@include('header')
      <meta charset="UTF-8">
      <meta name="viewport" content="width=device-width, initial-scale=1">
      <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/css/bootstrap.min.css" rel="stylesheet">
      <link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/bootstrap-icons@1.11.3/font/bootstrap-icons.min.css">

      <link rel="preconnect" href="https://fonts.googleapis.com">
      <link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
      <link href="https://fonts.googleapis.com/css2?family=Inter:wght@100..900&display=swap" rel="stylesheet">


<div class="container mt-4 mb-4">
    <div class="row justify-content-center">
        <div class="col-md-8">
            <div class="card">
                <div class="card-header">
                    <p class="fs-6 pb-0 mb-0" style="color: #ff751a;">Report PDUs</p>
                    <p class="fs-3 fw-bold pt-0 mt-0">Work as a Practitioner</p>
                </div>
                <div class="card-body">
                <form action="work/{id}/show" method="post" enctype="multipart/form-data">
     
                    @csrf
                    @method("PUT")
                        <div class="form-group mb-4">
                            <label for="employer" class="mb-2">Employer</label>
                            <input type="text" name="employer" id="employer" class="form-control @if($errors->has('employer')) is-invalid @endif" readonly placeholder="Employer" value="{{old('employer', $work -> employer )}}">
                            @if($errors->has('employer'))
                                <span class="invalid-feedback" role="alert">
                                    <strong>{{ $errors->first('employer') }}</strong>
                                </span>
                            @endif
                        </div>
                        <div class="form-group mb-4">
                            <label for="job_title" class="mb-2">Job Title</label>
                            <input type="text" name="job_title" id="job_title" class="form-control @if($errors->has('job_title')) is-invalid @endif"  readonly placeholder="Job Title" value="{{old('job_title', $work -> job_title )}}">
                            @if($errors->has('job_title'))
                                <span class="invalid-feedback" role="alert">
                                    <strong>{{ $errors->first('job_title') }}</strong>
                                </span>
                            @endif
                        </div>
                        <div class="form-group mb-4">
                            <label for="responsibilities" class="mb-2">Responsibilities (optional)</label>
                            <textarea name="responsibilities" id="responsibilities" class="form-control" rows="3">"{{old('responsibilities', $work -> responsibilities )}}"</textarea>
                        </div>
                        <div class="form-group mb-4">
                            <label for="url" class="mb-2">URL (optional)</label>
                            <input type="text" name="url" id="url" class="form-control"  readonly placeholder="URL" value="{{old('url', $work -> url )}}">
                        </div>

                        <div class="form-group mb-4">
                            <label for="contact_person" class="mb-2">Contact Person (optional) :</label>
                            <input type="text" name="contact_person" id="contact_person" class="form-control"  readonly placeholder="Contact Person" value="{{old('contact_person', $work -> contact_person )}}">
                        </div>

                        <div class="form-group mb-4">
                            <label for="contact_phone" class="mb-2">Contact Phone (optional) :</label>
                            <input type="text" name="contact_phone" id="contact_phone" class="form-control" readonly placeholder="Contact Phone "value="{{old('contact_phone', $work -> contact_phone )}}">
                        </div>

                        <div class="form-group mb-4">
                            <label for="contact_email" class="mb-2">Contact Email (optional) :</label>
                            <input type="email" name="contact_email" id="contact_email" class="form-control" readonly placeholder="Contact Email" value="{{old('contact_email', $work -> contact_email )}}">
                        </div>

                        <div class="form-group mb-4">
                        <label for="date_started" class="mb-2">Date Started :</label>
                            <input type="date" name="date_started" id="date_started" class="form-control @error('date_started') is-invalid @enderror" readonly placeholder="Date Started" value="{{old('date_started', $work -> date_started )}}">
                            @error('date_started')
                                <div class="invalid-feedback">{{ $message }}</div>
                            @enderror
                        </div>

                        <div class="form-group mb-4">
                            <label for="date_completed" class="mb-2">Date Completed :</label>
                            <input type="date" name="date_completed" id="date_completed" class="form-control @error('date_completed') is-invalid @enderror" readonly placeholder="Date Completed" value="{{old('date_completed', $work -> date_completed )}}">
                            @error('date_completed')
                                <div class="invalid-feedback">{{ $message }}</div>
                            @enderror
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
</div>
@include('footer')


<div class="form-group mb-4">