<%--  JSP設定         --%>
<%@ page language="java" session="true" pageEncoding="Windows-31J" contentType="text/html;charset=Windows-31J" %>

<%--  Import         --%>
<%@ page import="javax.servlet.*" %>
<%@ page import="javax.servlet.http.*" %>
<%@ page import="java.util.List" %>
<%@ page import="java.util.ArrayList" %>
<%@ page import="java.util.Arrays" %>
<%@ page import="jp.co.mdis.s1si25.portal.common.util.ViewHTMLUtil" %>

<%--  FORM初期値         --%>
<%
	String raisya_m       = "";
	String raisya_d       = "";
	String raisya_h       = "";
	String name_k         = "";
	String name           = "";
	String birth_y           = "";
	String birth_m           = "";
	String birth_d           = "";
	String sex           = "";
	String yubin1           = "";
	String yubin2           = "";
	String address           = "";
	String tel           = "";
	String fax           = "";
	String keitai_tel           = "";
	String mail           = "";
	String st_line           = "";
	String st_name           = "";
	String tsukin_kbn           = "";
	String tsukin_time           = "";
	String last_scool_nm           = "";
	String last_scool_rnk           = "";
	String last_scool_kbn           = "";
	String kaisi_y       = "";
	String kaisi_m       = "";
	String kaisi_d       = "";
	String kikan_cd           = "";
	String r_time_cd           = "";
	String[] r_type           = null;
	String r_text           = "";
	String kibo_occ_cd           = "";
	String kibo_gyosyu_cd           = "";
	String kibo_pay_cd           = "";
	String kibo_pay           = "0";
	String kibo_pay_rnk           = "";
	String area           = "";
	String kibo_area           = "";
	String reserve_flg           = "";
	String last_st_y 	           = "";
	String last_st_m 	           = "";
	String last_ed_y 	           = "";
	String last_ed_m 	           = "";
	String syugyou_flg           = "";
	String koyou_cd 	            = "";
	String last_corp 	           = "";
	String last_occ_cd           = "";
	String last_naiyo            = "";
	String last_st_y2 	           = "";
	String last_st_m2 	           = "";
	String last_ed_y2 	           = "";
	String last_ed_m2 	           = "";
	String koyou_cd2 	           = "";
	String last_corp2 	           = "";
	String last_occ_cd2           = "";
	String last_naiyo2            = "";
	String last_st_y3 	           = "";
	String last_st_m3 	           = "";
	String last_ed_y3 	           = "";
	String last_ed_m3 	           = "";
	String koyou_cd3 	           = "";
	String last_corp3 	           = "";
	String last_occ_cd3           = "";
	String last_naiyo3            = "";
	String skill_word 	           = "";
	String skill_excel            = "";
	String skill_ppoint           = "";
	String skill_access           = "";
	String toeic_point            = "";
	String toefl_point            = "";
	String lang_comment           = "";
	String skill 	           = "";
	String pr 	           = "";
        String workarea            = "";
         
