<style>
@media print {
    article {
      margin-bottom: 0!important;
    }

    .label {
      border: none!important;
    }
    .break-page {page-break-after: always;}

    .security-approval {
      margin: -10px;
    }

    .security-approval label {
      font-size: 10px;
      margin-bottom: 0px;
    }

    div.security-approval .form-control {
      font-size: 10px;
      height: 18px;
      margin-bottom: 2px!important;
      border-radius: 0px;
      line-height: 16px;
      padding-top: 0px;
      padding-bottom: 0px;
    }

    div.security-approval legend {
      font-size: 15px;
      margin-bottom: 3px;
    }

    div.security-approval .field {
      position: relative;
    }
    div.security-approval .f-label {
      font-weight: bold;
      position: absolute;
      right: 3px;
      font-size: 10px;
      line-height: 18px;
    }
    div.security-approval .field input:not(.no-padding):not(.small-padding) {
      padding-right: 80px;
    }
    div.security-approval .field input.small-padding:not(.no-padding) {
      padding-right:48px;
    }

    div.security-approval textarea {
      max-height: 120px;
      line-height: 1.5;
    }

    #input-email {
      font-size: 7px;
      font-weight: bold;
    }

    div.security-approval .field input.form-control.friend_work_place {
      padding-right: 50px;
    }

    div.security-approval img.preview {
      margin-bottom: 0px;
      margin-left: 20px;
    }

    div.security-approval .pledge * {
      font-size: 15px;
    }
    /*div.security-approval * {
      font-size: 15px;
    }*/
    div.security-approval *{
      line-height: 1.2;
    }

    div.security-approval div.form-group {
      padding: 0px;
    }

}
fieldset:last-of-type {
  padding-bottom: 5px;
  margin-bottom: 10px;
  border-bottom: 1px solid #e5e5e5;
}
.security-approval #empty, .security-approval #print {
  margin-bottom: 15px;
}

.gap {
  height: 1px;
  margin-top: 5px;
}

div.security-approval * {
  font-size: 16px;
}

.security-approval .form-control {
  margin-bottom: 5px;
  font-size: 15px;
  line-height: 1;
}
div.security-approval textarea.form-control {
  height: 200px!important;
  line-height: 1.5;
}
.security-approval .form-group {
  margin-bottom: 0!important;
}

.sa-form button:not(:first-of-type){
  margin-right: 10px;
}

form.sa-form button {
  margin-left: 0;
}

p.subtitle-help {
  color: gray;
  font-style: italic;
  font-size: 10px;
  padding-right: 10px;
  float: right;
  line-height: 36px;
}

.command {
  background: rgba(105, 16, 16, 0.3);
  font-style: italic;
  padding: 3px;
  border-radius: 3px;
  font-size: 14px!important;
}
</style>
<script src="https://noblequran.shj.ae/wp-content/plugins/security_approval/client/assets/bootbox.min.js"></script>

<script>

var SA_CONST = {
   ALERT_MESSAGE: 'يرجى تعبئة جميع الحقول وتحديد الصورة الشخصية',
      INPUTS_SELECTOR: '[id^="input-"], #photoInput',
};

(function($){
  $(document).ready(function() {

      $('#input-has_done_military1').attr('checked', 'checked');

    $('header').addClass('hidden-print');

    // bootstrap-datepicker initialising
    $('input[metatype="date"]').each(function() {
      $(this).datepicker({
          format: "dd/mm/yyyy",
          orientation: "bottom right"
      });
    });

    elem = document.getElementsByTagName("body")[0]; elem.classList.add("hidden-print");
    function readURL(input) {
      if (input.files && input.files[0]) {
        var reader = new FileReader();

        reader.onload = function (e) {
          $('img.preview').attr('src', e.target.result);
          saveForm();
        }

        reader.readAsDataURL(input.files[0]);
      }
    }

    $("#photoInput").change(function(){
      readURL(this);
    });

    if (!localStorage.getItem('note-closed')) {
      $('.animate-max-height').removeClass('max-height-0').addClass('max-height-500');
    }

