MENGISI FORMAT 5

<div class="form-style-5"> <form> <fieldset> <legend><span class="number">1</span> Candidate Info</legend> <input type="text" name="field1" placeholder="Your Name *"> <input type="email" name="field2" placeholder="Your Email *"> <textarea name="field3" placeholder="About yourself"></textarea> <label for="job">Interests:</label> <select id="job" name="field4"> <optgroup label="Indoors"> <option value="fishkeeping">Fishkeeping</option> <option value="reading">Reading</option> <option value="boxing">Boxing</option> <option value="debate">Debate</option> <option value="gaming">Gaming</option> <option value="snooker">Snooker</option> <option value="other_indoor">Other</option> </optgroup> <optgroup label="Outdoors"> <option value="football">Football</option> <option value="swimming">Swimming</option> <option value="fishing">Fishing</option> <option value="climbing">Climbing</option> <option value="cycling">Cycling</option> <option value="other_outdoor">Other</option> </optgroup> </select> </fieldset> <fieldset> <legend><span class="number">2</span> Additional Info</legend> <textarea name="field3" placeholder="About Your School"></textarea> </fieldset> <input type="submit" value="Apply" /> </form> </div>

1 Candidate Info

Interests:
Fishkeeping Reading Boxing Debate Gaming Snooker Other Football Swimming Fishing Climbing Cycling Other

2 Additional Info