support.dyatmika.org Open in urlscan Pro
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Form analysis
1 forms found in the DOM

Name: support — POST action.php

<form id="support" name="support" action="action.php" method="POST" enctype="multipart/form-data" onsubmit="return handleData()">
  <div class="form-group row">
    <label>Name / Nama</label>
    <div class="col-12">
      <div class="input-group">
        <input id="name" name="name" type="text" class="form-control" required="required">
      </div>
    </div>
  </div>
  <div class="form-group row">
    <label>Department / Departemen</label>
    <div class="col-12">
      <div class="custom-control custom-radio custom-control-inline">
        <input name="dept" id="radio_0" type="radio" class="custom-control-input" value="Admin" required="">
        <label for="radio_0" class="custom-control-label">Admin</label>
      </div>
      <div class="custom-control custom-radio custom-control-inline">
        <input name="dept" id="radio_1" type="radio" class="custom-control-input" value="Teacher" required="">
        <label for="radio_1" class="custom-control-label">Teacher / Guru</label>
      </div>
      <div class="custom-control custom-radio custom-control-inline">
        <input name="dept" id="radio_3" type="radio" class="custom-control-input" value="other" required="">
        <label for="radio_3" class="custom-control-label">Other</label>
      </div>
    </div>
  </div>
  <div class="form-group row">
    <label>Email</label>
    <div class="col-12">
      <div class="input-group">
        <input id="email" name="email" type="email" class="form-control" required="required" placeholder="enter your valid email">
      </div>
    </div>
  </div>
  <div class="form-group row">
    <label>Support Staff needed, please choose option below</label>
    <div class="col-12">
      <div style="visibility:hidden; color:red; " id="chk_option_error"> Please select at least one option. </div>
      <div class="custom-control custom-checkbox custom-control-inline">
        <input name="support[]" id="support_0" type="checkbox" class="custom-control-input" value="housekeeping-primary">
        <label for="support_0" class="custom-control-label">Housekeeping Primary</label>
      </div>
      <div class="custom-control custom-checkbox custom-control-inline">
        <input name="support[]" id="support_0" type="checkbox" class="custom-control-input" value="housekeeping">
        <label for="support_0" class="custom-control-label">Housekeeping High School</label>
      </div>
      <div class="custom-control custom-checkbox custom-control-inline">
        <input name="support[]" id="support_1" type="checkbox" class="custom-control-input" value="maintenance">
        <label for="support_1" class="custom-control-label">Maintenance</label>
      </div>
      <div class="custom-control custom-checkbox custom-control-inline">
        <input name="support[]" id="support_2" type="checkbox" class="custom-control-input" value="gardener">
        <label for="support_2" class="custom-control-label">Gardener</label>
      </div>
      <div class="custom-control custom-checkbox custom-control-inline">
        <input name="support[]" id="support_3" type="checkbox" class="custom-control-input" value="security">
        <label for="support_3" class="custom-control-label">Security</label>
      </div>
    </div>
  </div>
  <div class="form-group row">
    <label>Request Details / Rincian Permohonan</label>
    <div class="col-12">
      <textarea id="details" name="details" cols="40" rows="5" class="form-control" required="required"></textarea>
    </div>
  </div>
  <div class="form-group row">
    <label>Justification / Justifikasi permohonan</label>
    <div class="col-12">
      <!-- <input id="justification" name="justification" type="text" class="form-control" required="required"> -->
      <textarea id="justification" name="justification" cols="40" rows="5" class="form-control" required="required"></textarea>
    </div>
  </div>
  <div class="form-group row">
    <label for="location">Location / Lokasi</label>
    <div class="col-12">
      <input id="location" name="location" type="text" class="form-control" required="required">
    </div>
  </div>
  <div class="form-group row">
    <label>Criteria / Kriteria</label>
    <div class="col-12">
      <div class="custom-control custom-radio custom-control-inline">
        <input name="criteria" id="radio1_0" type="radio" class="custom-control-input" value="Essential" required="">
        <label for="radio1_0" class="custom-control-label">Essential</label>
      </div>
      <div class="custom-control custom-radio custom-control-inline">
        <input name="criteria" id="radio1_1" type="radio" class="custom-control-input" value="Desirable" required="">
        <label for="radio1_1" class="custom-control-label">Desirable</label>
      </div>
      <div class="custom-control custom-radio custom-control-inline">
        <input name="criteria" id="radio1_2" type="radio" class="custom-control-input" value="Not Urgent" required="">
        <label for="radio1_2" class="custom-control-label">Not Urgent</label>
      </div>
    </div>
  </div>
  <div class="form-group row">
    <label>Require Date/ Tanggal Dibutuhkan</label>
    <div class="input-group">
      <input type="date" name="date" required="" class="form-control" data-inputmask-alias="datetime" data-inputmask-inputformat="dd/mm/yyyy" data-mask="" inputmode="numeric">
    </div>
    <!-- /.input group -->
  </div>
  <div class="form-group row">
    <label>Require Time / Waktu Dibutuhkan:</label>
    <div class="input-group">
      <input type="time" class="form-control" id="appt" name="time" required="">
    </div>
    <!-- /.input group -->
  </div>
  <div class="form-group">
    <label>File (Optional)</label>
    <input type="file" accept=".jpg , .bmp , .gif , .doc , .docx , .pdf , .xls , .xlsx" multiple="multiple" id="file" name="myfile[]">
    <p class="help-block">If you want upload multiple file, Please make sure you put all the file in same folder. Maximum file size 4 MB</p>
    <br>
    <script>
      $(document).ready(function() {
        $('#file').change(function() {
          var fp = $("#file");
          var lg = fp[0].files.length; // get length
          var items = fp[0].files;
          var fileSize = 0;
          if (lg > 0) {
            for (var i = 0; i < lg; i++) {
              fileSize = fileSize + items[i].size; // get file size
            }
            if (fileSize > 4194304) {
              sweetAlert('File size must not be more than 4 MB');
              $('#file').val('');
            }
          }
        });
      });
    </script>
  </div>
  <div class="form-group row">
    <div class="col-12">
      <div class="col text-center">
        <button name="submit" type="submit" class="btn btn-primary btn-block">Submit</button>
      </div>
    </div>
  </div>
</form>

Text Content

Filling out this form completely and in as much detail as possible will make it
easier to arrange staff availability and their working hours. We will respond
and contact you as soon as possible.

Mengisi form ini secara lengkap dan sedetail mungkin akan memudahkan pengaturan
ketersediaan staff dan waktu kerja mereka Kami akan merespon dan menghubungi
anda segera setelah memungkinkan.

Name / Nama

Department / Departemen
Admin
Teacher / Guru
Other
Email

Support Staff needed, please choose option below
Please select at least one option.
Housekeeping Primary
Housekeeping High School
Maintenance
Gardener
Security
Request Details / Rincian Permohonan

Justification / Justifikasi permohonan

Location / Lokasi

Criteria / Kriteria
Essential
Desirable
Not Urgent
Require Date/ Tanggal Dibutuhkan

Require Time / Waktu Dibutuhkan:

File (Optional)

If you want upload multiple file, Please make sure you put all the file in same
folder. Maximum file size 4 MB


Submit