{"id":392,"date":"2024-12-27T16:09:26","date_gmt":"2024-12-27T06:09:26","guid":{"rendered":"https:\/\/www.orphans.org.au\/?page_id=392"},"modified":"2024-12-27T16:10:00","modified_gmt":"2024-12-27T06:10:00","slug":"agent-registration","status":"publish","type":"page","link":"https:\/\/www.orphans.org.au\/?page_id=392","title":{"rendered":"Agent Registration"},"content":{"rendered":"<align=\"center\">\n<div class=\"wlsm wlsm-grid\">\n\t<div id=\"wlsm-submit-staff-registration-section\">\n\n\t\t<div class=\"wlsm-header-title wlsm-font-bold wlsm-mb-3\">\n\t\t\t<span class=\"wlsm-border-bottom wlsm-pb-1\">\n\t\t\t<\/span>\n\t\t<\/div>\n\n\t\t<form action=\"https:\/\/www.orphans.org.au\/wp-admin\/admin-ajax.php\" method=\"post\" id=\"wlsm-submit-staff-registration-form\">\n\n\t\t\t\t\t\t<input type=\"hidden\" name=\"wlom-submit-agent-registration\" value=\"453ca4946c\">\n\n\t\t\t<input type=\"hidden\" name=\"action\" value=\"wlom-p-submit-agent-registration\">\n\n\t\t\t<!-- Personal Detail -->\n\t\t\t<div class=\"wlsm-form-section\">\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"wlsm-col-12\">\n\t\t\t\t\t\t<div class=\"wlsm-form-sub-heading wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u062a\u0641\u0627\u0635\u064a\u0644 \u0627\u0644\u0634\u062e\u0635\u064a\u0629\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_name\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t<span class=\"wlsm-important\">*<\/span> \u0627\u0644\u0625\u0633\u0645 \u0627\u0644\u0643\u0627\u0645\u0644:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"text\" name=\"name\" class=\"wlsm-form-control\" id=\"wlsm_name\" placeholder=\"\u0625\u062f\u062e\u0644 \u0627\u0644\u0627\u0633\u0645\" value=\"\">\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label class=\"wlsm-font-bold wlsm-d-block\">\n\t\t\t\t\t\t\t<span class=\"wlsm-important\">*<\/span> \u0627\u0644\u062c\u0646\u0633:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wlsm-form-check wlsm-form-check-inline\">\n\t\t\t\t\t\t\t\t<input class=\"wlsm-form-check-input\" type=\"radio\" name=\"gender\" id=\"wlsm_gender_\u0630\u0643\u0631\" value=\"male\"  checked='checked'>\n\t\t\t\t\t\t\t\t<label class=\"wlsm-ml-1 wlsm-form-check-label wlsm-font-bold\" for=\"wlsm_gender_\u0630\u0643\u0631\">\n\t\t\t\t\t\t\t\t\t\u0630\u0643\u0631\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wlsm-form-check wlsm-form-check-inline\">\n\t\t\t\t\t\t\t\t<input class=\"wlsm-form-check-input\" type=\"radio\" name=\"gender\" id=\"wlsm_gender_\u0623\u0646\u062b\u0649\" value=\"female\" >\n\t\t\t\t\t\t\t\t<label class=\"wlsm-ml-1 wlsm-form-check-label wlsm-font-bold\" for=\"wlsm_gender_\u0623\u0646\u062b\u0649\">\n\t\t\t\t\t\t\t\t\t\u0623\u0646\u062b\u0649\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\" id=\"registration_dob\">\n\t\t\t\t\t\t<label for=\"wlsm_date_of_birth\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u062a\u0623\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f:\n\t\t\t\t\t\t<\/label><br>\n\t\t\t\t\t\t<input type=\"text\" name=\"dob\" class=\"wlsm-form-control\" id=\"wlsm_date_of_birth\" placeholder=\"\u0627\u062e\u062a\u0631 \u0627\u0644\u062a\u0623\u0631\u064a\u062e\" value=\"\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\" id=\"registration_phone\">\n\t\t\t\t\t\t<label for=\"wlsm_phone\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u0647\u0627\u062a\u0641:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"text\" name=\"phone\" class=\"wlsm-form-control\" id=\"wlsm_phone\" placeholder=\"\u0627\u062f\u062e\u0644 \u0627\u0644\u0647\u0627\u062a\u0641\">\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_email\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u0627\u064a\u0645\u064a\u0644:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"email\" name=\"email\" class=\"wlsm-form-control\" id=\"wlsm_email\" placeholder=\"\u0627\u062f\u062e\u0644 \u0627\u0644\u0625\u064a\u0645\u064a\u0644\">\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_street\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u0634\u0627\u0631\u0639:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"text\" name=\"street\" class=\"wlsm-form-control\" id=\"wlsm_street\" placeholder=\"\u0627\u062f\u062e\u0644 \u0627\u0633\u0645 \u0627\u0644\u0634\u0627\u0631\u0639\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_city\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u0645\u062f\u064a\u0646\u0629:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<select name=\"city\" class=\"wlsm-form-control selectpicker\" id=\"wlsm_city\">\n\t\t\t\t\t\t\t<option value=\"\">\u0625\u062e\u062a\u0631 \u0627\u0644\u0645\u062d\u0627\u0641\u0638\u0629<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"baghdad\">\u0628\u063a\u062f\u0627\u062f<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"naserya\">\u0646\u0627\u0635\u0631\u064a\u0629<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"basra\">\u0627\u0644\u0628\u0635\u0631\u0629<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"najaf\">\u0627\u0644\u0646\u062c\u0641<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"samawa\">\u0627\u0644\u0633\u0645\u0627\u0648\u0629<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"karbala\">\u0643\u0631\u0628\u0644\u0627\u0621<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"wasit\">\u0648\u0627\u0633\u0637<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"maisan\">\u0645\u064a\u0633\u0627\u0646<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"other\">\u0623\u062e\u0631\u0649<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_country\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u0628\u0644\u062f:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<select name=\"country\" class=\"wlsm-form-control selectpicker\" id=\"wlsm_country\">\n\t\t\t\t\t\t\t<option value=\"\">\u2018\u062e\u062a\u0631 \u0627\u0644\u0628\u0644\u062f<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"iraq\">\u0627\u0644\u0639\u0631\u0627\u0642<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"australia\">\u0627\u0633\u062a\u0631\u0627\u0644\u064a\u0627<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"iran\">\u0625\u064a\u0631\u0627\u0646<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"lebanon\">\u0644\u0628\u0646\u0627\u0646<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"syria\">\u0633\u0648\u0631\u064a\u0627<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"other\">\u0628\u0644\u062f \u0627\u062e\u0631<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_nearest_point\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0646\u0642\u0637\u0629 \u062f\u0627\u0644\u0629:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea name=\"nearest_point\" class=\"wlsm-form-control\" id=\"wlsm_nearest_point\" cols=\"30\" rows=\"3\" placeholder=\"\u0625\u062f\u062e\u0644 \u0627\u064a \u0646\u0642\u0637\u0629 \u062f\u0627\u0644\u0629\"><\/textarea>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<div class=\"wlsm-photo-box wlsm-mt-2\">\n\t\t\t\t\t\t\t<div class=\"wlsm-photo-section\">\n\t\t\t\t\t\t\t\t<label for=\"wlsm_photo\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\t\t\u0627\u0644\u0635\u0648\u0631\u0629 \u0627\u0644\u0634\u062e\u0635\u064a\u0629:\n\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"custom-file mb-3\">\n\t\t\t\t\t\t\t\t\t<input type=\"file\" class=\"custom-file-input\" id=\"wlsm_photo\" name=\"photo\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<div class=\"wlsm-photo-box wlsm-mt-2\">\n\t\t\t\t\t\t\t<div class=\"wlsm-photo-section\">\n\t\t\t\t\t\t\t\t<label for=\"wlsm_id_1\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\t\t\u0635\u0648\u0631\u0629 \u0627\u0644\u062c\u0647\u0629 \u0627\u0644\u0623\u0648\u0644\u0649 \u0645\u0646 \u0627\u0644\u0628\u0637\u0627\u0642\u0629 \u0627\u0644\u0648\u0637\u0646\u064a\u0629:\n\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"custom-file mb-3\">\n\t\t\t\t\t\t\t\t\t<input type=\"file\" class=\"custom-file-input\" id=\"wlsm_id_1\" name=\"id_1\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<div class=\"wlsm-photo-box wlsm-mt-2\">\n\t\t\t\t\t\t\t<div class=\"wlsm-photo-section\">\n\t\t\t\t\t\t\t\t<label for=\"wlsm_id_2\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\t\t\u0635\u0648\u0631\u0629 \u0627\u0644\u062c\u0647\u0629 \u0627\u0644\u062e\u0644\u0641\u064a\u0629 \u0644\u0644\u0628\u0637\u0627\u0642\u0629 \u0627\u0644\u0648\u0637\u0646\u064a\u0629:\n\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"custom-file mb-3\">\n\t\t\t\t\t\t\t\t\t<input type=\"file\" class=\"custom-file-input\" id=\"wlsm_id_2\" name=\"id_2\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t<!