// パラメータ取得
	if(request.getParameter("request_page") !=null){
		raisya_m 	 = ( request.getParameter( "RAISYA_M"  ) != null ) ? request.getParameter( "RAISYA_M"     ) : "";
		raisya_d 	 = ( request.getParameter( "RAISYA_D"  ) != null ) ? request.getParameter( "RAISYA_D"     ) : "";
		raisya_h 	 = ( request.getParameter( "RAISYA_H"  ) != null ) ? request.getParameter( "RAISYA_H"     ) : "";
		name_k 	 = ( request.getParameter( "NAME_K"  ) != null ) ? request.getParameter( "NAME_K"     ) : "";
		name 	 = ( request.getParameter( "NAME"  ) != null ) ? request.getParameter( "NAME"     ) : "";
		birth_y 	 = ( request.getParameter( "BIRTH_Y"  ) != null ) ? request.getParameter( "BIRTH_Y"     ) : "";
		birth_m 	 = ( request.getParameter( "BIRTH_M"  ) != null ) ? request.getParameter( "BIRTH_M"     ) : "";
		birth_d 	 = ( request.getParameter( "BIRTH_D"  ) != null ) ? request.getParameter( "BIRTH_D"     ) : "";
		sex 	 = ( request.getParameter( "SEX"  ) != null ) ? request.getParameter( "SEX"     ) : "";
		yubin1 	 = ( request.getParameter( "YUBIN1"  ) != null ) ? request.getParameter( "YUBIN1"     ) : "";
		yubin2 	 = ( request.getParameter( "YUBIN2"  ) != null ) ? request.getParameter( "YUBIN2"     ) : "";
		address 	 = ( request.getParameter( "ADDRESS"  ) != null ) ? request.getParameter( "ADDRESS"     ) : "";
		tel 	 = ( request.getParameter( "TEL"  ) != null ) ? request.getParameter( "TEL"     ) : "";
		fax 	 = ( request.getParameter( "FAX"  ) != null ) ? request.getParameter( "FAX"     ) : "";
		keitai_tel 	 = ( request.getParameter( "KEITAI_TEL"  ) != null ) ? request.getParameter( "KEITAI_TEL"     ) : "";
		mail 	 = ( request.getParameter( "MAIL"  ) != null ) ? request.getParameter( "MAIL"     ) : "";
		st_line 	 = ( request.getParameter( "ST_LINE"  ) != null ) ? request.getParameter( "ST_LINE"     ) : "";
		st_name 	 = ( request.getParameter( "ST_NAME"  ) != null ) ? request.getParameter( "ST_NAME"     ) : "";
		tsukin_kbn 	 = ( request.getParameter( "TSUKIN_KBN"  ) != null ) ? request.getParameter( "TSUKIN_KBN"     ) : "";
		tsukin_time 	 = ( request.getParameter( "TSUKIN_TIME"  ) != null ) ? request.getParameter( "TSUKIN_TIME"     ) : "";
		last_scool_nm 	 = ( request.getParameter( "LAST_SCOOL_NM"  ) != null ) ? request.getParameter( "LAST_SCOOL_NM"     ) : "";
		last_scool_rnk 	 = ( request.getParameter( "LAST_SCOOL_RNK"  ) != null ) ? request.getParameter( "LAST_SCOOL_RNK"     ) : "";
		last_scool_kbn 	 = ( request.getParameter( "LAST_SCOOL_KBN"  ) != null ) ? request.getParameter( "LAST_SCOOL_KBN"     ) : "";
		kaisi_y 	 = ( request.getParameter( "KAISI_Y"  ) != null ) ? request.getParameter( "KAISI_Y"     ) : "";
		kaisi_m 	 = ( request.getParameter( "KAISI_M"  ) != null ) ? request.getParameter( "KAISI_M"     ) : "";
		kaisi_d 	 = ( request.getParameter( "KAISI_D"  ) != null ) ? request.getParameter( "KAISI_D"     ) : "";
		kikan_cd 	 = ( request.getParameter( "KIKAN_CD"  ) != null ) ? request.getParameter( "KIKAN_CD"     ) : "";
		r_time_cd 	 = ( request.getParameter( "R_TIME_CD"  ) != null ) ? request.getParameter( "R_TIME_CD"     ) : "";
		r_type 	 = ( request.getParameterValues( "R_TYPE"  ) != null ) ? request.getParameterValues( "R_TYPE"     ) : null;
		r_text 	 = ( request.getParameter( "R_TEXT"  ) != null ) ? request.getParameter( "R_TEXT"     ) : "";
		kibo_occ_cd 	 = ( request.getParameter( "KIBO_OCC_CD"  ) != null ) ? request.getParameter( "KIBO_OCC_CD"     ) : "";
		kibo_gyosyu_cd 	 = ( request.getParameter( "KIBO_GYOSYU_CD"  ) != null ) ? request.getParameter( "KIBO_GYOSYU_CD"     ) : "";
		kibo_pay_cd 	 = ( request.getParameter( "KIBO_PAY_CD"  ) != null ) ? request.getParameter( "KIBO_PAY_CD"     ) : "";
		kibo_pay 	 = ( request.getParameter( "KIBO_PAY"  ) != null ) ? request.getParameter( "KIBO_PAY"     ) : "";
		kibo_pay_rnk 	 = ( request.getParameter( "KIBO_PAY_RNK"  ) != null ) ? request.getParameter( "KIBO_PAY_RNK"     ) : "";
		area 	 = ( request.getParameter( "area"  ) != null ) ? request.getParameter( "area"     ) : "";
		kibo_area 	 = ( request.getParameter( "KIBO_AREA"  ) != null ) ? request.getParameter( "KIBO_AREA"     ) : "";