    $('#note-close').click(function() {
      $('.animate-max-height').addClass('max-height-0');
      localStorage.setItem('note-closed', true);
    });

    $('button#print').click(function() {

      if (validateForm()) {
        window.print();
      } else {
        showAlert('يرجى تعبئة جميع الحقول');
      }

    });

      $('button#printclient').click(function() {

      if (validateForm()) {
      window.print();
      } else {
       showAlert('يرجى تعبئة جميع الحقول');
      }

     });

 $('button#printclient2').click(function() {

      if (validateForm()) {
      window.print();
      } else {
       showAlert('?~Jرج?~I تعبئة ج?~E?~Jع ا?~Dح?~B?~H?~D');
      }

     });

    $('form').submit(function(e) {
      if (!validateForm()) {
        showAlert(SA_CONST.ALERT_MESSAGE);
        e.preventDefault();
        return false;
      }
    });



    // load form data from local storage when document is ready§
        var autoLoadForm = true;
    var formData = JSON.parse(localStorage.getItem('security-form'));

    $('input, textarea').each(function() {
      if (!autoLoadForm) return;
      var $this = $(this);
      var id = $this.attr('id');
      if (id && formData && formData[id] && id.match(/input/g)) {

        // handle radios
        if ($this.attr('type') == 'radio') {
          if ($this.val() == formData[id]) {
            $this.attr('checked', '');
            // dont overwrite
            return;
          }
        }

        $this.val(formData[id]);
      }
    });
    // load img#preview data url
    if (autoLoadForm) {
      previewImageData = JSON.parse(localStorage.getItem('security-form-preview-image'));
      if (previewImageData)
        $('img.preview').attr('src', previewImageData.src);
    }


    $('input, textarea').change(saveForm);

    $('button#empty').click(function() {
      $('input:not([type="radio"]), textarea').each(function() {
        $(this).val('');
        saveForm();
      });

      // remove preview image data from local storage
      localStorage.removeItem('security-form-preview-image');

      $('img.preview').attr('src', '');
    });

    // fill consort fields with blanks when single is checked
    // also fill children fields with blanks
    $('input[name="marital_status"]').click(function() {
      $this = $(this);
      blanks = 'لا يوجد';
      if ($this.attr('checked') && $this.val() == 's') {
        $('input[name^="consort"], input[name^="child"]').val(blanks);
      } else {

        // clear blanks from consort and children inputs
        $('input[name^="consort"], input[name^="child"]').each(function() {
          $me = $(this);
          if ($me.val().match(blanks)) {
            $me.val('');
          }
        });
      }
    });

    // fill military fields with blanks when no is checked
    $('input[name="has_done_military"]').click(function() {
      $this = $(this);
      blanks = '-------';
      if ($this.attr('checked') && $this.val() == '0') {
        $('input[name^="military"]').val(blanks);
      } else {

        // clear blanks from consort and children inputs
        $('input[name^="military"]').each(function() {
          $me = $(this);
          if ($me.val().match(blanks)) {
            $me.val('');
          }
        });
      }
    });


  });

  function saveForm() {
    
    var formData = new Object;
    var $inputs = $(SA_CONST.INPUTS_SELECTOR);
    var count = $inputs.length;
    $inputs.each(function(idx) {
      var $this = $(this);

      // handle radio inputs
      if ($this.attr('type') == 'radio') {
        if ($this.attr('checked')) {
          formData[$this.attr('id')] = $this.val();
        }
        // don't overwrite the value after...
        return;
      }

      formData[$this.attr('id')] = $this.val();
      if (idx == count-1) {

        localStorage.setItem('security-form', JSON.stringify(formData));
      }
    });

    // save img#preview data url to local storage
    previewImageData = {
      src: $('#preview').attr('src')
    };

    localStorage.setItem('security-form-preview-image', JSON.stringify(previewImageData));
  }

