Checkbox value is equal to text box

i have a form which is use to submit data in my sql database table by using PHP.

<form action="" method="POST">
<input type="date" name="date">
<input type="checkbox" name="uniform" value="">
<input type="checkbox" name="Shoe" value="">
<input type="checkbox" name="Glove" value="">
<input type="Submit" value="save" name="save">
</form>

i want to store date in DB Table, for each selected checkbox, how can i pass date in to checkbox value..?

DB Table Design id, uniform_date, Shoe_date, Glove_date.

NOTE: sometime employee issued just 1 thing.