		reserve_flg 	 = ( request.getParameter( "RESERVE_FLG"  ) != null ) ? request.getParameter( "RESERVE_FLG"     ) : "";
		last_st_y 	 = ( request.getParameter( "LAST_ST_Y"  ) != null ) ? request.getParameter( "LAST_ST_Y"     ) : "";
		last_st_m 	 = ( request.getParameter( "LAST_ST_M"  ) != null ) ? request.getParameter( "LAST_ST_M"     ) : "";
		last_ed_y 	 = ( request.getParameter( "LAST_ED_Y"  ) != null ) ? request.getParameter( "LAST_ED_Y"     ) : "";
		last_ed_m 	 = ( request.getParameter( "LAST_ED_M"  ) != null ) ? request.getParameter( "LAST_ED_M"     ) : "";
		syugyou_flg 	 = ( request.getParameter( "SYUGYOU_FLG"  ) != null ) ? request.getParameter( "SYUGYOU_FLG"     ) : "";
		koyou_cd 	 = ( request.getParameter( "KOYOU_CD"  ) != null ) ? request.getParameter( "KOYOU_CD"     ) : "";
		last_corp 	 = ( request.getParameter( "LAST_CORP"  ) != null ) ? request.getParameter( "LAST_CORP"     ) : "";
		last_occ_cd 	 = ( request.getParameter( "LAST_OCC_CD"  ) != null ) ? request.getParameter( "LAST_OCC_CD"     ) : "";
		last_naiyo 	 = ( request.getParameter( "LAST_NAIYO"  ) != null ) ? request.getParameter( "LAST_NAIYO"     ) : "";
		last_st_y2 	 = ( request.getParameter( "LAST_ST_Y2"  ) != null ) ? request.getParameter( "LAST_ST_Y2"     ) : "";
		last_st_m2 	 = ( request.getParameter( "LAST_ST_M2"  ) != null ) ? request.getParameter( "LAST_ST_M2"     ) : "";
		last_ed_y2 	 = ( request.getParameter( "LAST_ED_Y2"  ) != null ) ? request.getParameter( "LAST_ED_Y2"     ) : "";
		last_ed_m2 	 = ( request.getParameter( "LAST_ED_M2"  ) != null ) ? request.getParameter( "LAST_ED_M2"     ) : "";
		koyou_cd2 	 = ( request.getParameter( "KOYOU_CD2"  ) != null ) ? request.getParameter( "KOYOU_CD2"     ) : "";
		last_corp2 	 = ( request.getParameter( "LAST_CORP2"  ) != null ) ? request.getParameter( "LAST_CORP2"     ) : "";
		last_occ_cd2 	 = ( request.getParameter( "LAST_OCC_CD2"  ) != null ) ? request.getParameter( "LAST_OCC_CD2"     ) : "";
		last_naiyo2 	 = ( request.getParameter( "LAST_NAIYO2"  ) != null ) ? request.getParameter( "LAST_NAIYO2"     ) : "";
		last_st_y3 	 = ( request.getParameter( "LAST_ST_Y3"  ) != null ) ? request.getParameter( "LAST_ST_Y3"     ) : "";
		last_st_m3 	 = ( request.getParameter( "LAST_ST_M3"  ) != null ) ? request.getParameter( "LAST_ST_M3"     ) : "";
		last_ed_y3 	 = ( request.getParameter( "LAST_ED_Y3"  ) != null ) ? request.getParameter( "LAST_ED_Y3"     ) : "";
		last_ed_m3 	 = ( request.getParameter( "LAST_ED_M3"  ) != null ) ? request.getParameter( "LAST_ED_M3"     ) : "";
		koyou_cd3 	 = ( request.getParameter( "KOYOU_CD3"  ) != null ) ? request.getParameter( "KOYOU_CD3"     ) : "";
		last_corp3 	 = ( request.getParameter( "LAST_CORP3"  ) != null ) ? request.getParameter( "LAST_CORP3"     ) : "";
		last_occ_cd3 	 = ( request.getParameter( "LAST_OCC_CD3"  ) != null ) ? request.getParameter( "LAST_OCC_CD3"     ) : "";
		last_naiyo3 	 = ( request.getParameter( "LAST_NAIYO3"  ) != null ) ? request.getParameter( "LAST_NAIYO3"     ) : "";
		skill_word 	 = ( request.getParameter( "SKILL_WORD"  ) != null ) ? request.getParameter( "SKILL_WORD"     ) : "";
		skill_excel 	 = ( request.getParameter( "SKILL_EXCEL"  ) != null ) ? request.getParameter( "SKILL_EXCEL"     ) : "";
		skill_ppoint 	 = ( request.getParameter( "SKILL_PPOINT"  ) != null ) ? request.getParameter( "SKILL_PPOINT"     ) : "";
		skill_access 	 = ( request.getParameter( "SKILL_ACCESS"  ) != null ) ? request.getParameter( "SKILL_ACCESS"     ) : "";
		toeic_point 	 = ( request.getParameter( "TOEIC_POINT"  ) != null ) ? request.getParameter( "TOEIC_POINT"     ) : "";
		toefl_point 	 = ( request.getParameter( "TOEFL_POINT"  ) != null ) ? request.getParameter( "TOEFL_POINT"     ) : "";
		lang_comment 	 = ( request.getParameter( "LANG_COMMENT"  ) != null ) ? request.getParameter( "LANG_COMMENT"     ) : "";
		skill 	 = ( request.getParameter( "SKILL"  ) != null ) ? request.getParameter( "SKILL"     ) : "";
		pr 	 = ( request.getParameter( "PR"  ) != null ) ? request.getParameter( "PR"     ) : "";
		workarea 	 = ( request.getParameter( "WORKAREA"  ) != null ) ? request.getParameter( "WORKAREA"     ) : "";
	}
%>