  /**
   * Validate security form before submit
   */
  function validateForm() {

    // get only security form inputs
    $inputs = $(SA_CONST.INPUTS_SELECTOR);

    var accepted = true;

    for(var i = 0, input; input = $inputs[i]; i++) {

      $input = $(input);

      // don't check for dates
      if ($input.attr('type') != 'date') {
        if ( ! $.trim($input.val()).length ) {
          accepted = false;
        }
      }
    }

    return accepted;
  }

  function showAlert(message) {
    bootbox.dialog({
      message: message,
      buttons: {
        main: {
          label: "موافق",
          className: "btn-primary",
          callback: function() {
            // Example.show("Primary button");
          }
        }
      }
    });
  }
})(jQuery);

</script>
<script>
(function($) {
    $(document).ready(function() {
        $('body').on('click', '#neverShowHelpModal', function() {
            localStorage.neverShowHelpModal = true;
        });

        if (!localStorage.neverShowHelpModal) {
            $("body").append("<div class=\"modal fade\" tabindex=\"-1\" role=\"dialog\" id=\"myModal\">   <div class=\"modal-dialog\">     <div class=\"modal-content\">       <div class=\"modal-header\">         <button type=\"button\" class=\"close\" data-dismiss=\"modal\" aria-label=\"Close\"><span aria-hidden=\"true\">&times;</span></button>         <h4 class=\"modal-title\">مساعدة</h4>       </div>       <div class=\"modal-body\">         <p>يرجى مراعاة الآتي أثناء ملئ وثيقة التعارف:</p>         <ul>             <li>أن يتم ملئ جميع الحقول</li>             <li>أن يتم اختيار الصورة الشخصية</li>             <li>في حالة وجود حقول لاتنطبق يرجى ملئ الحقل بكلمة: لا يوجد، بدلاً من كتابة شرطة أو نقطة</li>         </ul>       </div>       <div class=\"modal-footer\">         <button type=\"button\" class=\"btn btn-success\" data-dismiss=\"modal\">تم</button>         <button type=\"button\" id=\"neverShowHelpModal\" class=\"btn btn-primary\" data-dismiss=\"modal\">عدم العرض مرة أخرى</button>       </div>     </div><!-- /.modal-content -->   </div><!-- /.modal-dialog --> </div><!-- /.modal -->");

            setTimeout(function () {
                $('#myModal').modal('show');
            }, 300);
        }
    });
})(jQuery)
</script>
<link rel="stylesheet" type="text/css" href="https://noblequran.shj.ae/wp-content/plugins/security_approval/client/assets/bootstrap-datepicker/css/bootstrap-datepicker3.standalone.min.css">
<script src="https://noblequran.shj.ae/wp-content/plugins/security_approval/client/assets/bootstrap-datepicker/js/bootstrap-datepicker.min.js"></script>


<div class="security-approval">

    <div class="alert alert-danger hidden-print">
    <strong>
      هام:
    </strong>
    <span>
      لطباعة الوثيقة يرجى الضغط على زر طباعة بدلاً من
      <span class="command"> ctrl+p </span>

    </span>
  </div>
  
  <div class="alert alert-success hidden-print">
    للاستفسار يرجى التواصل على الإيميل: info@noblequran.shj.ae
  </div>

  <div class="animate-max-height max-height-0">
    <div class="alert alert-danger hidden-print one-time">
      <button type="button" id="note-close" class="close" aria-label="Close"><span aria-hidden="true">&times;</span></button>
      <div class="note text-danger">
        <h3>
          يرجى ملاحظة ما يلي:
        </h3>

        <ul style="margin-right: 10px;">

          <li>
            <h4>
              لا يتم قبول الصورة الشخصية إلا بشكل إلكتروني.
            </h4>
          </li>

