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crslga.nugitech.com Open in urlscan Pro
74.207.228.39  Public Scan

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URL: https://crslga.nugitech.com/
Submission: On August 28 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

<form class="login-register text-start mt-20" action="">
  <div class="login-register-cover">
    <div class="text-center mb-5">
      <p class="font-sm text-brand-2">Register </p>
      <h2 class="mt-10 mb-5 text-brand-1">As an Agent</h2>
    </div>
    <div class="row">
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="agent_first_name">First Name *</label>
        <input class="form-control" id="agent_first_name" type="text" name="agent_first_name" placeholder="Steven" required="">
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="agent_last_name">Last Name *</label>
        <input class="form-control" id="agent_last_name" type="text" name="agent_last_name" placeholder="Job" required="">
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="agent_email">Email *</label>
        <input class="form-control" id="agent_email" type="email" name="agent_email" placeholder="stevenjob@gmail.com" required="">
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="agent_phone_number">Phone Number *</label>
        <input class="form-control" id="agent_phone_number" type="text" name="agent_phone_number" required="">
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="agent_company_name">Company Name or Trading name *</label>
        <input class="form-control" id="agent_company_name" type="text" name="agent_company_name" required="">
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="agent_code">Agent Code *</label>
        <input class="form-control" id="agent_code" type="text" name="agent_code" required="">
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="operator_id">Operator *</label>
        <select class="form-control" id="operator_id" name="operator_id">
          <option disabled="" selected="">Select Operator</option>
          <option value=""></option>
          <option value=""></option>
          <option value=""></option>
          <option value=""></option>
          <option value=""></option>
          <option value=""></option>
          <option value=""></option>
        </select>
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="agent_shop_address">Agent Shop Address *</label>
        <input class="form-control" id="agent_shop_address" type="text" name="agent_shop_address" required="">
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="operator">State of Residence *</label>
        <select class="form-control" id="agent_state_of_residence" name="agent_state_of_residence" onchange="getLgas('agent_state_of_residence', 'agent_lga');">
          <option disabled="" selected="">Select State of Residence</option>
          <option value="37">Abuja</option>
          <option value="36">Enugu</option>
          <option value="35">Zamfara</option>
          <option value="34">Yobe</option>
          <option value="33">Taraba</option>
          <option value="32">Sokoto</option>
          <option value="31">Rivers</option>
          <option value="30">Plateau</option>
          <option value="29">Oyo</option>
          <option value="28">Osun</option>
          <option value="27">Ondo</option>
          <option value="26">Ogun</option>
          <option value="25">Niger</option>
          <option value="24">Nasarawa</option>
          <option value="23">Lagos</option>
          <option value="22">Kwara</option>
          <option value="21">Kogi</option>
          <option value="20">Kebbi</option>
          <option value="19">Katsina</option>
          <option value="18">Kano</option>
          <option value="17">Kaduna</option>
          <option value="16">Jigawa</option>
          <option value="15">Imo</option>
          <option value="14">Gombe</option>
          <option value="13">Ekiti</option>
          <option value="12">Edo</option>
          <option value="11">Ebonyi</option>
          <option value="10">Delta</option>
          <option value="9">Cross River</option>
          <option value="8">Borno</option>
          <option value="7">Benue</option>
          <option value="6">Bayelsa</option>
          <option value="5">Bauchi</option>
          <option value="4">Anambra</option>
          <option value="3">Akwa Ibom</option>
          <option value="2">Adamawa</option>
          <option value="1">Abia</option>
        </select>
      </div>
      <div class="col-md-6 mb-4 form-group">
        <label class="form-label" for="agent_lga">LGA *</label>
        <select class="form-control" id="agent_lga" name="agent_lga">
          <option disabled="" selected="">Select a State First</option>
        </select>
      </div>
      <div class="col mb-4 order-last">
        <div class="login_footer form-group d-flex justify-content-between">
          <label class="cb-container">
            <input type="checkbox">
            <span class="text-small">Agree our terms and policy</span>
            <span class="checkmark"></span>
          </label>
          <!-- <a class="text-muted" href="">Lean more</a> -->
        </div>
        <div class="form-group text-center">
          <button class="btn btn-brand-1 hover-up w-40" type="submit" name="login"> Submit &amp; Register </button>
        </div>
      </div>
    </div>
    <div class="img-1 d-none d-lg-block">
      <img class="shape-1" src="https://crslga.nugitech.com/assets/imgs/page/login-register/img-1.svg" alt="JobBox">
    </div>
    <div class="img-2">
      <img src="https://crslga.nugitech.com/assets/imgs/page/login-register/img-2.svg" alt="JobBox">
    </div>
  </div>
</form>

Text Content

Main Site
Main Site

Register


AS AN AGENT

First Name *
Last Name *
Email *
Phone Number *
Company Name or Trading name *
Agent Code *
Operator * Select Operator
Agent Shop Address *
State of Residence * Select State of Residence Abuja Enugu Zamfara Yobe Taraba
Sokoto Rivers Plateau Oyo Osun Ondo Ogun Niger Nasarawa Lagos Kwara Kogi Kebbi
Katsina Kano Kaduna Jigawa Imo Gombe Ekiti Edo Ebonyi Delta Cross River Borno
Benue Bayelsa Bauchi Anambra Akwa Ibom Adamawa Abia
LGA * Select a State First
Agree our terms and policy
Submit & Register


Cross River State Civil Service Commission - In pursuit of its stated vision, to
meticulously be guided by extant rules and regulations in the discharge of its
core mandate, at all times and to all persons, fairly, honestly, equitably,
transparently and meritoriously.

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