<html>
<head>
<title>仮登録申込票</title>

<meta http-equiv="content-type" content="text/html; charset=shift_jis">
<script language="JavaScript" src='./PortalServ2.js'></script>
<script language="JavaScript" src='./image/mhp_entry4.js'></script>

</head>
<body bgcolor="#ffffff" text="#333333" link="#003399" vlink="#cc0099" topmargin="0" marginheight="0">

<table width="100%" border="0" cellspacing="0" cellpadding="1">
 <tr>
 <td align="left" valign="top" width="85%"> 

 <table border="0" cellspacing="0" cellpadding="0">
  <tr><td><img src="./image/1pix.gif" width="1" height="16"></td></tr>
  <tr><td><img src="image/entry_logo.jpg" width="320" height="40" alt="仮登録申込票"></td>
      <td width="20"></td>
      <td width="120" align="center"><script src=https://seal.verisign.com/getseal?host_name=www.mdlife.co.jp&size=M&use_flash=NO&use_transparent=YES&lang=ja></script>      </td>
      <td width="220" align="center"><font size="2">このページはプライバシー保護のため<br>SSL暗号化通信を導入しています</font></td>
  </tr>
 </table>

 </td></tr>
 <tr>
 <td align="left" valign="top">

 <table width=100% border=0 cellspacing=0 cellpadding=1 bgcolor=darkgray>
  <tr><td><img src="./image/1pix.gif" width=1 height=1></td></tr>
 </table>

 </td></tr>
<form name="entry_input" action="entry_conf4.jsp" method="post">
 <tr>
 <td align="left" valign="top">