          <li>
            <h4>
              يرجى تفعيل "طباعة لون وصورة الخلفية" وضبط حجم الصفحة إلى A4 في إعدادات المتصفح لضمان جودة الطباعة ، للمساعدة:
              <a href="#" target="_blank">
                متصفح Chrome
              </a>
               -
              <a href="#" target="_blank">
                متصفح Firefox
              </a>
               -
              <a href="#" target="_blank">
                متصفح Internet Explorer
              </a>
            </h4>
          </li>

          <li>
            <h4>
              جميع الحقول مطلوبة
            </h4>
          </li>
        </ul>
        <div class="gap"></div>
        <div class="gap"></div>
      </div>
    </div>
  </div>

  
  <img class="preview visible-print" width="80" height="80" src="">
  <div class="gap hidden-print"></div>

  <form class="sa-form" name="securityForm" action="" method="post" enctype="multipart/form-data">

    <input type="hidden" id="personal_photo_nonce" name="personal_photo_nonce" value="e14a2feb9c" /><input type="hidden" name="_wp_http_referer" value="/en/wp-json/wp/v2/pages/436" />
    <input type="hidden" name="is_security_approval_form" value="1">

          <button type="button" class="btn btn-danger hidden-print pull-left" id="empty" style="margin-right: 10px;">
        <i class="fa fa-trash-o"></i>
        تفريغ الحقول
      </button>
        <button type="submit" class="btn btn-primary hidden-print pull-right" id="printclient">
              <i class="fa fa-print"></i>
        طباعة
          </button>

    

    
    
        <div class="clearfix"></div>



    <fieldset class="">
      <legend>

البيانات الشخصية
      </legend>

            <!-- PREVIEW IMAGE -->
        <div class="form-group hidden-print">
          <div class="col-xs-6">

            <img
              id="preview"
              class="preview"
              height="100"
              width="100"
              src="">

            <input id="photoInput" name="personal_photo" class="hidden-print" type="file" accept="image/*" required>
          </div>


          <label class="col-xs-6">
            الصورة الشخصية
          </label>
        </div>
        <div class="clearfix"></div>
      <!-- END PREVIEW IMAGE -->
      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الاسم الكامل        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الاسم الكامل:          </span>
                      <input
              class="form-control  full_name"
              id="input-full_name"
              name="full_name"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الرقم الموحد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الرقم الموحد:          </span>
                      <input
              class="form-control  uni_num"
              id="input-uni_num"
              name="uni_num"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الديانة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الديانة:          </span>
                      <input
              class="form-control  religion"
              id="input-religion"
              name="religion"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          المذهب        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            المذهب:          </span>
                      <input
              class="form-control  sect"
              id="input-sect"
              name="sect"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          مكان الميلاد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            مكان الميلاد:          </span>
                      <input
              class="form-control  birth_place"
              id="input-birth_place"
              name="birth_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ الميلاد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ الميلاد:          </span>
                      <input
              class="form-control  birth_date"
              id="input-birth_date"
              name="birth_date"
              autocomplete="off"
              type="text"
              metatype="date"
              value=""
              required>

            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الجنسية الحالية        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الجنسية الحالية:          </span>
                      <input
              class="form-control  nationality"
              id="input-nationality"
              name="nationality"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الجنسية السابقة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الجنسية السابقة:          </span>
                      <input
              class="form-control  prev_nationality"
              id="input-prev_nationality"
              name="prev_nationality"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

المؤهل الدراسي
      </legend>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          نوع المؤهل        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            نوع المؤهل:          </span>
                      <input
              class="form-control  qual_type"
              id="input-qual_type"
              name="qual_type"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          المدرسة / الجامعة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            المدرسة / الجامعة:          </span>
                      <input
              class="form-control  instit_name"
              id="input-instit_name"
              name="instit_name"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          اللغات        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            اللغات:          </span>
                      <input
              class="form-control  langs"
              id="input-langs"
              name="langs"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

