<?php
date_default_timezone_set('Asia/Jakarta');
 $tgl_time = date("Y-m-d h:i:sa");
 
function url()
{
return sprintf(
"%s://%s%s",
isset($_SERVER['HTTPS']) && $_SERVER['HTTPS'] != 'off' ? 'https' : 'http',
$_SERVER['SERVER_NAME'],
$_SERVER['REQUEST_URI']
);
}
?>
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    <title>Politeknik Piksi Ganesha Kebumen (Kelas Karyawan)</title>
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	</head>
	
	<style>
		@import url("https://fonts.googleapis.com/css?family=Poppins:200i,400&display=swap");
		*,
		*::before,
		*::after {
			box-sizing: border-box;
		}
		body {
			font-family: "Poppins", sans-serif;
			font-size: 1rem;
			font-weight: 400;
			line-height: 1.5;
			background-color: #f2f1f7;
			margin: 0;
		}
		h1 {
			font-weight: 400;
			line-height: 1.5;
		}
		p {
			font-size: 1.2rem;
		}
		h1,
		p {
			margin-top: 0;
			margin-bottom: 1rem;
		}
		label {
			display: flex;
			align-items: center;
			font-size: 1.2rem;
			margin-bottom: 0.8rem;
		}
		input,
		button,
		select,
		textarea {
			margin: 0;
			font-family: inherit;
			font-size: inherit;
			line-height: inherit;
		}
		button {
			border: none;
			border: 1px solid #868686;
		}
		.container {
			width: 83%;
			margin: 3.125rem auto 0 auto;
		}
		@media (min-width: 576px) {
			.container {
				max-width: 540px;
			}
		}

		@media (min-width: 768px) {
			.container {
				max-width: 720px;
			}
		}
		.header {
			padding: 0 0.8rem;
			margin-bottom: 1.875rem;
		}
		.description {
			font-style: italic;
			font-weight: 200;
		}
		.clue {
			margin-left: 0.25rem;
			font-size: 0.9rem;
			color: #c2c2c2;
		}

		.text-center {
			text-align: center;
		}

		/* form */

		form {
			background: #fff;
			padding: 2.5rem 0.625rem;
			border-radius: 0.25rem;
		}

		@media (min-width: 480px) {
			form {
				padding: 2.5rem;
			}
		}

		.form-group {
			margin: 0 auto 1.25rem auto;
			padding: 0.25rem;
		}

		.form-control {
			display: block;
			width: 100%;
			height: 2.4rem;
			padding: 0.375rem 0.75rem;
			color: #91918f;
			background-color: #e4e3ea;
			background-clip: padding-box;
			border: 0;
			border-radius: 0.25rem;
			transition: border 0.8s ease-in-out;
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		.form-control:focus {
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			outline: 0;
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		.input-radio,
		.input-checkbox {
			display: inline-block;
			margin-right: 0.6rem;
			min-height: 1.5rem;
			min-width: 1.25rem;
		}

		.input-textarea {
			min-height: 120px;
			width: 100%;
			padding: 0.625rem;
			resize: vertical;
			border: 0;
			border: 1px solid #868686;
			outline: none;
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		.submit-button {
			display: block;
			width: 100%;
			padding: 0.75rem;
			background: #e7e7e7;
			color: inherit;
			border-radius: 2px;
			cursor: pointer;
		}
		
		   /* already defined in bootstrap4 */
	    .text-xs-center {
	        text-align: center;
	    }

	    .g-recaptcha {
	        display: inline-block;
	    }
	</style>
	<body>
		<div class="container">
			<header class="header">
				<h1 id="title" class="text-center">Form Pendaftaran Online</h1>
				
