This is my project so far I have this I took the code from part of my project
<?php error_reporting(E_ERROR | E_PARSE); ?>
<!DOCTYPE html>
<html>
<head>
<title>Call Ins </title>
<script type="text/javascript" src="Javascript/jquery.js"></script>
<script type="text/javascript" src="Javascript/jquery-1.11.1.min.js"></script>
<script type="text/javascript" src="Javascript/employee_number_autocomplete.js"></script>
<link href="css/create.css" rel="stylesheet" type="text/css" >
</head>
<body style="background-image: url('http://a0319p528/new_callins/images/background.jpg')">
<div align="center">
</div>
<h1 class="h1">Call Ins Entry Page<br><br></h1>
<div align="center">
<form action = "insert_process.php" method ="post" class="form" style="width: 700px; height: 575px">
<br><br><br><br><br>
<table style="width: 81%">
<tr>
<!--start of Scheduled Date--!>
<td style="width: 133px">Scheduled Date</td>
<td style="width: 152px">
<input name="Date_Scheduled" id="Date_Scheduled" type="text"value="<?php echo date("M j, Y - g:i"); ?>"/>
</td>
<!--end of Scheduled Date--!>
<!--start of reason--!>
<td style="width: 159px">Reason</td>
<td>
<select name ="Reason" style="width: 160px" >
<option value ="">Please select ...</option></select>
</td></tr>
<!--end of reason--!>
<!--start of Employee Name--!>
<tr>
<td style="width: 133px">Employee Name</td>
<td style="width: 152px">
<input type="text" id="Employee_Name" name="Employee_Name">
</td>
<!--end of Employee Name--!>
<!--start of Contact--!>
<td style="width: 159px">Contact</td><td>
<select name ="Contact" style="width: 160px">
<option value ="">Please select ...</option></select>
</td></tr>
<!--end of Contact--!>
<!--start of Employee Number--!>
<tr>
<td style="width: 133px">Employee Number</td>
<td style="width: 152px">
<input type="text" id="Employee_Number" name="Employee_Number" ></td>
<!--end of Employee Number--!>
<!--start of Approval--!>
<td style="width: 159px">Approval</td>
<td>
<select name ="Approval" style="width: 160px">
<option value ="">Please select ...</option></select>
</td>
</tr>
<!--end of Approval--!>
<tr>
<td style="width: 133px">Time_Reported</td>
<td style="width: 152px"><input name="Time_Reported" id="Time_Reported" type="text"value="<?php echo date("M j, Y - g:i"); ?>"/></td>
</td>
<!--end of Approval--!>
<!--start of Scheduled Area--!>
<td style="width: 159px">Scheduled Area</td>
<td><select name ="Scheduled_Area" style="width: 160px" >
<option value ="">Please select ...</option></select></td>
</tr>
<!--end of Scheduled Area --!>
</table>
<br>
<input type="submit" value= "Submit Request "><br><br><br><br>
<!--start of yes or no Checkbox--!>
<p class="style1">Do not check Box bellow human resources use only<strong>.</strong></p>
<label>no</label>
<input type="checkbox" id="Complete" name="Complete" value="N">
<label>yes</label>
<input type="checkbox" id="Complete" name="Complete" value="Y"> <br>
<!--end of no or yes checkbox--!>
</form>
</div>
</body>
</html>