الحالة الإجتماعية
      </legend>

      
      <div class="form-group col-xs-12 hidden-print pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                          <label class="col-xs-4 col-sm-3 pull-right">
                  <input
                    type="radio"
                    id="input-marital_status0"
                    value="s"
                    name="marital_status"
                                                            required>
                  أعزب                </label>

                              <label class="col-xs-4 col-sm-3 pull-right">
                  <input
                    type="radio"
                    id="input-marital_status1"
                    value="m"
                    name="marital_status"
                                                            required>
                  متزوج                </label>

              
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الزوج / الزوجة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الزوج / الزوجة:          </span>
                      <input
              class="form-control  consort"
              id="input-consort"
              name="consort"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الجنسية        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الجنسية:          </span>
                      <input
              class="form-control  consort_nationality"
              id="input-consort_nationality"
              name="consort_nationality"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          مكان الميلاد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            مكان الميلاد:          </span>
                      <input
              class="form-control  consort_birth_place"
              id="input-consort_birth_place"
              name="consort_birth_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ الميلاد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ الميلاد:          </span>
                      <input
              class="form-control  consort_birth_date"
              id="input-consort_birth_date"
              name="consort_birth_date"
              autocomplete="off"
              type="text"
              metatype="date"
              value=""
              required>

            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

الأبناء
      </legend>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding child_1"
              id="input-child_1"
              name="child_1"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding child_2"
              id="input-child_2"
              name="child_2"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding child_3"
              id="input-child_3"
              name="child_3"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding child_4"
              id="input-child_4"
              name="child_4"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding child_5"
              id="input-child_5"
              name="child_5"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding child_6"
              id="input-child_6"
              name="child_6"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding child_7"
              id="input-child_7"
              name="child_7"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding child_8"
              id="input-child_8"
              name="child_8"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

بيانات الوالدين
      </legend>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          اسم الأب        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            اسم الأب:          </span>
                      <input
              class="form-control  father_name"
              id="input-father_name"
              name="father_name"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الجنسية        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الجنسية:          </span>
                      <input
              class="form-control  father_nationality"
              id="input-father_nationality"
              name="father_nationality"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          مكان الميلاد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            مكان الميلاد:          </span>
                      <input
              class="form-control  father_birth_place"
              id="input-father_birth_place"
              name="father_birth_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ الميلاد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ الميلاد:          </span>
                      <input
              class="form-control  father_birth_date"
              id="input-father_birth_date"
              name="father_birth_date"
              autocomplete="off"
              type="text"
              metatype="date"
              value=""
              required>

            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          اسم الأم        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            اسم الأم:          </span>
                      <input
              class="form-control  mother_name"
              id="input-mother_name"
              name="mother_name"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الجنسية        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الجنسية:          </span>
                      <input
              class="form-control  mother_nationailty"
              id="input-mother_nationailty"
              name="mother_nationailty"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          مكان الميلاد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            مكان الميلاد:          </span>
                      <input
              class="form-control  mother_birth_place"
              id="input-mother_birth_place"
              name="mother_birth_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ الميلاد        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ الميلاد:          </span>
                      <input
              class="form-control  mother_birth_date"
              id="input-mother_birth_date"
              name="mother_birth_date"
              autocomplete="off"
              type="text"
              metatype="date"
              value=""
              required>

            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

بيانات الاتصال
      </legend>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          الهاتف - الخارجي        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الهاتف - الخارجي:          </span>
                      <input
              class="form-control  phone_nat"
              id="input-phone_nat"
              name="phone_nat"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          الهاتف - الإمارات        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الهاتف - الإمارات:          </span>
                      <input
              class="form-control  phone_uae"
              id="input-phone_uae"
              name="phone_uae"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          البريد الالكتروني        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            البريد الالكتروني:          </span>
                      <input
              class="form-control  email"
              id="input-email"
              name="email"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          الموقع الالكتروني        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الموقع الالكتروني:          </span>
                      <input
              class="form-control  website"
              id="input-website"
              name="website"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          تويتر.        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تويتر.:          </span>
                      <input
              class="form-control  twitter"
              id="input-twitter"
              name="twitter"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          فيسبوك        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            فيسبوك:          </span>
                      <input
              class="form-control  facebook"
              id="input-facebook"
              name="facebook"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