 <table width="100%" border="0" cellspacing="0" cellpadding="0">
  <tr><td>

  <table border=0 cellspacing=0 cellpadding=0>
   <tr><td>
    </td><td>

   </td>
   <td><font size="3">　来社希望日時　</font></td>
   <td><font size="3">
   <select name="RAISYA_M">
    <option value="" <%= "".equals(raisya_m) ? "selected" : "" %>>@@
    <option value="01" <%= "01".equals(raisya_m) ? "selected" : "" %>>01
    <option value="02" <%= "02".equals(raisya_m) ? "selected" : "" %>>02
    <option value="03" <%= "03".equals(raisya_m) ? "selected" : "" %>>03
    <option value="04" <%= "04".equals(raisya_m) ? "selected" : "" %>>04
    <option value="05" <%= "05".equals(raisya_m) ? "selected" : "" %>>05
    <option value="06" <%= "06".equals(raisya_m) ? "selected" : "" %>>06
    <option value="07" <%= "07".equals(raisya_m) ? "selected" : "" %>>07
    <option value="08" <%= "08".equals(raisya_m) ? "selected" : "" %>>08
    <option value="09" <%= "09".equals(raisya_m) ? "selected" : "" %>>09
    <option value="10" <%= "10".equals(raisya_m) ? "selected" : "" %>>10
    <option value="11" <%= "11".equals(raisya_m) ? "selected" : "" %>>11
    <option value="12" <%= "12".equals(raisya_m) ? "selected" : "" %>>12
   </select>
   </font></td>
   <td><font size="2">月</font></td>
   <td><font size="3">
   <select name="RAISYA_D">
    <option value="" <%= "".equals(raisya_d) ? "selected" : "" %>>@@
    <option value="01" <%= "01".equals(raisya_d) ? "selected" : "" %>>01
    <option value="02" <%= "02".equals(raisya_d) ? "selected" : "" %>>02
    <option value="03" <%= "03".equals(raisya_d) ? "selected" : "" %>>03
    <option value="04" <%= "04".equals(raisya_d) ? "selected" : "" %>>04
    <option value="05" <%= "05".equals(raisya_d) ? "selected" : "" %>>05
    <option value="06" <%= "06".equals(raisya_d) ? "selected" : "" %>>06
    <option value="07" <%= "07".equals(raisya_d) ? "selected" : "" %>>07
    <option value="08" <%= "08".equals(raisya_d) ? "selected" : "" %>>08
    <option value="09" <%= "09".equals(raisya_d) ? "selected" : "" %>>09
    <option value="10" <%= "10".equals(raisya_d) ? "selected" : "" %>>10
    <option value="11" <%= "11".equals(raisya_d) ? "selected" : "" %>>11
    <option value="12" <%= "12".equals(raisya_d) ? "selected" : "" %>>12
    <option value="13" <%= "13".equals(raisya_d) ? "selected" : "" %>>13
    <option value="14" <%= "14".equals(raisya_d) ? "selected" : "" %>>14
    <option value="15" <%= "15".equals(raisya_d) ? "selected" : "" %>>15
    <option value="16" <%= "16".equals(raisya_d) ? "selected" : "" %>>16
    <option value="17" <%= "17".equals(raisya_d) ? "selected" : "" %>>17
    <option value="18" <%= "18".equals(raisya_d) ? "selected" : "" %>>18
    <option value="19" <%= "19".equals(raisya_d) ? "selected" : "" %>>19
    <option value="20" <%= "20".equals(raisya_d) ? "selected" : "" %>>20
    <option value="21" <%= "21".equals(raisya_d) ? "selected" : "" %>>21
    <option value="22" <%= "22".equals(raisya_d) ? "selected" : "" %>>22
    <option value="23" <%= "23".equals(raisya_d) ? "selected" : "" %>>23
    <option value="24" <%= "24".equals(raisya_d) ? "selected" : "" %>>24
    <option value="25" <%= "25".equals(raisya_d) ? "selected" : "" %>>25
    <option value="26" <%= "26".equals(raisya_d) ? "selected" : "" %>>26
    <option value="27" <%= "27".equals(raisya_d) ? "selected" : "" %>>27
    <option value="28" <%= "28".equals(raisya_d) ? "selected" : "" %>>28
    <option value="29" <%= "29".equals(raisya_d) ? "selected" : "" %>>29
    <option value="30" <%= "30".equals(raisya_d) ? "selected" : "" %>>30
    <option value="31" <%= "31".equals(raisya_d) ? "selected" : "" %>>31
   </select>
   </font></td>
   <td><font size="2">日</font></td>
   <td><font size="3">
   <select name="RAISYA_H">
    <option value="" <%= "".equals(raisya_h) ? "selected" : "" %>>@@
    <option value="08" <%= "08".equals(raisya_h) ? "selected" : "" %>>08
    <option value="09" <%= "09".equals(raisya_h) ? "selected" : "" %>>09
    <option value="10" <%= "10".equals(raisya_h) ? "selected" : "" %>>10
    <option value="11" <%= "11".equals(raisya_h) ? "selected" : "" %>>11
    <option value="12" <%= "12".equals(raisya_h) ? "selected" : "" %>>12
    <option value="13" <%= "13".equals(raisya_h) ? "selected" : "" %>>13
    <option value="14" <%= "14".equals(raisya_h) ? "selected" : "" %>>14
    <option value="15" <%= "15".equals(raisya_h) ? "selected" : "" %>>15
    <option value="16" <%= "16".equals(raisya_h) ? "selected" : "" %>>16
    <option value="17" <%= "17".equals(raisya_h) ? "selected" : "" %>>17
    <option value="18" <%= "18".equals(raisya_h) ? "selected" : "" %>>18
    <option value="19" <%= "19".equals(raisya_h) ? "selected" : "" %>>19
    <option value="20" <%= "20".equals(raisya_h) ? "selected" : "" %>>20
   </select>
   </font></td>
   <td><font size="2">時頃</font></td>
   </tr>
    <tr>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td colspan="6"><font size="1" color="ff0000">（当社担当者からの連絡をお待ち下さい。）</font></td>
    </tr>
  </table>

  </td></tr>
  </table>

  </td></tr>
  <tr><td>


  </td></tr>
  <tr><td><img src="./image/1pix.gif" width="1" height="7"></td>
  </tr>
</table>

 </td></tr>
 <tr>
 <td align="left" valign="top">

 <table width=100% border=0 cellspacing=0 cellpadding=1 bgcolor=darkgray>
  <tr><td><img src="./image/1pix.gif" width=1 height=1></td></tr>
 </table>

