CONTOH FORM MENGGUNAKAN HTML
<html>
<head><title>FORM PENDAFTARAN BRIGADIR POLRI</title>
<style>
fieldset{
width: 250px; /* lebar */
border-color: rgb(135, 217, 238); /* warna garis tepi */
box-shadow: 2px 2px 4px rgb(14, 12, 12); /* bayangan */
}
</style>
</head>
<body>
<form>
<font color="blue"><h1 align="center">FORM PENDAFTARAN BRIGADIR POLRI</h1></font>
<fieldset>
<legend><font color="red">Asal Polda dan Pol Res/Ta/Bes</font></legend>
<table>
<tr></tr>
<tr>
<td>Asal Polda</td>
<td>: <select name="asal">
<option>Sulsel</option>
<option>Sultra</option>
<option>Sulbar</option>
<option>Sulut</option>
<option>Sulteng</option>
</select></td>
<td>Pilih Pol Res/TA/Bes</td>
<td>: <select name="polres">
<option>POLRESTA SULSEL </option>
<option>POLRESTA SULTRA</option>
<option>POLRESTA SULBAR</option>
<option>POLRESTA SULUT</option>
<option>POLRESTA SULTENG</option>
</select></td>
</tr>
</table>
</fieldset>
<fieldset>
<legend><font color="red">Data Diri</font></legend>
<table>
<tr></tr>
<tr>
<td>Nama Lengkap</td>
<td>: <input type="text" placeholder="Masukkan nama"></td>
</tr>
<tr>
<td>Tinggi (cm)</td>
<td>: <input type="text" maxlength="3" size="2">
Berat (kg) : <input type="text" maxlength="3" size="2"></td>
</tr>
<tr>
<td>Umur</td>
<td>: <input type="number"></td>
</tr>
<tr>
<td>Jenis Kelamin</td>
<td>: <input type="radio" name="jk" />Pria
<input type="radio" name="jk"/>Wanita</td>
<td>Tempat Lahir</td>
<td>: <input type="text"></td>
</tr>
<tr>
<td>(Tamtama hanya Pria)</td>
</tr>
<tr>
<td>Agama</td>
<td>: <select name="agama">
<option>Islam</option>
<option>Kristen</option>
<option>Katolik</option>
<option>Hindu</option>
<option>Budha</option>
<option>Lainnya</option>
</select></td>
<td>Tanggal Lahir</td>
<td>: <input type="date"></td>
</tr>
<tr>
<td>Alamat Lengkap</td>
<td><textarea rows="5" cols="20" >
</textarea></td>
<td>Suku</td>
<td>: <input type="text" placeholder="Masukkan Suku"></td>
</tr>
<tr>
<td>Email</td>
<td>: <input type="email" placeholder="Masukkan e-mail"></td>
</tr>
<tr>
<td>Kabupaten</td>
<td>: <input type="text" placeholder="Masukkan Kabupaten"></td>
</tr>
<tr>
<td>Telepon</td>
<td>: <input type="text" placeholder="Masukkan No HP"></td>
</tr>
<tr>
<td>Kelengkapan Berkas</td>
<td>: <input type="checkbox">Ijazah
<input type="checkbox">FC KK</td>
</tr>
<tr>
<td>No KTP</td>
<td>: <input type="text" placeholder="Masukkan NIK"></td>
<td>Tgl Pembuatan KTP</td>
<td>: <input type="date"></td>
</tr>
</table>
</fieldset>
<fieldset>
<legend><font color="red">Latar Belakang Pendidikan</font></legend>
<table>
<tr>
<td><b>SD</b></td>
<td>: <input type="text" placeholder="Nama SD"></td>
<td>Provinsi</td>
<td>: <input type="text" placeholder="provinsi SD"></td>
</tr>
</tr>
<td>Tahun Lulus</td>
<td>: <input type="text"></td>
<td>NEM SD</td>
<td>: <input type="text"></td>
</tr>
<tr></tr>
<tr>
<td><b>SMP</b></td>
<td>: <input type="text" placeholder="Nama SMP"></td>
<td>Provinsi</td>
<td>: <input type="text" placeholder="provinsi SMP"></td>
</tr>
<tr>
<td>Tahun Lulus</td>
<td>: <input type="text"></td>
<td>NEM SMP</td>
<td>: <input type="text"></td>
</tr>
<tr></tr>
<tr>
<td><b>SMA</b></td>
<td>: <input type="text" placeholder="Nama SMA"></td>
<td>Provinsi</td>
<td>: <input type="text" placeholder="provinsi SMA"></td>
</tr>
<tr>
<td>Tahun Lulus</td>
<td>: <input type="text"></td>
<td>NEM SMA</td>
<td>: <input type="text"></td>
</tr>
<tr>
<td>Jurusan SMA</td>
<td>: <select name="jurusan">
<option>IPA</option>
<option>IPS</option>
<option>BAHASA</option>
<option>IPA</option>
</select><input type="text" placeholder="Jurusan Lainnya"></td>
</tr>
<tr>
<td></td>
<td></td>
</tr>
<tr>
<td><b>Perguruan Tinggi</b></td>
</tr>
<tr>
<td>Menggunakan Ijazah</td>
<td>: <input type="radio" name="a">SMA/SMK
<input type="radio" name="a">D3
<input type="radio" name="a">D4/S1
<input type="radio" name="a">S2/S3</td>
</tr>
<tr>
<td></td>
<td><input type="submit" name="simpan" value="Simpan">
<input type="reset" value="Reset"></td>
</tr>
</table>
</fieldset>
</form>
</body>
</html>
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