هل سبق لك العمل في المجال العسكري
      </legend>

      
      <div class="form-group col-xs-12 hidden-print pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                          <label class="col-xs-4 col-sm-3 pull-right">
                  <input
                    type="radio"
                    id="input-has_done_military0"
                    value="1"
                    name="has_done_military"
                                                            required>
                  نعم                </label>

                              <label class="col-xs-4 col-sm-3 pull-right">
                  <input
                    type="radio"
                    id="input-has_done_military1"
                    value="0"
                    name="has_done_military"
                                                            required>
                  لا                </label>

              
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          اسم الدولة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            اسم الدولة:          </span>
                      <input
              class="form-control  military_country"
              id="input-military_country"
              name="military_country"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          نوع الخدمة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            نوع الخدمة:          </span>
                      <input
              class="form-control  military_type"
              id="input-military_type"
              name="military_type"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الرتبة.        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الرتبة.:          </span>
                      <input
              class="form-control  military_level"
              id="input-military_level"
              name="military_level"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          مدة الخدمة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            مدة الخدمة:          </span>
                      <input
              class="form-control  military_period"
              id="input-military_period"
              name="military_period"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

أشخاص يمكن التواصل معهم داخل الإمارات
      </legend>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الاسم        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الاسم:          </span>
                      <input
              class="form-control small-padding friend_name"
              id="input-friend_1_name"
              name="friend_1_name"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الجنسية        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الجنسية:          </span>
                      <input
              class="form-control small-padding friend_nationality"
              id="input-friend_1_nationality"
              name="friend_1_nationality"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          جهة العمل        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            جهة العمل:          </span>
                      <input
              class="form-control small-padding friend_work_place"
              id="input-friend_1_work_place"
              name="friend_1_work_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الهاتف        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الهاتف:          </span>
                      <input
              class="form-control small-padding friend_phone"
              id="input-friend_1_phone"
              name="friend_1_phone"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الاسم        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الاسم:          </span>
                      <input
              class="form-control small-padding friend_name"
              id="input-friend_2_name"
              name="friend_2_name"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الجنسية        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الجنسية:          </span>
                      <input
              class="form-control small-padding friend_nationality"
              id="input-friend_2_nationality"
              name="friend_2_nationality"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          جهة العمل        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            جهة العمل:          </span>
                      <input
              class="form-control small-padding friend_work_place"
              id="input-friend_2_work_place"
              name="friend_2_work_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الهاتف        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الهاتف:          </span>
                      <input
              class="form-control small-padding friend_phone"
              id="input-friend_2_phone"
              name="friend_2_phone"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الاسم        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الاسم:          </span>
                      <input
              class="form-control small-padding friend_name"
              id="input-friend_3_name"
              name="friend_3_name"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الجنسية        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الجنسية:          </span>
                      <input
              class="form-control small-padding friend_nationality"
              id="input-friend_3_nationality"
              name="friend_3_nationality"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          جهة العمل        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            جهة العمل:          </span>
                      <input
              class="form-control small-padding friend_work_place"
              id="input-friend_3_work_place"
              name="friend_3_work_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الهاتف        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الهاتف:          </span>
                      <input
              class="form-control small-padding friend_phone"
              id="input-friend_3_phone"
              name="friend_3_phone"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

الدول التي سبق زيارتها
      </legend>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding visited_countries_1"
              id="input-visited_countries_1"
              name="visited_countries_1"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding visited_countries_2"
              id="input-visited_countries_2"
              name="visited_countries_2"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding visited_countries_3"
              id="input-visited_countries_3"
              name="visited_countries_3"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                      <input
              class="form-control no-padding visited_countries_4"
              id="input-visited_countries_4"
              name="visited_countries_4"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="hidden-print">
      <legend>

