在 留 资 格 认 定 证 明 书 交 付 申 请 书

MinistryofJustice,GovernmentofJapanTotheDirectorGeneralofRegionalImmigrationBureauPursuanttotheprovisionsofArticle7-2oftheImmigration-ControlandRefugee-RecognitionAct,IherebyapplyforthecertificateshowingeligibilityfortheconditionsprovidedforinArticle7,Paragraph1,Item2ofthesaidAct.photoFamilynameGivennamesNationalityNameSexMale/FemaleDateofbirthYearMonthDayPlaceofbirthMaritalstatusMarried/SingleOccupationHometown/cityAddressinJapanTelephoneNo.PassportNumberDateofexpirationYearMonthDayPurposeofentry;Identifyoneofthefollowing.Professor/InstructorArtist/CulturalActivitiesReligiousActivitiesJournalist/Intra-companyTransfereeInvestor/BusinessManagerResearcher/Engineer/SpecialistinHumanities/InternationalServices/SkilledLaborEntertainerCollegeStudent/Pre-collegeStudentTraineeDependentSpouseorChildofJapaneseNational/SpouseorChildofPermanentResident/LongTermResidentOthersDateofentryYearMonthDayPortofentryIntendedlengthofstayAccompanyingpersons,ifanyYes/NoPlacetoapplyforvisaPastentryinto/stayinJapanYesTimesThelatestentryYearMonthDaytoYearMonthDay/NoCriminalrecordinJapanoroverseasYesDetails:/NoFamilyinJapanFather,Mother,Spouse,Son,Daughter,Brother,Sisterorothersorco-residentsRelationshipNameDateofbirthNationalityResidingwithPlaceofemployment/StatusofresidenceapplicantornotschoolNote:PleasefillinFormPart2andPart3.SeeNotesonReverseSide.FOROFFICIALUSEONLYYes/NoYes/NoYes/NoYes/NoYes/NoNotesSelecttypeofformwhichcorrespondstothepurposeofentryinJapan.PurposeofentryExampleAcademicorartisticactivitiesthatprovidenoincome,oractivitiesforthepurposeofpursuinglearningandacquiringJapanesecultureorartsDependentwhointendstolivewithhisorhersupporterActivitiesofspecialistswhohavebeentransferredtoabusinessofficeinJapanforalimitedperiodoftimeActivitiesforresearch,researchguidanceoreducationatcollegesProfessorJuniorhighschoolteacherMusician,PhotographerStudyteaceremony,judoBishop,MissionaryJournalist,NewsPhotographerEmployeeassignedtoaforeignfirmPresident,DirectorofaforeignfirmEngineerofmechanicalengineeringInterpreter,DesignerSinger,ModelCollegestudent,Pre-collegestudentTechnicalorProfessionaltraineeSpouseofJapanesenationalLawyer,DoctorAmateursportsathleteForeigncuisinechefSport'sinstructorReseacherofagovernmentbodyorcompanyActivitiestoengageinlanguageinstructionatjuniorhighschoolsandhighschoolsetc.ActivitiesfortheartsthatprovideanincomeReligiousactivitiesconductedbyforeignreligionistsdispatchedbyforeignreligiousorganizationsJournalisticactivitiesconductedonthebasisofacontractwithaforeignpressorganizationInvestment,OperationorManagementActivitiestoengageinresearchthatprovideincomeActivitiestoengageinserviceswhichrequireknowledgepertinenttonaturalsciencefieldsActivitiestoengageinserviceswhichrequireknowledgepertinenttohumansciencefieldsActivitiestoengageinserviceswhichrequireskillsbelongingtospecialfieldsEntertainmentSpouseorchildofJapanesenational,PermanentresidentStudyTrainingOtherpurposesNoteIfitisfoundthatyouhavemisrepresentedthefactsinanapplication,youwillbeunfavorablytreatedintheprocess.Ifthespaceprovidedisnotsufficientforyouranswer,writeonaseparatepieceofpaperandattachittotheapplication.AllpartsofthisapplicationmustbeonJISsizeA4Paper210297.AsprovidedforinaMinistryofJusticeOrdinance,aproxyisabletoapplyforthecertificateofeligibility,suchasanemployeebelongingtotheorganizationwhichwillaccepttheapplicantorrelationsetc.oftheapplicantwholiveinJapan.PartProfessor/InstructorForcertificateofeligibilityPlaceofemploymentNameAddressTelephoneNo.NumberofforeignemployeesTypeofworkperiodofworkResearchResearchguidanceEducationMonthlysalaryPositionyouholdEducationlastschoolorinstitutionDoctorMasterBachelorJuniorcollegeCollegesoftechnologySeniorhighschoolJuniorhighschoolOthersNameofschoolDateofgraduationYearMonthDayMajorfieldofstudyincasethatyouranswerinthequestion25isfromdoctortojuniorcollegeLawEconomicsPoliticsCommercialManagementLiteratureLinguisticsSociologyHistoryPsychologyEducationScienceofartOthersCollegeofsocialscienceScienceChemistryEngineeringAgricultureFisheriesPharmacyMedicineDentistryOthersCollegeofnaturalsciencePhysicaleducationOthersincasethatyouranswerinthequestion25iscollegesoftechnologyEngineeringAguricultureMedicalservices/HygienicsEducation/SocialwelfareLawPracticalcommercialbusinessDressdesign/HomeeconomicsCulture/EducationOthersEmploymenthistoryfillin28to30ifyouhaveappliedforthecertificateofeligibilityInstructorTeacher'scertificateYes/NoTeachingexperienceofthesubjectthatyouareplanningtoteachYearsTotalperiodofreceivingforeignlanguageeducationifyouareplanningonteachingaforeignlanguageApplicant,legalrepresentativeortheproxyinaccordancewiththeprovisionofArticle7-2,Paragraph2.NameRelationshipwiththeapplicantAddressTelephoneNo.Iherebydeclarethatthestatementgivenaboveistrueandcorrect.SignatureofapplicantlegalrepresentativeortheproxyYearMonthDayAgentorotherincaseofanagent,lawyer,administrativescrivenerorotherNameAddressOrganizationtowhichtheagentbelongsTelephoneNo.YearMonthEmploymenthistoryYearMonthEmploymenthistoryRefereProfessorInstruct