29 lines
1.8 KiB
Plaintext
29 lines
1.8 KiB
Plaintext
<%@include file="jspf/enteteJSPF.jspf" %>
|
|
<br /><br />
|
|
<table style='border: 0px solid white;'>
|
|
<tr>
|
|
<td style='border :0px;'>
|
|
<fieldset><legend>Coordonnées Pompier</legend>
|
|
<table>
|
|
<tr><th>Nom : <input type="text" name="ztNom" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Prénom : <input type="text" name="ztPrenom" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Adresse : <input type="text" name="ztAdr" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Ville : <input type="text"name="ztVille" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Code postal : <input type="text" name="ztCp" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Téléphone : <input type="text" name="ztTel" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Mail : <input type="text" name="ztMail" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Statut : <input type="text" name="ztStatut" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Grade : <input type="text" name="ztGrade" size="20" maxlength="30"></th></tr>
|
|
</table>
|
|
</fieldset>
|
|
<fieldset><legend>Coordonnées Employeur</legend>
|
|
<table>
|
|
<tr><th>Nom employeur : <input type="text" name="ztNomEmp" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Téléphone employeur : <input type="text" name="ztTelEmp" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Adresse employeur : <input type="text" name="ztadrEmp" size="20" maxlength="30"></th></tr>
|
|
<tr><th>Mail employeur : <input type="text" name="ztMailEmp" size="20" maxlength="30"></th></tr>
|
|
</table>
|
|
</fieldset>
|
|
</td>
|
|
</tr>
|
|
</table> |