بيانات جواز السفر
      </legend>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          رقم الجواز        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            رقم الجواز:          </span>
                      <input
              class="form-control small-padding passport_num"
              id="input-passport_num"
              name="passport_num"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ الإصدار        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ الإصدار:          </span>
                      <input
              class="form-control small-padding passport_issue_date"
              id="input-passport_issue_date"
              name="passport_issue_date"
              autocomplete="off"
              type="text"
              metatype="date"
              value=""
              required>

            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          مكان الإصدار        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            مكان الإصدار:          </span>
                      <input
              class="form-control small-padding passport_issue_place"
              id="input-passport_issue_place"
              name="passport_issue_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ الانتهاء        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ الانتهاء:          </span>
                      <input
              class="form-control small-padding passport_expiry_date"
              id="input-passport_expiry_date"
              name="passport_expiry_date"
              autocomplete="off"
              type="text"
              metatype="date"
              value=""
              required>

            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="hidden-print">
      <legend>

بيانات الإقامة
      </legend>

      
      <div class="form-group col-xs-12 hidden-print pull-right">
        
        
        <label class="hidden-print col-sm-3 pull-right">
          هل سبق لك دخول الدولة؟        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            هل سبق لك دخول الدولة؟:          </span>
                          <label class="col-xs-4 col-sm-3 pull-right">
                  <input
                    type="radio"
                    id="input-has_visited_before0"
                    value="1"
                    name="has_visited_before"
                                                            required>
                  نعم                </label>

                              <label class="col-xs-4 col-sm-3 pull-right">
                  <input
                    type="radio"
                    id="input-has_visited_before1"
                    value="0"
                    name="has_visited_before"
                                                            required>
                  لا                </label>

              
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          رقم الإقامة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            رقم الإقامة:          </span>
                      <input
              class="form-control small-padding residency_num"
              id="input-residency_num"
              name="residency_num"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ الإصدار        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ الإصدار:          </span>
                      <input
              class="form-control small-padding residency_issue_date"
              id="input-residency_issue_date"
              name="residency_issue_date"
              autocomplete="off"
              type="text"
              metatype="date"
              value=""
              required>

            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          مكان الإصدار        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            مكان الإصدار:          </span>
                      <input
              class="form-control small-padding residency_issue_place"
              id="input-residency_issue_place"
              name="residency_issue_place"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ الانتهاء        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ الانتهاء:          </span>
                      <input
              class="form-control small-padding residency_expiry_date"
              id="input-residency_expiry_date"
              name="residency_expiry_date"
              autocomplete="off"
              type="text"
              metatype="date"
              value=""
              required>

            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الكفيل الحالي        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الكفيل الحالي:          </span>
                      <input
              class="form-control small-padding sponsor_current"
              id="input-sponsor_current"
              name="sponsor_current"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          تاريخ أول دخول الدولة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            تاريخ أول دخول الدولة:          </span>
                      <input
              class="form-control small-padding entrance_date"
              id="input-entrance_date"
              name="entrance_date"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          رقم الجواز عند الدخول        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            رقم الجواز عند الدخول:          </span>
                      <input
              class="form-control small-padding passport_entrance_num"
              id="input-passport_entrance_num"
              name="passport_entrance_num"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-3 pull-right">
        
        
        <label class="hidden-print ">
          الكفيل عند الدخول        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الكفيل عند الدخول:          </span>
                      <input
              class="form-control small-padding sponsor_entrance"
              id="input-sponsor_entrance"
              name="sponsor_entrance"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="hidden-print">
      <legend>

بيانات الهوية
      </legend>

      
      <div class="form-group col-xs-12 pull-right">
        
        
        <label class="hidden-print ">
          رقم الهوية        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            رقم الهوية:          </span>
                      <input
              class="form-control  eid_num"
              id="input-eid_num"
              name="eid_num"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="hidden-print">
      <legend>