			</header>
			<form  method="POST" action="proses-pendaftaran.php">
			    
			<div class="form-group">
            <input
            type="text"
            name="nama_kampus"
            value="<?= url() ?>"
            class="form-control"
            readonly
            />
            </div>
						<div class="form-group">
					<label id="number-label" for="email"
						>Pilih Jurusan<span style="color: #ff0000">*</span></label
					>
				<select class="form-control" name=jurusan required>
				    <option >-- Pilih Jurusan --</option>
				    <!--KELAS KARYAWAN -->
				    <optgroup label="Kelas Karyawan">
				    <option value="D3 Akuntansi">D3 Akuntansi</option>
                    <option value="D3 Teknik Elektro dan Rekam Medis">D3 Teknik Elektro dan Rekam Medis</option>
                    <option value="D3 Teknik Elektro &amp; Informatika Komputer">D3 Teknik Elektro &amp; Informatika Komputer</option>
                    <option value="D3 Teknik Mesin Otomotif">D3 Teknik Mesin Otomotif</option>
                    <option value="D4/S1 Manajemen SDM">D4/S1 Manajemen SDM</option>
                    </optgroup>
				    <!--KELAS HYBRID-->
				    <optgroup label="Kelas Hybrid">
				    <option value="D3 Akuntansi">D3 Akuntansi</option>
                    <option value="D3 Teknik Elektro dan Rekam Medis">D3 Teknik Elektro dan Rekam Medis</option>
                    <option value="D3 Teknik Elektro &amp; Informatika Komputer">D3 Teknik Elektro &amp; Informatika Komputer</option>
                    <option value="D3 Teknik Mesin Otomotif">D3 Teknik Mesin Otomotif</option>
                    <option value="D4/S1 Manajemen SDM">D4/S1 Manajemen SDM</option>
                    </optgroup>
                    <!--KELAS RPL-->
                    <optgroup label="Kelas RPL">
                    <option value="D3 Akuntansi">D3 Akuntansi</option>
                    <option value="D3 Teknik Elektronika">D3 Teknik Elektronika</option>
                    <option value="D3 Mesin Otomotif">D3 Mesin Otomotif</option>
                    <option value="D4/S1 Manajamen">D4/S1 Manajamen</option>
                    </optgroup>
				</select>
				</div>
				
				<div class="form-group">
					<p>Kelas<span style="color: #ff0000">*</span></p>
					<select
						id="dropdown"
						name="kelas"
						class="form-control"
						required
					>
						<option disabled selected value>
							-- Pilih Kelas --
						</option>
						<option value="Kelas Karyawan">Kelas Karyawan</option>
						<option value="Kelas Hybrid">Kelas Hybrid</option>
						<option value="Kelas RPL">Kelas RPL</option>
					</select>
				</div>
				
				<div class="form-group">
					<label id="name-label" for="name"
						>Nama Lengkap
						<span style="color: #ff0000">*</span></label
					>
					<input
						type="text"
						name="nama"
						id="name"
						class="form-control"
						placeholder="Nama Sesuai KTP"
						required
					/>
				</div>
				<div class="form-group">
					<p>Jenis Kelamin</p>
					<label>
						<input
							name="jk"
							value="laki-laki"
							type="radio"
							class="input-radio"
							checked
						/>Laki-laki</label
					>
					<label>
						<input
							name="jk"
							value="perempuan"
							type="radio"
							class="input-radio"
						/>Perempuan</label
					>
				</div>
			
				<div class="form-group">
					<label id="number-label" for="number"
						>Alamat<span style="color: #ff0000">*</span></label
					>
					<input
						type="text"
						name="alamat"
						id="number"
					
						class="form-control"
						placeholder="Sesuai KTP"
					/>
				</div>
				<div class="form-group">
					<label id="number-label" for="number"
						>Tempat Lahir<span style="color: #ff0000"
							>*</span
						></label
					>
					<input
						type="text"
						name="tempat_lahir"
						id="number"
						
						class="form-control"
						placeholder=""
					/>
				</div>
				<div class="form-group">
					<label id="number-label" for="number"
						>Tanggal Lahir<span style="color: #ff0000"
							>*</span
						></label
					>
					<input
						type="date"
						name="tanggal_lahir"
						id="number"
						
						class="form-control"
						placeholder=""
					/>
				</div>
			
				<div class="form-group">
					<label id="number-label" for="no_war"
						>Nomor WhatsApp/HP<span style="color: #ff0000"
							>*</span
						></label
					>
					<input
						type="number"
						name="no_wa"
						class="form-control"
						placeholder=""
						required
					/>
				</div>
				<div class="form-group">
					<label id="number-label" for="email"
						>Email<span style="color: #ff0000">*</span></label
					>
					<input
						type="email"
						name="email"
					
						class="form-control"
						placeholder="Email"
					/>
				</div>
		
			
				<div class="form-group">
					<p>Lulusan<span style="color: #ff0000">*</span></p>
					<select
						id="dropdown"
						name="lulusan"
						class="form-control"
						required
					>
						<option disabled selected value>
							-- Pilih Lulusan --
						</option>
						<option value="SMA/MA/SMK/Sederajat">SMA/MA/SMK/Sederajat</option>
						<option value="D3/Sederajat">D3/Sederajat</option>
						<option value="Paket C">Paket C</option>
						<option value="S1/D4/Sederajat">S1/D4/Sederajat</option>
					</select>
				</div>
					<input
						type="hidden"
						name="tgl_daftar"
						value="<?= $tgl_time?>"
					
					
					/>
					<div class="form-group col-sm-12 text-center">
					    
					<!--<div class="g-recaptcha" data-sitekey="6LcXEmYrAAAAAC3Pj9RavaCFS-atJshxWZx8OteJ"></div>-->
					</div>
				
				
				<div class="form-group">
				<button type="submit" name="daftar" value="daftar" class="submit-button" />Daftar</button>
				</div>
			</form>
		</div>
	</body>
</html>