 </td></tr>
 <tr>
 <td align="left" valign="top">
<img src="./image/1pix.gif" width=10 height=1>
 <table border=0 cellpadding=0 cellspacing=0>
  <tr>
  <td><img src="./image/1pix.gif" width="10" height="1"></td>
  <td><font size="1" color="#3366ff">※印は必須項目です</font></td>
  </tr>
 </table>

 </td></tr>
 <tr><td align="left" valign="top"></td></tr>
 <tr>
 <td align="left" valign="top">

 <!-- Profile -->
 <table border="0" cellspacing="0" cellpadding="2">
  <tr>
  <td colspan="5">

  <table border="0" cellspacing="0" cellpadding="0">
   <tr>
   <td><img src="./image/ar_02.gif" width="29" height="21""></td>
   <td nowrap><font size="2"><b>あなたのプロフィール</b></font></td>
   </tr><tr>
   <td colspan=2><img src="./image/1pix.gif" width="1" height="10"></td>
   </tr>
  </table>

  </td></tr>
  <tr><td rowspan=9><img src="./image/1pix.gif" width="10" height="1"></td>
  <td><font size="2"><font size="2" color="#3366ff">※</font></td>
  <td><font size="2">フリガナ(全角)</font></td>
  <td rowspan=9><img src="./image/1pix.gif" width="5" height="1"></td>
  <td><font size="3"><input type="text" name="NAME_K" size="40" maxlength=40 value="<%= ViewHTMLUtil.replaceStr(name_k) %>"></font></td>
  </tr><tr>
  <td><font size="2"><font size="2" color="#3366ff">※</font></td>
  <td><font size="2">氏名</font></td>
  <td><font size="3"><input type="text" name="NAME" size="40" maxlength=40 value="<%= ViewHTMLUtil.replaceStr(name) %>"></font></td>
  </tr><tr>
  <td><font size="2"><font size="2" color="#3366ff">※</font></td>
  <td><font size="2">生年月日</font></td>
  <td>

  <table border="0" cellspacing="0" cellpadding="0">
   <tr>
   <td><font size="2">西暦 </font></td>
   <td><font size="3"><input type="text" name="BIRTH_Y" size="4" maxlength=4 value="<%= ViewHTMLUtil.replaceStr(birth_y) %>"></font></td>
   <td><font size="2">年</font></td>
   <td><font size="3">
    <select name="BIRTH_M">
     <option value="" <%= "".equals(birth_m) ? "selected" : "" %>>@@
     <option value="01" <%= "01".equals(birth_m) ? "selected" : "" %>>01
     <option value="02" <%= "02".equals(birth_m) ? "selected" : "" %>>02
     <option value="03" <%= "03".equals(birth_m) ? "selected" : "" %>>03
     <option value="04" <%= "04".equals(birth_m) ? "selected" : "" %>>04
     <option value="05" <%= "05".equals(birth_m) ? "selected" : "" %>>05
     <option value="06" <%= "06".equals(birth_m) ? "selected" : "" %>>06
     <option value="07" <%= "07".equals(birth_m) ? "selected" : "" %>>07
     <option value="08" <%= "08".equals(birth_m) ? "selected" : "" %>>08
     <option value="09" <%= "09".equals(birth_m) ? "selected" : "" %>>09
     <option value="10" <%= "10".equals(birth_m) ? "selected" : "" %>>10
     <option value="11" <%= "11".equals(birth_m) ? "selected" : "" %>>11
     <option value="12" <%= "12".equals(birth_m) ? "selected" : "" %>>12
    </select>
   </font></td>
   <td><font size="2">月</font></td>
   <td><font size="3">
    <select name="BIRTH_D">
     <option value="" <%= "".equals(birth_d) ? "selected" : "" %>>@@
     <option value="01" <%= "01".equals(birth_d) ? "selected" : "" %>>01
     <option value="02" <%= "02".equals(birth_d) ? "selected" : "" %>>02
     <option value="03" <%= "03".equals(birth_d) ? "selected" : "" %>>03
     <option value="04" <%= "04".equals(birth_d) ? "selected" : "" %>>04
     <option value="05" <%= "05".equals(birth_d) ? "selected" : "" %>>05
     <option value="06" <%= "06".equals(birth_d) ? "selected" : "" %>>06
     <option value="07" <%= "07".equals(birth_d) ? "selected" : "" %>>07
     <option value="08" <%= "08".equals(birth_d) ? "selected" : "" %>>08
     <option value="09" <%= "09".equals(birth_d) ? "selected" : "" %>>09
     <option value="10" <%= "10".equals(birth_d) ? "selected" : "" %>>10
     <option value="11" <%= "11".equals(birth_d) ? "selected" : "" %>>11
     <option value="12" <%= "12".equals(birth_d) ? "selected" : "" %>>12
     <option value="13" <%= "13".equals(birth_d) ? "selected" : "" %>>13
     <option value="14" <%= "14".equals(birth_d) ? "selected" : "" %>>14
     <option value="15" <%= "15".equals(birth_d) ? "selected" : "" %>>15
     <option value="16" <%= "16".equals(birth_d) ? "selected" : "" %>>16
     <option value="17" <%= "17".equals(birth_d) ? "selected" : "" %>>17
     <option value="18" <%= "18".equals(birth_d) ? "selected" : "" %>>18
     <option value="19" <%= "19".equals(birth_d) ? "selected" : "" %>>19
     <option value="20" <%= "20".equals(birth_d) ? "selected" : "" %>>20
     <option value="21" <%= "21".equals(birth_d) ? "selected" : "" %>>21
     <option value="22" <%= "22".equals(birth_d) ? "selected" : "" %>>22
     <option value="23" <%= "23".equals(birth_d) ? "selected" : "" %>>23
     <option value="24" <%= "24".equals(birth_d) ? "selected" : "" %>>24
     <option value="25" <%= "25".equals(birth_d) ? "selected" : "" %>>25
     <option value="26" <%= "26".equals(birth_d) ? "selected" : "" %>>26
     <option value="27" <%= "27".equals(birth_d) ? "selected" : "" %>>27
     <option value="28" <%= "28".equals(birth_d) ? "selected" : "" %>>28
     <option value="29" <%= "29".equals(birth_d) ? "selected" : "" %>>29
     <option value="30" <%= "30".equals(birth_d) ? "selected" : "" %>>30
     <option value="31" <%= "31".equals(birth_d) ? "selected" : "" %>>31
    </select>
   </font></td>
   <td><font size="2">日生</font></td>
   </tr>
  </table>