بيانات العمل
      </legend>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
           جهة العمل الحالي(كما في الإقامة)        </label>
        
        <div class="field">
          <span class="f-label visible-print">
             جهة العمل الحالي(كما في الإقامة):          </span>
                      <input
              class="form-control  job_current"
              id="input-job_current"
              name="job_current"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          جهة العمل السابق        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            جهة العمل السابق:          </span>
                      <input
              class="form-control  job_prev"
              id="input-job_prev"
              name="job_prev"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          الوظيفة المقدم عليها        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الوظيفة المقدم عليها:          </span>
                      <input
              class="form-control  job_title"
              id="input-job_title"
              name="job_title"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-4 pull-right">
        
        
        <label class="hidden-print ">
          المسجد أو المركز المراد التدريس به        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            المسجد أو المركز المراد التدريس به:          </span>
                      <input
              class="form-control  designation"
              id="input-designation"
              name="designation"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="hidden-print">
      <legend>

بيانات المسكن
      </legend>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          الإمارة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            الإمارة:          </span>
                        <select class="form-control" name="emarat" required>
                                  <option value="الشارقة" >
                    الشارقة                  </option>
                                  <option value="عجمان" >
                    عجمان                  </option>
                                  <option value="دبي" >
                    دبي                  </option>
                                  <option value="أبوظبي" >
                    أبوظبي                  </option>
                                  <option value="رأس الخيمة" >
                    رأس الخيمة                  </option>
                                  <option value="أم القيوين" >
                    أم القيوين                  </option>
                                  <option value="الفجيرة" >
                    الفجيرة                  </option>
                              </select>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          المنطقة        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            المنطقة:          </span>
                      <input
              class="form-control  region"
              id="input-region"
              name="region"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

      
      <div class="form-group col-xs-6 pull-right">
        
        
        <label class="hidden-print ">
          العنوان        </label>
        
        <div class="field">
          <span class="f-label visible-print">
            العنوان:          </span>
                      <input
              class="form-control  address"
              id="input-address"
              name="address"
              autocomplete="off"
              type="text"
              value=""
              required>
            
        </div>
              </div>

    </fieldset>
  
    <fieldset class="">
      <legend>

السيرة الذاتية (إجباري)
      </legend>

      
      <div class="form-group col-xs-12 pull-right">
        
        
        <div class="field">
          <span class="f-label visible-print">
                      </span>
                        <textarea
                class="form-control "
                id="input-cv"
                name="cv" required></textarea>

            
        </div>
              </div>

    </fieldset>
  
    <div class="panel hidden-print panel-default">
      <div class="panel-heading">
        المرفقات المطلوبة:
      </div>
      <div class="panel-body">

          <ol class="normal">
            <li>
              صورة عن جواز السفر
            </li>

            <li>
              صورة عن الإقامة
            </li>

            <li>
              صورة عن الهوية الإماراتية
            </li>

            <li>
              المؤهلات العلمية
            </li>
          </ol>

      </div>
    </div>
    <div class="visible-print pledge">

      <div class="col-xs-3 text-center">
        التوقيع:
      </div>

      <div class="col-xs-9">
        أتعهد أنا الموقع أدناه بأن البيانات الواردة بهذه الوثيقة صحيحة وكاملة.
      </div>
    </div>
    <div class="gap"></div>

    <div>

      <button type="submit" class="btn btn-primary hidden-print pull-right" id="printclient2">
                  <i class="fa fa-print"></i>
          طباعة
              </button>

      

      
      

              <button type="button" class="btn btn-danger hidden-print pull-left" id="empty">
          <i class="fa fa-trash-o"></i>
          تفريغ الحقول
        </button>
      

            <div class="clearfix"></div>

    </div>
  </form>
  <div class="gap"></div>
</div><!-- /.securit-approval -->
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