<%@ page language="java" contentType="text/html; charset=UTF-8"
	pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<%@ taglib prefix="fmt" uri="http://java.sun.com/jsp/jstl/fmt"%>

<%@ taglib prefix="webpath" uri="/WEB-INF/tlds/path.tld"%>
<%@ taglib prefix="webpage" uri="/WEB-INF/tlds/pageview.tld"%>

<head>


</head>
		

<div class="main-content">
	<div class="breadcrumbs" id="breadcrumbs">
		

		<ul class="breadcrumb">
			<li>
				<i class="icon-home home-icon"></i>
				<a href="#">首页</a>
			</li>
			<li class="active">用户管理</li>
			<li class="active">新增</li>
		</ul><!-- .breadcrumb -->

		
	</div>
	<div class="page-content">
		<div class="row">
		
			<div class="col-xs-12">
				
				<form action="#" id="userForm" name="userForm" method="post" onsubmit="return false" class="form-horizontal" role="form">
				
				<div class="row">
				<div class="col-xs-12">
				<h3 class="header smaller lighter blue">用户信息</h3></div>
				</div>
				
				
				<div class="row">
				<div class="col-xs-4">
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1">  角色 </label>

						<div class="col-sm-9">
							<select class="col-xs-10 col-sm-10" id="role" name="role">
									<option value="2">普通用户</option>
									<option value="1">管理员</option>
							</select>
						</div>
					</div>
				
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> <font color="red">*</font> 姓名 </label>

						<div class="col-sm-9">
							<input type="text" id="name" name="name" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>

					

					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-2"> 性别 </label>

						<div class="col-sm-9">
						
						<label>
							<input name="gender" type="radio" class="ace" value="male">
							<span class="lbl"> 男</span>
						</label>
						<label>
							<input name="gender" type="radio" class="ace" value="female">
							<span class="lbl"> 女</span>
						</label>							
													
							
						</div>
					</div>

					

					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> <font color="red">*</font> 出生日期 </label>

						<div class="col-sm-9">
							<input class="col-xs-10 col-sm-10" id="birthday" name="birthday" type="text" data-date-format="yyyy-mm-dd" />
							
						</div>
					</div>

					

					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> <font color="red">*</font> 证件类型 </label>

						<div class="col-sm-9">
							<select class="col-xs-10 col-sm-10" id="paperType" name="paperType">
								
								<c:forEach var="value" items="${dict.paperType}">
									<option value="${value}">${value}</option>
								</c:forEach>
											
											
											
							</select>
							
							
							
						</div>
					</div>

					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> <font color="red">*</font> 证件号码 </label>

						<div class="col-sm-9">
							<input type="text" id="paperId" name="paperId" placeholder="" class="col-xs-10 col-sm-10" />
							
						</div>
					</div>

					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 民族 </label>

						<div class="col-sm-9">
							<select name="nation" id="nation" class="col-xs-10 col-sm-10">  
							    <c:forEach var="value" items="${dict.nation}">
									<option value="${value}" >${value}</option>
								</c:forEach>
							</select>  
							
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 国籍 </label>

						<div class="col-sm-9">
							<select class="col-xs-10 col-sm-10" id="nationality" name="nationality">
								<c:forEach var="value" items="${dict.nationality}">
									<option value="${value}">${value}</option>
								</c:forEach>

							</select>
							
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> <font color="red">*</font> 籍贯 </label>

						<div class="col-sm-9">
							<select class="col-xs-10 col-sm-10" id="nativePlace" name="nativePlace">
								<option value=""></option>
								<c:forEach var="value" items="${dict.nativePlace}">
									<option value="${value}">${value}</option>
								</c:forEach>
							</select>
						</div>
					</div>
					
					
					
					
					
					
				</div>
				
				
				<div class="col-xs-4">
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 户籍所在地 </label>

						<div class="col-sm-9">
							<input type="text" id="domicilePlace" name="domicilePlace" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
				
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> <font color="red">*</font> 经常居住地</label>

						<div class="col-sm-9">
							<input type="text" id="addr" name="addr" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 学历</label>

						<div class="col-sm-9">
							<select class="col-xs-10 col-sm-10" id="education" name="education">
								<option value="">请选择</option>
								<c:forEach var="value" items="${dict.education}">
									<option value="${value}">${value}</option>
								</c:forEach>
							</select>
							
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 工作单位/学校 </label>

						<div class="col-sm-9">
							<input type="text" id="unit" name="unit" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 职业 </label>

						<div class="col-sm-9">
							<input type="text" id="profession" name="profession" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 单位/学校地址 </label>

						<div class="col-sm-9">
							<input type="text" id="unitAddr" name="unitAddr" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 单位/学校电话 </label>