-- Joining Detail -->\n\t\t\t<div class=\"wlsm-form-section\">\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"col-md-12\">\n\t\t\t\t\t\t<div class=\"wlsm-form-sub-heading wlsm-font-bold\">\n\t\t\t\t\t\t\t\u062a\u0641\u0627\u0635\u064a\u0644 \u0627\u0644\u0639\u0645\u0644 \u0645\u0639 \u0627\u0644\u0635\u0646\u062f\u0648\u0642\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\" id=\"registration_state\">\n\t\t\t\t\t\t<label for=\"wlsm_state\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u062a\u0623\u0631\u064a\u062e \u0627\u0644\u0639\u0645\u0644 \u0645\u0639 \u0627\u0644\u0635\u0646\u062f\u0648\u0642:\n\t\t\t\t\t\t<\/label><br>\n\t\t\t\t\t\t<input type=\"text\" name=\"joining_date\" class=\"wlsm-form-control\" id=\"wlsm_joining_date\" placeholder=\"\u0625\u062e\u062a\u0631 \u0627\u0644\u062a\u0623\u0631\u064a\u062e\">\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_designation\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u062c\u0647\u0629 \u0627\u0644\u0645\u0639\u0631\u0641\u0629:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"text\" name=\"designation\" class=\"wlsm-form-control\" id=\"wlsm_designation\" placeholder=\"\u0627\u0643\u062a\u0628 \u0645\u0646 \u0639\u0631\u0641\u0643 \u0639\u0644\u0649 \u0627\u0644\u0635\u0646\u062f\u0648\u0642\">\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_sms\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\tSend SMS:\n\t\t\t\t\t\t<\/label><br>\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"enable_sms\" id=\"wlsm_enable_sms\">\n\t\t\t\t\t\t<label for=\"wlsm_enable_sms\">\n\t\t\t\t\t\t\tEnable SMS\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_note\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u0645\u0644\u0627\u062d\u0638\u0627\u062a:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"text\" name=\"note\" class=\"wlsm-form-control\" id=\"wlsm_note\" placeholder=\"\u0625\u062f\u062e\u0644 \u0627\u064a \u0645\u0644\u0627\u062d\u0638\u0627\u062a\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t<!-- Login Detail -->\n\t\t\t<div class=\"wlsm-form-section\">\n\t\t\t\t<div class=\"wlsm-row\">\n\t\t\t\t\t<div class=\"wlsm-col-12\">\n\t\t\t\t\t\t<div class=\"wlsm-form-sub-heading wlsm-font-bold\">\n\t\t\t\t\t\t\tLogin Detail\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t<div class=\"wlsm-row wlsm-student-new-user\">\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_username\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0625\u0633\u0645 \u0645\u0633\u062a\u062e\u062f\u0645:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"text\" name=\"username\" class=\"wlsm-form-control\" id=\"wlsm_username\" placeholder=\"\u0627\u0643\u062a\u0628 \u0627\u0633\u0645 \u0645\u0633\u062a\u062e\u062f\u0645 \u0645\u0646\u0627\u0633\u0628\">\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_login_email\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0627\u0644\u0625\u0645\u064a\u0644:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"email\" name=\"login_email\" class=\"wlsm-form-control\" id=\"wlsm_login_email\" placeholder=\"\u0625\u062f\u062e\u0644 \u0627\u0644\u0627\u064a\u0645\u064a\u0644\">\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wlsm-form-group wlsm-col-4\">\n\t\t\t\t\t\t<label for=\"wlsm_login_password\" class=\"wlsm-font-bold\">\n\t\t\t\t\t\t\t\u0643\u0644\u0645\u0629 \u0645\u0631\u0648\u0631:\n\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<input type=\"password\" name=\"password\" class=\"wlsm-form-control\" id=\"wlsm_login_password\" placeholder=\"\u0623\u062e\u062a\u0631 \u0643\u0644\u0645\u0629 \u0645\u0631\u0648\u0631\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\n\t<div class=\"wlsm-border-top wlsm-pt-2 wlsm-mt-1\">\n\t\t<button class=\"button wlsm-btn btn btn-primary\" type=\"submit\" 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