<%= f.label :number %>
<%= f.text_field :number %>

<%= f.label :firstname %>
<%= f.text_field :firstname %>

<%= f.label :lastname %>
<%= f.text_field :lastname %>

<%= f.label :ssn %>
<%= f.text_field :ssn %>

<%= f.label :dob %>
<%= f.date_select :dob, :start_year => Time.now.year - 70, :end_year => Time.now.year - 17, :default => Time.now - 30.years %>

<%= f.label :hired %>
<%= f.date_select :hired, :start_year => Time.now.year - 10, :end_year => Time.now.year + 1 %>

<%= f.label :tax_status %>
<%= f.text_field :tax_status %>

<%= f.label :dependents %>
<%= f.text_field :dependents %>

<%= f.label :payrate %>
<%= f.text_field :payrate %>

<%= f.submit "Submit" %>