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formulario de entrada

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Bruno Martínez Luna 2025-04-28 08:01:26 -06:00
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commit 6f935fcc39
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<!DOCTYPE html>
<html lang="es">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Centro de Certificación LANIA</title>
<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/css/bootstrap.min.css" rel="stylesheet">
</head>
<body class="bg-light">
<div class="container py-5">
<div class="text-center mb-4">
<h1 class="display-5">Centro de Certificación LANIA</h1>
<p class="lead">Formulario de registro para candidatos de exámenes PEARSON VUE</p>
</div>
<div class="card shadow p-4">
<form action="procesar_formulario.php" method="POST">
<div class="row g-3">
<div class="col-md-6">
<label for="nombre" class="form-label">Nombre completo</label>
<input type="text" class="form-control" id="nombre" name="nombre" required>
</div>
<div class="col-md-6">
<label for="correo" class="form-label">Correo electrónico</label>
<input type="email" class="form-control" id="correo" name="correo" required>
</div>
<div class="col-md-6">
<label for="telefono" class="form-label">Teléfono</label>
<input type="text" class="form-control" id="telefono" name="telefono" required>
</div>
<div class="col-md-6">
<label for="genero" class="form-label">Género</label>
<select class="form-select" id="genero" name="genero" required>
<option value="">Selecciona una opción</option>
<option value="Masculino">Masculino</option>
<option value="Femenino">Femenino</option>
<option value="Otro">Prefiero no especificar</option>
</select>
</div>
<div class="col-md-6">
<label for="empresa" class="form-label">Empresa</label>
<input type="text" class="form-control" id="empresa" name="empresa" required>
</div>
<div class="col-md-6">
<label for="examen" class="form-label">Examen</label>
<input type="text" class="form-control" id="examen" name="examen" required>
</div>
<div class="col-md-6">
<label for="certificacion" class="form-label">Certificación</label>
<input type="text" class="form-control" id="certificacion" name="certificacion" required>
</div>
<div class="col-md-6">
<label for="hora" class="form-label">Hora de entrada</label>
<select class="form-select" id="hora" name="h_entrada" required>
<option value="">Selecciona una hora</option>
<option value="09:00">09:00 AM</option>
<option value="10:00">10:00 AM</option>
<option value="11:00">11:00 AM</option>
</select>
</div>
<div class="col-md-3">
<label for="fecha" class="form-label">Fecha</label>
<input type="date" class="form-control" id="fecha" name="fecha" required>
</div>
</div>
<div class="mt-4 text-end">
<button type="submit" class="btn btn-primary">Enviar registro</button>
</div>
</form>
</div>
</div>
<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/js/bootstrap.bundle.min.js"></script>
</body>
</html>