Jason Jordan
36 lines
1.5 KiB
Plaintext
36 lines
1.5 KiB
Plaintext
<div class="bg-deepcove h-full w-full flex flex-col">
|
|
<div class="flex items-center">
|
|
<%= link_to employers_path, class: "flex items-center h-14 space-x" do %>
|
|
<div class="flex items-center h-14 text-bluemana hover:text-bronze">
|
|
<%= icon "arrow-big-left-dash", library: "lucide", class: "h-full w-20 text-center" %>
|
|
<div class="w-full pb-1 font-bold text-2xl">
|
|
<%= "Back to Employer Control" %>
|
|
</div>
|
|
</div>
|
|
<% end %>
|
|
</div>
|
|
<h1 class="font-bold text-4xl text-platinum my-5">New Employer</h1>
|
|
<%= form_with model: @employer, local: true, multipart: true do |f| %>
|
|
<div class="flex flex-col space-y-6 pb-10">
|
|
<div class="flex w-full items-end" data-controller="logo-upload">
|
|
<div class="flex flex-col space-y-6 w-4/5">
|
|
<div class="flex items-end space-x-10">
|
|
<div class="w-full">
|
|
<%= f.text_field :name, label: { text: "Employer Name" }, data: { logo_upload_target: "employer" }, class: "w-full" %>
|
|
</div>
|
|
<div class="w-full">
|
|
<%= f.text_field :effective_date, label: { text: "Effective Date" }, class: "w-full" %>
|
|
</div>
|
|
<div class="w-full">
|
|
<%= f.text_field :group_number, label: { text: "Group/Medical Number" }, class: "w-full" %>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="py-8">
|
|
<%= f.submit "Create New Employer" %>
|
|
</div>
|
|
</div>
|
|
<% end %>
|
|
</div>
|