@extends('layouts.app')

@section('content')
    <div class="container">
        <div class="row justify-content-center">
            <div class="col-md-10">
                {{ Breadcrumbs::render('agency.entry') }}
                <div class="shadow card">
                    <div class="shadow-sm card-header fs-3">労保連労働災害保険事業業務取扱申込画面</div>
                    <form id="entryForm" method="POST" action="{{ route('agency.confirm') }}" autocomplete="off">
                        @csrf
                        <div class="card-body">
                            @if (session('status'))
                                <div class="alert alert-success" role="alert">
                                    {{ session('status') }}
                                </div>
                            @endif
                            <ul>
                                @foreach ($errors->all() as $error)
                                    <li class="fs-6 text-danger">{{ $error }}</li>
                                @endforeach
                            </ul>
                            <div class="d-flex">
                                <div class="col-5">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">事務組合整理番号</span>
                                        <div class="form-floating col-2">
                                            <input type="text"
                                                class="form-control fs-5 @error('ass1') is-invalid @enderror"
                                                name="ass1" id="ass1" maxlength="2" minlength="2" value="{{ old('ass1') }}"
                                                placeholder="99" required>
                                            <label for="ass1">府県</label>
                                        </div>
                                        <div class="form-floating col-5">
                                            <input type="text"
                                                class="form-control fs-5 @error('ass2') is-invalid @enderror"
                                                name="ass2" id="ass2" maxlength="4" minlength="4"
                                                value="{{ old('ass2') }}" placeholder="9999" required>
                                            <label for="ass2">一連番号</label>
                                        </div>
                                    </div>
                                </div>
                                <div class="col-6 ms-3">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">労働保険番号</span>
                                        <div class="form-floating col-2">
                                            <input type="text"
                                                class="form-control fs-5 @error('LINumber') is-invalid @enderror @error('LINumber1') is-invalid @enderror"
                                                name="LINumber1" id="LINumber1" maxlength="2" minlength="2" value="{{ old('LINumber1') }}"
                                                placeholder="99" required>
                                            <label for="LINumber1">府県</label>
                                        </div>
                                        <div class="form-floating col-5">
                                            <input type="text"
                                                class="form-control fs-5 @error('LINumber') is-invalid @enderror @error('LINumber2') is-invalid @enderror"
                                                name="LINumber2" id="LINumber2" maxlength="5" minlength="5"
                                                value="{{ old('LINumber2') }}" placeholder="99999" required>
                                            <label for="LINumber2">基幹番号（上５桁）</label>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="d-flex">
                                <div class="col-4">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">郵便番号</span>
                                        <input type="text"
                                            class="form-control fs-5 @error('post_number_1') is-invalid @enderror"
                                            maxlength="3" minlength="3" name="post_number_1" value="{{ old('post_number_1') }}" required>
                                        <span class="input-group-text bg-secondary-subtle">―</span>
                                        <input type="text"
                                            class="form-control fs-5 @error('post_number_2') is-invalid @enderror"
                                            maxlength="4" minlength="4" name="post_number_2" value="{{ old('post_number_2') }}" required>
                                    </div>
                                </div>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">所在地</span>
                                <input type="text" class="form-control fs-5 @error('address') is-invalid @enderror"
                                    maxlength="255" name="address" value="{{ old('address') }}" required>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">事務組合名</span>
                                <input type="text" class="form-control fs-5 @error('workspace') is-invalid @enderror"
                                    maxlength="255" name="workspace" value="{{ old('workspace') }}" required>
                            </div>
                            <div class="d-flex">
                                <div class="col-6">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">電話番号</span>
                                        <input type="text" maxlength="5" minlength="1"
                                            class="form-control fs-5 @error('tel') is-invalid @enderror" name="tel1"
                                            value="{{ old('tel1') }}" required>
                                        <span class="input-group-text bg-secondary-subtle">―</span>
                                        <input type="text" maxlength="5" minlength="1"
                                            class="form-control fs-5 @error('tel') is-invalid @enderror" name="tel2"
                                            value="{{ old('tel2') }}" required>
                                        <span class="input-group-text bg-secondary-subtle">―</span>
                                        <input type="text" maxlength="4" minlength="1"
                                            class="form-control fs-5 @error('tel') is-invalid @enderror" name="tel3"
                                            value="{{ old('tel3') }}" required>
                                    </div>
                                </div>
                                <div class="col-6 ps-1">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">FAX番号</span>
                                        <input type="text" maxlength="5" minlength="1"
                                            class="form-control fs-5 @error('fax') is-invalid @enderror" name="fax1"
                                            value="{{ old('fax1') }}" >
                                        <span class="input-group-text bg-secondary-subtle">―</span>
                                        <input type="text" maxlength="5" minlength="1"
                                            class="form-control fs-5 @error('fax') is-invalid @enderror" name="fax2"
                                            value="{{ old('fax2') }}" >
                                        <span class="input-group-text bg-secondary-subtle">―</span>
                                        <input type="text" maxlength="4" minlength="1"
                                            class="form-control fs-5 @error('fax') is-invalid @enderror" name="fax3"
                                            value="{{ old('fax3') }}" >
                                    </div>
                                </div>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">メールアドレス</span>
                                <input type="email"
