履歴書 PERSONAL RECORDS
活字体ではっきりと書いてください。Please Print. 請用正規的漢字填写。
■Ⅰ.
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国籍 |
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氏名（漢字） |
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Nationality |
Name (Kanji / if
applicable) |
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性別 |
□女
□男 |
氏名（英字） |
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Gender Female/Male |
Name Family
Name Middle Name First Name |
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生年月日 |
/ / |
出生地 |
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Date of Birth
Year / Month / Day |
Place of Birth |
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配偶者の有無 |
□無 □有 (配偶者の名前: ) |
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Married Status |
Single/Married (Name of Spouse:
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現住所 |
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Address (in home country) |
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■Ⅱ. 家族(Family Member)
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氏名 |
続柄 |
年齢 |
職業 |
居住地 |
電話番号 |
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Name |
Relation |
Age |
Occupation |
Address |
TEL |
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1 |
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父(father) |
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2 |
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母(mother) |
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3 |
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4 |
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5 |
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■Ⅲ.学歴－初等教育から順次最終学歴まで(Educational Record-from elementary education to the last education)
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学校名 |
所在地 |
入学年月日 |
卒業年月日 |
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Name of School |
Address |
Date of Entrance 年(Year) / 月(month) |
Date of Graduate 年(Year) / 月(month) |
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1 |
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/ |
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2 |
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/ |
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3 |
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/ |
/ |
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4 |
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/ |
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5 |
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/ |
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6 |
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/ |
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■Ⅳ.職歴(Work Experience)
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勤務先名 |
所在地 |
入社年月日 |
退職年月日 |
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Place of Employment |
Address |
Date of Entrance 年(Year) / 月(month) |
Date of Resignation 年(Year) / 月(month) |
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1 |
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/ |
/ |
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2 |
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/ |
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3 |
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/ |
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■Ⅴ.兵役(Military Service)
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兵役期間 □無 □有 Term of Military Service
(Not Served / Served) |
From 年(Year)/月(Month) To 年(Year)/月(Month) / － / |
■Ⅵ.学歴・職歴以外の期間が六ヶ月以上ある場合は、その期間と理由を書いてください。
If there is any blank period of more than six months other than your educational background and work experience, please write its period of time and reasons.
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■Ⅶ.日本語学習歴(Record of Japanese Language Study)
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日本語学習(Japanese Language Study) □無(Never) □有(Have Studied
Before) |
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学校名 |
所在地 |
入学年月日 |
修了年月日 |
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Name of School |
Address |
Date of Entrance 年(Year) / 月(month) |
Date of Completion 年(Year) / 月(month) |
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1 |
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/ |
/ |
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2 |
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/ |
/ |
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■Ⅷ.出入国歴－全ての来日歴を記入(Record of Previous Stay in Japan-Please fill out all previous stays in Japan)
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日本滞在(Stay in Japan) □無(Never) □有(Have Stayed
Before) |
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入国年月日 |
出国年月日 |
在留資格 |
入国目的 |
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Date of Entry 年(Year) /月(month)/日(Day) |
Date of Departure 年(Year) /月(month)/日(Day) |
Status |
Purpose of Entry |
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1 |
/ / |
/ / |
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2 |
/ / |
/ / |
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3 |
/ / |
/ / |
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■Ⅸ.就学理由－足りない場合は別紙記入(Purpose of Study-please attach a paper, if you would like to write more)
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■Ⅹ.就学後の予定 －下記[1][2]のいずれかに記入してください。
(Specific Plan After Graduation –Please Complete One of the Following.)
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1 |
進学希望先学校名 (Name of School
Wish To Enroll) |
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希望専攻科目 (Your Major Will Be) |
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2 |
その他 (Other) |
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以上のことはすべて事実であり、申請者が直筆したものです。
I hereby declare the above statement is true and correct. Personal Records must be completed by the applicant in his or her own handwriting.
作成日(Date) 年(year) 月(month) 日(day)
申請人署名(Signature) 印