  </td></tr>
  <tr>
  <td><font size="2"><font size="2" color="#3366ff">※</font></td>
  <td><font size="2">性別</font></td>
  <td>

  <table border="0" cellspacing="0" cellpadding="0">
   <tr>
   <td><input type="radio" name="SEX" value="男性" <%= "男性".equals(sex) ? "checked" : "" %>></td>
   <td><font size="2">男性</font></td>
   <td><img src="./image/1pix.gif" width="5" height="1"></td>
   <td><input type="radio" name="SEX" value="女性" <%= "女性".equals(sex) ? "checked" : "" %>></td>
   <td><font size="2">女性</font></td>
   </tr>
  </table>

  </td></tr>
  <tr align="left" valign="top">
  <td><img src="./image/1pix.gif" width="1" height="3"><br>  <font size="2"><font size="2" color="#3366ff">※</font></td>
  <td><img src="./image/1pix.gif" width="1" height="3"><br><font size="2">自宅住所</font></td>
  <td>

  <table border="0" cellspacing="0" cellpadding="0" width=100%>
   <tr><td>

   <table border="0" cellspacing="0" cellpadding="0">
    <tr>
    <td><font size="2">〒</font></td>
    <td><font size="3"><input type="text" name="YUBIN1" size="3" maxlength=3 value="<%= ViewHTMLUtil.replaceStr(yubin1) %>"></font></td>
    <td><font size="2">-</font></td>
    <td><font size="3"><input type="text" name="YUBIN2" size="4" maxlength=4 value="<%= ViewHTMLUtil.replaceStr(yubin2) %>"></font></td>
    </tr>
   </table>

   </td></tr>
   <tr>
   <td><font size="3"><textarea name="ADDRESS" cols="50" rows=2><%= ViewHTMLUtil.replaceStr(address) %></textarea></font></td>
   </tr><tr>
   <td>

   <table border=0 cellpadding=0 cellspacing=0>
    <tr>
    <td align=center width=45><font size="2"><font size="2" color="#3366ff">※</font>ＴＥＬ</font></td>
    <td><font size="3"><input type="text" name="TEL" value="<%= ViewHTMLUtil.replaceStr(tel) %>" size="19" maxlength=15></font>
    </td>
    <td align=center width=45><font size="2">ＦＡＸ</font></td>
    <td><font size="3"><input type="text" name="FAX" value="<%= ViewHTMLUtil.replaceStr(fax) %>" size="19" maxlength=15></font></td>
    </tr>
    <tr>
    <td align=center width=45>　</td>
    <td><font size="2">（固定電話または携帯電話）</font></td>
    <td align=center width=45></td>
    <td></td>
    </tr>
    
