with-errors"></div>
            </div>
          </div>
            <div class="col-md-4">
                <div class="form-group">
                    <label>Do you have your own Car/Motorcycle/Scooter/Bicycle?</label><br/>
                    <div class="radio-inline">
                        <label><input type="radio" name="ownVehicle" value="Yes" <?=isset($driver_details['own_vehicle']) && $driver_details['own_vehicle'] == "Yes" ? "checked":''?> required>Yes</label>
                    </div>
                    <div class="radio-inline">
                        <label><input type="radio" name="ownVehicle" value="No" <?=isset($driver_details['own_vehicle']) && $driver_details['own_vehicle'] == "No" ? "checked":''?> required>No</label>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>
            </div>
            <div class="col-md-4">
                <div class="form-group">
                    <label>Are you atleast 18 years old?</label><br/>
                    <div class="radio-inline">
                        <label><input type="radio" name="ageConfirm" value="Yes" <?=isset($driver_details['age_confirm']) && $driver_details['age_confirm'] == "Yes" ? "checked":''?> required>Yes</label>
                    </div>
                    <div class="radio-inline">
                        <label><input type="radio" name="ageConfirm" value="No" <?=isset($driver_details['age_confirm']) && $driver_details['age_confirm'] == "No" ? "checked":''?> required>No</label>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>
            </div>
            <div class="col-md-4">
                <div class="form-group">
                    <label>Have you ever worked in Australia before or do you have a work permit?</label><br/>
                    <div class="radio-inline">
                        <label><input type="radio" name="hasWorkPermit" value="Yes" <?=isset($driver_details['has_work_permit']) && $driver_details['has_work_permit'] == "Yes" ? "checked":''?> required>Yes</label>
                    </div>
                    <div class="radio-inline">
                        <label><input type="radio" name="hasWorkPermit" value="No" <?=isset($driver_details['has_work_permit']) && $driver_details['has_work_permit'] == "No" ? "checked":''?> required>No</label>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>
            </div>
            <div class="col-md-4">
                <div class="form-group">
                    <label>Do you have an ABN?</label><br/>
                    <div class="radio-inline">
                        <label><input type="radio" name="hasABN" value="Yes" <?=isset($driver_details['has_abn']) && $driver_details['has_abn'] == "Yes" ? "checked":''?> required>Yes</label>
                    </div>
                    <div class="radio-inline">
                        <label><input type="radio" name="hasABN" value="No" <?=isset($driver_details['has_abn']) && $driver_details['has_abn'] == "No" ? "checked":''?> required>No</label>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>
            </div>
            <div class="col-md-4">
                <div class="form-group">
                    <label>Available working hour per week?</label><br/>
                    <div class="radio-inline">
                        <label><input type="radio" name="workingHour" value="1-12" <?=isset($driver_details['working_hour']) && $driver_details['working_hour'] == "1-12" ? "checked":''?> required>1-12</label>
                    </div>
                    <div class="radio-inline">
                        <label><input type="radio" name="workingHour" value="13-20" <?=isset($driver_details['working_hour']) && $driver_details['working_hour'] == "13-20" ? "checked":''?> required>13-20</label>
                    </div>
                    <div class="radio-inline">
                        <label><input type="radio" name="workingHour" value="21+" <?=isset($driver_details['working_hour']) && $driver_details['working_hour'] == "21+" ? "checked":''?> required>21+</label>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>
            </div>

          <!-- <div class="col-md-12">
            <div class="form-group">
              <div class="checkbox" style="padding-left: 0px;">
                <label>
                  <input type="checkbox" name="is_vehicle_certify" id="is_vehicle_certify" data-error="Please check this box to forward" required="">
                  By checking this box, you certify that you have valid and current vehicle insurance.
                </label>
              </div>
            </div>
          </div> -->
          <div class="clearfix"></div>
          <div class="col-md-12">
            <input type="hidden" name="form_name" value="driver_apply_details">
            <input type="hidden" name="driver_id" value="<?=isset($driver_id)?$driver_id:''?>">
            <button type="submit" class="btn btn-info nxt-btn">Next</button>
          </div>
        </div>
      </div>
      <div class="row">
        <!-- <div class="policy">
          <input type="checkbox" name="is_vehicle_certify" id="is_vehicle_certify" data-error="Please check this box to forward" required="">
          <p>By checking this box, you certify that you have valid and current vehicle insurance.</p>
          <div class="help-block with-errors"></div>
        </div> -->
      </div>
      </form>
    </div>
  </section>
    <script>
    function requiredRemove(value) {
        //alert(value);
        if(value == "Bicycle")
        {
            $("#driver_vehicle_model, #driver_vehicle_year").removeAttr("required");
        }else
        {
            $("#driver_vehicle_model, #driver_vehicle_year").attr("required", true);
        }
    }
    </script>
  <style type="text/css">
    .help-block.with-errors {
      min-height: 20px;
    }
  </style>