{{ Form::open(['action' => 'EmployeeContactDetailsController@update','id' => 'EmployeeContactDetailsForm','autocomplete' => 'off']) }}

<br>
<div class="container-fluid">
    {{-- <div class="row">
            <h3 style="margin-top:3px !important; margin-bottom:2px !important;" class="txtCenter">Contact Details</h3>
        </div> --}}
<input type="hidden" name="employee_id" value="{{$em->employee_id}}">
<input type="hidden" name="employee_address_c" value="{{$eac->employee_address_id}}">
<div class="row no-gutters" style="margin-top:10px;">
    <div class="col-md-4 txtCentre"><label class="txtRight name">Present Address</label></div>
    <div class="col-md-4 txtCentre"><label class="txtRight name">Permanent Address</label></div>
</div>

<br>
<div class="row no-gutters">
    <div class="col-md-2"><label class="txtRight name">Address Line 1</label></div>
    <div class="col-md-2">
        <input type="text" name="address_line1_pre" value="{{$ea->address_line1}}">
    </div>
    <div class="col-md-2"><label class="txtRight name">Address Line 1</label></div>
    <div class="col-md-2">
        <input type="text" name="address_line1_per" value="{{$eac->address_line1}}">
    </div>

</div>
<br>
<div class="row no-gutters">
    <div class="col-md-2"><label class="txtRight name">Address Line 2</label></div>
    <div class="col-md-2">
        <input type="text" name="address_line2_pre" value="{{$ea->address_line2}}">
    </div>
    <div class="col-md-2"><label class="txtRight name">Address Line 2</label></div>
    <div class="col-md-2">
        <input type="text" name="address_line2_per" value="{{$eac->address_line2}}">
    </div>

</div>
<br>
<div class="row no-gutters">
    <div class="col-md-2"><label class="txtRight name">City</label></div>
    <div class="col-md-2">
        <input type="text" name="city_pre" value="{{$ea->city}}">
    </div>
    <div class="col-md-2"><label class="txtRight name">City</label></div>
    <div class="col-md-2">
        <input type="text" name="city_per" value="{{$eac->city}}">
    </div>


</div>
<br>
<div class="row no-gutters">
    <div class="col-md-2"><label class="txtRight name">State</label></div>
    <div class="col-md-2">
        <input type="text" name="state_pre" value="{{$ea->state}}">
    </div>
    <div class="col-md-2"><label class="txtRight name">State</label></div>
    <div class="col-md-2">
        <input type="text" name="state_per" value="{{$eac->state}}">
    </div>

</div>
<br>
<div class="row no-gutters">
    <div class="col-md-2"><label class="txtRight name">Pin-Code</label></div>
    <div class="col-md-2">
        <input type="text" pattern="[0-9]{1,15}" title="Only digits" name="pin_code_pre" value="{{$ea->pincode}}">
    </div>
    <div class="col-md-2"><label class="txtRight name">Pin-Code</label></div>
    <div class="col-md-2">
        <input type="text" pattern="[0-9]{1,15}" title="Only digits" name="pin_code_per" value="{{$eac->pincode}}">
    </div>

</div>
<br>
<div class="row no-gutters">
    <div class="col-md-2"><label class="txtRight name">Country</label></div>
    <div class="col-md-2">
        <input type="text" name="country" value="{{$ea->country_code}}">
    </div>
    <div class="col-md-2"><label class="txtRight name">Country</label></div>
    <div class="col-md-2">
        <input type="text" name="country" value="{{$eac->country_code}}">
    </div>

</div>
<br>
<div class="row no-gutters" style="margin-top:10px;">
    <div class="col-md-2 txtCentre"><label class="txtRight name">Home Telephone</label></div>
    <div class="col-md-4 txtCentre">
        <input type="text" name="home_telephone" value="{{$em->employee_home_phone}}">
    </div>
</div>
<br>
<div class="row no-gutters" style="margin-top:10px;">
    <div class="col-md-2 txtCentre"><label class="txtRight name">Office Telephone</label></div>
    <div class="col-md-4 txtCentre">
        <input type="text" name="office_telephone" value="{{$em->employee_office_phone}}">
    </div>
</div>
<br>
<div class="row no-gutters" style="margin-top:10px;">
    <div class="col-md-2 txtCentre"><label class="txtRight name">Mobile Phone</label></div>
    <div class="col-md-4 txtCentre">
        <input type="text" pattern="[0-9]{1,10}" title="Only digits" name="mobile_phone" value="{{$em->employee_mobile}}">
    </div>
</div>
<br>
<div class="row no-gutters" style="margin-top:10px;">
    <div class="col-md-2 txtCentre"><label class="txtRight name">Work Email</label></div>
    <div class="col-md-4 txtCentre">
        <input type="email" name="work_email" value="{{$em->employee_work_email}}">
    </div>
</div>
<br>
<div class="row no-gutters" style="margin-top:10px;">
    <div class="col-md-2 txtCentre"><label class="txtRight name">Personal Email</label></div>
    <div class="col-md-4 txtCentre">
        <input type="email" name="personal_email" value="{{$em->employee_personal_email}}">
    </div>
</div>
<br>
<br>
</div>
<div class="modal-footer">
    <div class="form-group">
        <div class="col-sm-offset-2 col-sm-10">
            <button type="submit" class="btn btn-success btn-sm" id="btnSubmit" >Submit</button>
        </div>
    </div>
</div>


{{ Form::close() }}