<table style="width:60%"> <tr> <td> <form action="#" method="post" name="job_application" id="job_form"> <fieldset> <legend><h3>Personal Information</h3></legend> <label for="fullname">Full Name:</label> <input type="text" id="name_field" name="name"><br> <label for="address">Home Address:</label> <input type="text" id="address_field" name="address"><br> <label for="phone">Phone Number:</label> <input type="text" id="phone_field" name="phone"> <br> <br> <b> Account Details: </b><br> <label for="email-address">Email Address:</label> <input type="text" id="email_field" name="email"><br> <label for="password">Password:</label> <input type="password" id="password_field" name="password"><br> <br> <br> <b> Gender: </b><br> <input type="radio" name="gender" value="male" checked> Male<br> <input type="radio" name="gender" value="female"> Female<br> <input type="radio" name="gender" value="other"> Not Disclose<br> </fieldset> <br> <fieldset> <legend><h3>Department Interest</h3></legend> <b>State</b> <select> <option value="New Jersey" selected>New Jersey</option> <option value="New York">New York</option> <option value="Texas">Texas</option> <option value="California">California</option> </select> <br> <br> <input type="checkbox" name="departmentAcc" value="Accounting" checked>Accounting <br> <input type="checkbox" name="departmentHR" value="HR">Human Resources <br> <input type="checkbox" name="departmentComp" value="Compliance">Compliance <br> <input type="checkbox" name="departmentIT" value="IT">Information Tech <br> </fieldset><br> <fieldset> <legend><h3>Create Account</h3></legend> <input type="submit" id="submit" name="submit" value="Submit"> </fieldset> </form> </td> <td> <div> <textarea rows="15" id="output_value" cols="40"></textarea> </div> </td> <tr> </table>