<?php
include("sess_check.php");

// deskripsi halaman
$pagedesc = "Data Siswa";
$menuparent = "siswa";
include("layout_top.php");
$tgl_lahir = date('Y-m-d');
?>
<!-- top of file -->
<!-- Page Content -->
<div id="page-wrapper">
	<div class="container-fluid">
		<div class="row">
			<div class="col-lg-12">
				<h1 class="page-header">Data Penduduk</h1>
			</div><!-- /.col-lg-12 -->
		</div><!-- /.row -->

		<div class="row">
			<div class="col-lg-12"><?php include("layout_alert.php"); ?></div>
		</div>

		<div class="row">
			<div class="col-lg-12">
				<form class="form-horizontal" action="penduduk_insert.php" method="POST" enctype="multipart/form-data">
					<div class="panel panel-default">
						<div class="panel-heading">
							<h3>Tambah Data Penduduk</h3>
						</div>
						<div class="panel-body">
							<div class="form-group">
								<label class="control-label col-sm-3">Nik</label>
								<div class="col-sm-4">
									<input type="text" name="nik" class="form-control" placeholder="" required>
								</div>
							</div>
							<div class="form-group">
								<label class="control-label col-sm-3">Nama Lengkap</label>
								<div class="col-sm-4">
									<input type="text" name="nama_lengkap" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Tempat Lahir</label>
								<div class="col-sm-4">
									<input type="text" name="tempat_lahir" class="form-control" placeholder="" required>
								</div>
							</div>
							<div class="form-group">
								<label class="control-label col-sm-3">Tanggal Lahir</label>
								<div class="col-sm-4">
									<input type="date" class="form-control" name="tgl_lahir" placeholder="From Date(dd/mm/yyyy)" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Warga Negara</label>
								<div class="col-sm-4">
									<input type="text" name="warga_negara" class="form-control" placeholder="WNI / WNA" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Jenis Kelamin</label>
								<div class="col-sm-4">
									<input type="text" name="jenis_kelamin" class="form-control" placeholder="Laki-laki / Perempuan" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Pekerjaan</label>
								<div class="col-sm-4">
									<input type="text" name="pekerjaan" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Agama</label>
								<div class="col-sm-4">
									<input type="text" name="agama" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Pendidikan</label>
								<div class="col-sm-4">
									<input type="text" name="pendidikan" class="form-control" placeholder="SD/SMP/MTs/SMA/SMK/S1/S2/S3" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">No. KK</label>
								<div class="col-sm-4">
									<input type="text" name="no_kk" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Kepala Keluarga</label>
								<div class="col-sm-4">
									<input type="text" name="kepala_keluarga" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Desa</label>
								<div class="col-sm-4">
									<input type="text" name="desa" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Jalan</label>
								<div class="col-sm-4">
									<input type="text" name="jalan" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">RT</label>
								<div class="col-sm-4">
									<input type="text" name="rt" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">RW</label>
								<div class="col-sm-4">
									<input type="text" name="rw" class="form-control" placeholder="" required>
								</div>
							</div>

							<div class="form-group">
								<label class="control-label col-sm-3">Kecamatan</label>
								<div class="col-sm-4">
									<input type="text" name="kecamatan" class="form-control" placeholder="" required>
								</div>
							</div>
							
							<div class="form-group">
								<label class="control-label col-sm-3">Kabupaten</label>
								<div class="col-sm-4">
									<input type="text" name="kabupaten" class="form-control" placeholder="" required>
								</div>
							</div>

							

							<div class="form-group">
								<label class="control-label col-sm-3">Provinsi</label>
								<div class="col-sm-4">
									<input type="text" name="provinsi" class="form-control" placeholder="" required>
								</div>
							</div>


						<div class="panel-footer">
							<button type="submit" name="simpan" class="btn btn-success">Simpan</button>
						</div>
					</div><!-- /.panel -->
				</form>
			</div><!-- /.col-lg-12 -->
		</div><!-- /.row -->
	</div><!-- /.container-fluid -->
</div><!-- /#page-wrapper -->
<!-- bottom of file -->
<?php
include("layout_bottom.php");
?>