<link href="//netdna.bootstrapcdn.com/bootstrap/3.1.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.1.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<div class="search-background">
<img src="https://lh4.googleusercontent.com/-T4pmKmAS5D4/U0uihfPzEZI/AAAAAAAAA2c/sN0mjJS2bx4/w957-h374-no/141.jpg">
</div>
<div class="well-searchbox">
<form class="form-horizontal" role="form">
<div class="form-group">
<label class="col-md-4 control-label">Keyword</label>
<div class="col-md-8">
<input type="text" class="form-control" placeholder="Keyword">
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label">Country</label>
<div class="col-md-8">
<select class="form-control" placeholder="Country">
<option value="">All</option>
<option value="">Country 1</option>
<option value="">Country 2</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label">Province</label>
<div class="col-md-8">
<select class="form-control" placeholder="Province">
<option value="">All</option>
<option value="">Province 1</option>
<option value="">Province 2</option>
</select>
</div>