demarches-normaliennes/app/views/dossiers/etapes/etape_2/_individual.html.haml

46 lines
1.4 KiB
Text
Raw Normal View History

2017-02-14 17:08:14 +01:00
.col-xs-3.center
%h3 Mes informations
%p
2016-08-30 11:18:43 +02:00
Les informations de bases
%br
vous concernant.
.etape.etapes-informations.col-xs-9
= form_for @facade.dossier, url: { controller: '/users/dossiers', action: :update } do |f|
.row
2017-02-14 17:08:14 +01:00
.col-xs-12.padding-left-30
= f.hidden_field :id
2016-08-30 11:18:43 +02:00
= f.fields_for :individual, @facade.individual do |ff|
.form-group
%label
%h4
Civilité
2017-03-27 15:32:11 +02:00
= ff.select :gender, ['M.', 'Mme']
.form-group
%label
%h4
2016-12-07 17:55:34 +01:00
Nom *
= ff.text_field :nom, { class: 'form-control', required: true }
.form-group
%label
%h4
2016-12-07 17:55:34 +01:00
Prénom *
= ff.text_field :prenom, { class: 'form-control', required: true }
.form-group
%label
%h4
2016-12-07 17:55:34 +01:00
Date de naissance *
= ff.date_field :birthdate, { value: @facade.individual.birthdate, class: 'form-control', placeholder: 'jj/mm/aaaa', required: true }
2016-08-30 11:18:43 +02:00
%p
%label{ style: 'font-weight: normal;' }
= f.check_box :autorisation_donnees
2018-01-24 18:10:40 +01:00
 J'accepte
= link_to "les CGU", CGU_URL, target: :blank
.row
2017-02-14 17:08:14 +01:00
.col-xs-5.col-xs-5
.col-xs-2.col-xs-2
= f.submit 'Etape suivante', class: "action", id: 'etape_suivante'
2017-02-14 17:08:14 +01:00
.col-xs-5.col-xs-5