						<div class="col-sm-9">
							<input type="text" id="unitTel" name="unitTel" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> <font color="red">*</font> 本人手机 </label>

						<div class="col-sm-9">
							<input type="text" id="mobile" name="mobile" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 固定电话 </label>

						<div class="col-sm-9">
							<input type="text" id="tel" name="tel" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
				
				
				</div>
				
				
				<div class="col-xs-4">
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 邮箱 </label>

						<div class="col-sm-9">
							<input type="text" id="email" name="email" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> QQ号码 </label>

						<div class="col-sm-9">
							<input type="text" id="qq" name="qq" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 微信号 </label>

						<div class="col-sm-9">
							<input type="text" id="weixin" name="weixin" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 无偿献血次数 </label>

						<div class="col-sm-9">
							<input type="text" id="donateBloodCount" name="donateBloodCount" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 血型 </label>

						<div class="col-sm-9">
							<input type="text" id="bloodType" name="bloodType" placeholder="" class="col-xs-10 col-sm-10" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 身高 </label>
						<div class="col-sm-9">
							<input type="text" id="height" name="height" placeholder="" class="col-xs-10 col-sm-10" />
							<span class="help-inline col-xs-12 col-sm-2">
								<span class="middle">cm</span>
							</span>
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 体重 </label>
						<div class="col-sm-9">
							<input type="text" id="weight" name="weight" placeholder="" class="col-xs-10 col-sm-10" />
							<span class="help-inline col-xs-12 col-sm-2">
								<span class="middle">kg</span>
							</span>
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 备注 </label>

						<div class="col-sm-9">
							<textarea rows="4" class="col-xs-10 col-sm-10" id="remark" name="remark"></textarea>
						</div>
					</div>
					
				
				</div>
				</div>
				
				<div class="row">
				<div class="col-xs-12">
				<h3 class="header smaller lighter blue">联系人一（请填写直系亲属）</h3></div>
				</div>
				
				
				
				<div class="row">

					<div class="col-xs-4">
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 姓名 </label>
							<div class="col-sm-9">
								<input type="text" id="contactsName1" name="contactsName1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
						
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> QQ号 </label>
							<div class="col-sm-9">
								<input type="text" id="contactsQQ1" name="contactsQQ1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
						
					</div>
					
					
					<div class="col-xs-4">
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 关系</label>
							<div class="col-sm-9">
								<input type="text" id="contactsRelation1" name="contactsRelation1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
						
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 微信号</label>
							<div class="col-sm-9">
								<input type="text" id="contactsWeixin1" name="contactsWeixin1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
					</div>
					
					
					<div class="col-xs-4">
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 手机</label>
							<div class="col-sm-9">
								<input type="text" id="contactsMobile1" name="contactsMobile1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
						
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 联系地址</label>
							<div class="col-sm-9">
								<input type="text" id="contactsAddr1" name="contactsAddr1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
					</div>
					
				</div>
				
				
				<div class="row">
				<div class="col-xs-12">
				<h3 class="header smaller lighter blue">联系人二(请勿填写在校学生、现役士兵、未成年人)</h3></div>
				</div>
				<div class="row">
	
					<div class="col-xs-4">
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 姓名 </label>
							<div class="col-sm-9">
								<input type="text" id="contactsName1" name="contactsName1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
						
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> QQ号 </label>
							<div class="col-sm-9">
								<input type="text" id="contactsQQ1" name="contactsQQ1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
						
					</div>
					
					
					<div class="col-xs-4">
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 关系</label>
							<div class="col-sm-9">
								<input type="text" id="contactsRelation1" name="contactsRelation1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
						
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 微信号</label>
							<div class="col-sm-9">
								<input type="text" id="contactsWeixin1" name="contactsWeixin1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
					</div>
					
					
					<div class="col-xs-4">
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 手机</label>
							<div class="col-sm-9">
								<input type="text" id="contactsMobile1" name="contactsMobile1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
						
						<div class="form-group">
							<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 联系地址</label>
							<div class="col-sm-9">
								<input type="text" id="contactsAddr1" name="contactsAddr1" placeholder="" class="col-xs-10 col-sm-10" />
								
							</div>
						</div>
					</div>
					
				</div>
				
				
					<div class="col-md-offset-3 col-md-9">
						<button class="btn btn-sm btn-success">
							<i class="icon-save bigger-110"></i>
							保存
						</button>

						&nbsp; &nbsp; &nbsp;
						<button class="btn btn-sm btn-success">
							<i class="icon-reply bigger-110"></i>
							返回
						</button>
					</div>
				
				
			</form>
			
			
											
											
										
			</div>
			
		</div>
	</div>
	
	
	
	
	
	
</div>
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