                                    class="form-control fs-5 @error('email') is-invalid @enderror" name="email"
                                    value="{{ old('email') }}">
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">他の業務の種類</span>
                                <input type="text" class="form-control fs-5 @error('anotherwork') is-invalid @enderror"
                                    maxlength="255" name="anotherwork" value="{{ old('anotherwork') }}" required>
                            </div>
                            <div class="d-flex">
                                <div class="col-6">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">募集人の見込数</span>
                                        <input type="number" class="form-control fs-5 @error('target_num') is-invalid @enderror"
                                            name="target_num" value="{{ old('target_num') }}" required>
                                        <span class="input-group-text bg-secondary-subtle fs-5">名</span>
                                    </div>
                                </div>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">代表者氏名</span>
                                <input type="text" class="form-control fs-5 @error('owner') is-invalid @enderror"
                                   maxlength="255" name="owner" value="{{ old('owner') }}" required>
                            </div>
                            <div class="shadow-sm input-group mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">代表者ふりがな  </span>
                                <input type="text" class="form-control fs-5 @error('o_furi') is-invalid @enderror"
                                   maxlength="255" name="o_furi" value="{{ old('o_furi') }}" required>
                            </div>
                            <div class="d-flex">
                                <div class="col-6">
                                    <div class="shadow-sm input-group mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">代表者生年月日</span>
                                        <input type="date" class="form-control fs-5 @error('ownerbirthday') is-invalid @enderror"
                                            name="ownerbirthday" value="{{ old('ownerbirthday') }}">
                                    </div>
                                </div>
                                <div class="col-6 ms-3">
                                    <div class="d-flex mb-3">
                                        <span class="input-group-text bg-secondary-subtle fs-5">代表者性別</span>
                                        <div class="form-check fs-5 my-2 ms-2">
                                            <input class="form-check-input @error('gender') is-invalid @enderror"
                                                type="radio" name="gender" id="gender1" value="1"
                                                {{ old('gender', '1') == '1' ? 'checked' : '' }} required>
                                            <label class="form-check-label" for="gender1">男性</label>
                                        </div>
                                        <div class="form-check fs-5 my-2 ms-2">
                                            <input class="form-check-input @error('gender') is-invalid @enderror"
                                                type="radio" name="gender" id="gender2" value="2"
                                                {{ old('gender','1') == '2' ? 'checked' : '' }}>
                                            <label class="form-check-label" for="gender2">女性</label>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="d-flex mb-3">
                                <span class="input-group-text bg-secondary-subtle fs-5">適格請求書（インボイス）発行事業者登録情報</span>
                                <div class="form-check fs-5 my-2 ms-2">
                                    <input
                                        class="form-check-input @error('invoice') is-invalid @enderror"
                                        type="radio" name="invoice" value="1"
                                        onchange="spChange()" id="flexRadioDefault2"
                                        {{ old('invoice', '1') == '1' ? 'checked' : '' }}>
                                    <label class="form-check-label" for="flexRadioDefault2">登録無</label>
                                </div>
                                <div class="form-check fs-5 my-2 ms-2">
                                    <input
                                        class="form-check-input @error('invoice') is-invalid @enderror"
                                        type="radio" name="invoice" value="0"
                                        onchange="spChange()" id="flexRadioDefault1"
                                        {{ old('invoice', '1') == '0' ? 'checked' : '' }} required>
                                    <label class="form-check-label" for="flexRadioDefault1">登録有</label>
                                </div>
                            </div>
                            <div id="invoice_area" class="d-none">
                                <div class="shadow-sm input-group mb-3">
                                    <span class="input-group-text bg-secondary-subtle fs-5">登録番号（１３桁）</span>
                                    <span class="input-group-text bg-secondary-subtle fs-5">T</span>
                                    <input id="invoice_number" name="invoice_number" type="text" maxlength="13"
                                        class="form-control fs-5 @error('invoice_number') is-invalid @enderror"
                                        onchange="sumvalChange()" value="{{ old('invoice_number') }}">
                                </div>
                                <div class="shadow-sm input-group mb-3">
                                    <span class="input-group-text bg-secondary-subtle fs-5">登録年月日</span>
                                    <input type="date" class="form-control fs-5 @error('invoice_date') is-invalid @enderror"
                                        name="invoice_date" value="{{ old('invoice_date') }}">
                                </div>
                                <div class="shadow-sm input-group mb-3">
                                    <span class="input-group-text bg-secondary-subtle fs-5">登録名称又は氏名</span>
                                    <input type="text" class="form-control fs-5 @error('invoice_name') is-invalid @enderror"
                                       maxlength="255" name="invoice_name" value="{{ old('invoice_name') }}">
                                </div>
                            </div>
                            <div class="d-flex">
                                <a href="{{ route('home') }}" class="fs-5 btn btn-secondary shadow-sm">一覧に戻る</a>
                                <button type="button" class="fs-5 btn btn-secondary shadow-sm"  onClick="submitAfterValidate();"
                                    style="margin:auto 0px auto auto">確認する</button>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
    </div>
    <style>
        label:has(input[type="radio"]:checked) {
            background: #86b7fe;
        }
    </style>
    <script>
        function submitAfterValidate() {
            const form = document.getElementById('entryForm');
            form.submit();
        }
        function spChange() {
            const radio = document.getElementById('flexRadioDefault2');
            const ia = document.getElementById('invoice_area');
            if (radio.checked) {
                ia.classList.add('d-none');
            } else {
                ia.classList.remove('d-none');
            }
        }
        spChange();
        window.addEventListener('pageshow', function (e) {
            if (e.persisted) {
                spChange()
                requestAnimationFrame(() => window.scrollTo({ top: 0, left: 0, behavior: 'auto' }));
            }
        });
    </script>
@endsection