    <tr>
    <td align=center width=45><font size="2">E-Mail</font></td>
    <td colspan=3><font size="3"><input type="text" name="MAIL" value="<%= ViewHTMLUtil.replaceStr(mail) %>" size="55" maxlength=60></font></td>
    </tr>
   </table>

   </td></tr>
  </table>

  </td></tr>
  </table>
 <!-- Profile End -->

 </td></tr>
 <tr><td align="left" valign="top"><img src="./image/1pix.gif" width="1" height="15"></td></tr>
 <tr>
 <td align="left" valign="top">

 <!-- Work Area -->
 <table border="0" cellspacing="0" cellpadding="2">
  <tr>
  <td colspan="2">

  <table border="0" cellspacing="0" cellpadding="0">
   <tr>
   <td><img src="./image/ar_02.gif" width="29" height="21""></td>
   <td nowrap><font size="2"><b>ご希望のエリア</b></font><font size="2" color="#3366ff">※</font></td>
   </tr><tr>
   <td colspan=2><img src="./image/1pix.gif" width="1" height="10"></td>
   </tr>
  </table>

  </td>
  </tr>
  <tr>
  <td>
  <table align="center" border="0" cellspacing="0" cellpadding="0">
   <tr>
   <td><input type="radio" name="WORKAREA" value="関東" <%= "関東".equals(workarea) ? "checked" : "" %>></td>
   <td><font size="2">関東</font></td>
   <td><img src="./image/1pix.gif" width="16" height="1"></td>
   <td><input type="radio" name="WORKAREA" value="東海" <%= "東海".equals(workarea) ? "checked" : "" %>></td>
   <td><font size="2">東海</font></td>
   <td><img src="./image/1pix.gif" width="16" height="1"></td>
   <td><input type="radio" name="WORKAREA" value="関西" <%= "関西".equals(workarea) ? "checked" : "" %>></td>
   <td><font size="2">関西</font></td>
   <td><img src="./image/1pix.gif" width="16" height="1"></td>
   <td><input type="radio" name="WORKAREA" value="中・四国" <%= "中・四国".equals(workarea) ? "checked" : "" %>></td>
   <td><font size="2">中・四国</font></td>
   <td><img src="./image/1pix.gif" width="16" height="1"></td>
   <td><input type="radio" name="WORKAREA" value="九州" <%= "九州".equals(workarea) ? "checked" : "" %>></td>
   <td><font size="2">九州</font></td>
   </tr>
  </table>

 <!-- Work Area End-->

 </td>
 </tr>
 <tr>
 <td align="left" valign="top">
 <tr><td align="left" valign="top"><img src="./image/1pix.gif" width="1" height="15"></td></tr>
 <tr>
 <td align="left" valign="top">

 <!-- Message -->
 <table border="0" cellspacing="0" cellpadding="0">
  <tr>
  <td colspan=2>

  <table border="0" cellspacing="0" cellpadding="0">
   <tr>
   <td><img src="./image/ar_02.gif" width="29" height="21""></td>
   <td nowrap><font size="2"><b>連絡事項</b>　　</font></td>
   </tr><tr>
   <td colspan=2><img src="./image/1pix.gif" width="1" height="10"></td>
   </tr>
  </table>

  </td></tr>
  <tr><td rowspan=2><img src="./image/1pix.gif" width="15" height="1"></td>
  <td><font size=3><textarea name="PR" cols="63" rows=8><%= ViewHTMLUtil.replaceStr(pr) %></textarea></font></td>
  </tr>
  <tr>
  <td align="right"><font size=2>全角300字以内で入力してください。</font></td>
  </tr>
 </table>
 <!-- Message End -->

 </td></tr>
 <tr><td align="left" valign="top"><img src="./image/1pix.gif" width="1" height="15"></td></tr>
 <tr><td align="left" valign="top"><img src="./image/1pix.gif" width="1" height="15"></td></tr>
 <tr>
 <td align="left" valign="top">

 <table width=100% border=0 cellspacing=0 cellpadding=1 bgcolor=darkgray>
  <tr><td><img src="./image/1pix.gif" width=1 height=1></td></tr>
 </table>

 </td></tr>
 <tr><td align="left" valign="top"><img src="./image/1pix.gif" width="1" height="15"></td></tr>
 <tr>
 <td align="center" valign="top"><br>
  <input type="button" value="確認画面へ" onClick="inputCheck()">
 </td></tr>
</table>
</form>
<br>
<br>
</body>
</html>