（令和６年度 保育所入所申込・無償化申請用）
To gardians
Please let us know if you change your job.

<Blanks for gardians>
保育施設名(Nursery name)

生年月日

児童名（Child's name）(Date of birth)

Notes:If there are any untrue statements on the certificate,your child's admission and daycare practice will be canceled.

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To whom it may concern
See the examples on the back and fill out this form with ball-point pen in all block letters.
We will call or visit your office to confirm the certificate. Thank you for your cooperation.

Certificate of EmploymentI hereby certify that the employee ( has been employed / will be employed ) as mentioned below.
//Office address(MM/ DD / YYYY )Name of the person who wrote this form

Office nameName of employer

STAMP

STAMP

・The Certificate without date of issue and stamp or signature is invalid.
Employee's
name

Employee's
address

Date of employment
Expiry date ofcontract
Type ofemployment//(month/ day / year )//(Write the expired of contract.)
Prospect of continuous employment ( Yes / No )A regular employee / A contract employee / A part-timer / Others(
There is family relationship between the employee and the employer. ( Yes / No )Office address：

Office nameBlanks for office

Office phone number：
Description of job(Write in detail)Type of working timeWorkinghours
・Totalhours
includebreaks.

Rotating shift

am. / pm.

Total () hours

Social insurance（ Yes / No )Fromam. / pm. To

am. / pm.

Total () hours

Withholding slip

（ Yes / No )Fromam. / pm. To

am. / pm.

Total () hours

Pay statement（ Yes / No )Attendance bookor time card

（ Yes / No )hours

Rotating shift: Total working hours per week (including breaks)(basic)days/per monthor・Circle the working days ( Mon.
Tue.
Wed.
by car / bus / walk / Other(Basic pay of monthly (・Write the number ofworking days in last sixmonths.

/(YYYY / MM)・If the employee is on thematernity leave, write thesituation before that.

/(YYYY / MM)・Total pay includes taxes andother reductions except thetransport allowance.

/(YYYY / MM)

yen)

Thu.
)

days/per week
Fri.
Sat.
Sun )
(Oneway)

km/ hourly wage(yen)Commuting distance/ Daily wage(yen)Days worked

days

Total payyen

Days worked

days

Total payyen

Days worked

days

Total payyen/
(YYYY/ MM)/(YYYY/ MM)/(YYYY/ MM)Days worked

days

Total payyen

Days worked

days

Total payyen

Days worked

days

Total payyen

Period of maternity leave

From/

/

(MM/ DD / YYYY ) To//

Period of child-care leave

From/

/

(MM/ DD / YYYY ) To////

Date of returning to work
<For official use only>
調 査 日 調 査 員.

/am. / pm. To

How to commute to work

SalaryFixed shift

FromThe number ofworking days

【市記入欄)

担当者（相手）(MM/ DD / YYYY )
調査・確

認内容.

】

宜野湾市役所 子育て支援課 電話：893-4411 保育児童係（内線：3312・3313）
幼稚園係（内線：3331・3332）

To whom it may concern
We use this application only for entering nursery.
We will call or visit your office to confirm this certificate.
Thank you for your cooperation.
【Notes】
・This certificate must be written by the employer.
・To make corrections, write double line there and put your stamp.
・When the date of issue on the certificate is before the hiring date, it will be invalid.
(Excepting prospective emplyees)
・If there are any untrue statements on the certificate,・the employee's child's admission and daycare practice will be canceled.
・Please make sure to write the number of days the employee worked in last six months.
Please see the notes below and fill out all blanks.
If you have any questions, please contact us.

'≪Contact information≫
Ginowan city nursery school section Tel 098-893-4411 Extension 3312・3313【Working hours】
Write a base basic
working hours on
thecontract.(includingbreaks andexcepting over time.)【Rotating shift】①Write total working
hours per week
including breaks.
②Write usual
working time andtotal working hours
per week.
If the employee has
more than four shift
patterns, pleaseattach the shiftschedule.

The certifcicate without date ofissue, date of employment, expiry
date of contract and stamp or
signature is invalid.

【Office address】
If the employee is hired by staffing company for othercompany and location,①Write staffing company name and address above.
②Write the company name, addres and phone numberthat employee actualy works.

Certificate of Employment
I hereby certify that the employee ( has been employed / will be employed ) as mentioned below.
//(MM/ DD / YYYY )Office address

Name of the person who wrote this form

Office name
STAMP

Name of employer

STAMP

・The Certificate without date of issue and stamp or signature is invalid.
Employee'saddress

Employee's nameDate of employment//(month/ day / year )//(Write the expired of contract.)
Expiry date of contract
Prospect of continuous employment ( Yes / No )Type ofemployment

A regular employee / A contract employee / A part-timer / Others(
There is family relationship between the employee and the employer. ( Yes / No ))Office address

Office name

Office phone number
Description of job(Write in detail)Fixed shift

Type of working time

【The number of workingdays】
Write basic number ofworking days per monthon the contract.

Workinghours
・Totalhours
includebreaks.

/Rotating shift

Fromam. / pm. Toam. / pm. Total () hours

Social insurance（ Yes / No )Fromam. / pm. To

am. / pm. Total () hours

Withholding slip

（ Yes / No )Fromam. / pm. To

am. / pm. Total () hours

Pay statement（ Yes / No )Attendance book or timecard（ Yes / No )hours

Rotating shift: Total working hours per week (including breaks)

The number ofworking days(basic)days/per month ordays/per week
・Circle the working days ( Mon. Tue. Wed. Thu. Fri. Sat. Sun )How to commute to work

SalaryIf the employee works insome rotating shifts, write
avarage days per week ormonth.

【Salary】
Please write basic pay
per month, daily wage
or weekly wage.

by car / bus / walk / Other(Basic pay of monthly (・Write the number of working
days in last six months.

/(YYYY / MM)・If the employee is on thematernity leave, write thesituation before that.

/(YYYY / MM)・Total pay includes taxes andother reductions except thetransport allowance.

/(YYYY / MM)

Period of maternity leave

From

Period of child-care leave

FromDate of returning to workyen))Commuting distance(Oneway)

Kmyen)/ hourly wage(yen)/ Daily wage(Days worked

days

Total payyen

Days worked

days

Total payyen

Days worked

days

Total payyen/

(MM/ DD / YYYY ) To//////(YYYY/ MM)/(YYYY/ MM)/(YYYY/ MM)//(MM/ DD / YYYY ) To//

(MM/ DD / YYYY )Days worked

days

Total payyen

Days worked

days

Total payyen

Days worked

days

Total payyen

【Number of workingdays in last sixmonth】①Days worked→Including paid
holidays②Total pay→Excepting anybonus.
③If the employee
works less than six
month, fill out theblanks as much as
possible.

【Maternity leave andChild-care leave】
If the employee is in
the maternity leave or
child-care leave,
please make sure to
fill out these blanks
and date of returning
to work.