(preschool application）

Date：y/m/d/*Please see the Sample in the back
* For correction, please double line and stamp, using white out is not acceptable.

Date must be written! If not, it won`t be
accepted

Certification of Employment
For Mayor of Yomitan Village
Office Name
Office AddressCompanyStamp

Company Representitive
Company Phone Number

I comfirm the information here below is accurate.
Namesign

Form completed by : Name

Address: Aza of Yomitan son,

Date of employment
ValidDatey/

untily/（If period of contract applies)

Type of Employmentm/d（ Hired / in prorocess of hiring ）d/ Continuation（ yes ・ no ・ unknown ）m/full time・part time・contract worker・junior employee・semi full time・others（)

Relative of the applicant?（ yes ・ no ）Type of employment/ Hours of employment
Set Schedule

Shift Schedule

From AM / PM
To AM / PM
Duty Hours（::）h） Break（Duty Days per month（In Contract）

Basic Salary
Job
Description

Monthly(from AM / PM:～ to AM / PM:

Duty hours（h） / Break （）from AM / PM:～ to AM / PM:

Duty hours（h） / Break （）from AM / PM:～ to AM / PM:

Duty hours（h） / Break （）days of a week （ Mon/Tue/Wed/Thur/Fri/Sat/Sun ）days / a month oryen) ・ Daily（yen） ・ Hourly(yen）*choose the one that applies（plese be speciffic）

Total work days per month / total paid salary （including paid leave) in last 3 months

Company medical insurance（ yes ・ no ）Month of （）・Days（day）・Paid Ammount（yen）

W2 Income Tax form

（ yes ・ no ）Month of （）・Days（day）・Paid Ammount（yen）

Salary Slip（ yes ・ no ）Month of （）・Days（day）・Paid Ammount（yen） working schedule or time card

Period of Maternity Leave

y/

m/

d/

toy/

m/d/

Period of Child Care Leavey/m/d/

toy/

m/d/

（ yes ・ no ）（ for sure / planning to ）Returning to work

Office Address(place of employment)*write only if its different than above office address
Office NameOffice AddressCompanyStamp

Company Representitive
Company Phone Number* For the company`s POC, please fill out all the information. Please use company stamp or company representitive signiture.
age（at point of 4/1 ）CompleteName ofd byChild
Parentsage（at point of 4/1 ）Name of current
preschoolage（at point of 4/1 ）※以下は記入しないで下さい
調査日H.

.

調査印

勤務確認

様

Sample Only(preschool application）

Date：y/m/d/*Please see the Sample in the back
* For correction, please double line and stamp, using white out is not acceptable.

Date must be written! If not, it won`t be
accepted

Certification of Employment
For Mayor of Yomitan Village
Office Name

ABC Industry

Office Address

123-1 Zakimi, Yomitan-son

Bill Bob

Company Phone Number098-001-0002

Suzy JapanName

Address: Aza of Yomitan son,100 Nagahama

Date of employment
ValidDate** y/until*y/（If period of contract applies)

Type of Employment

Mike Naha

Written by the name of Naha Mike

I confirm the information below is accurate.

YOMiTANABC

Bill Bob

Company Representitive*m/*d（ Hired / in prorocess of hiring ）*d/ Continuation（ yes ・ no ・ unknown ）*m/full time・part time・contract worker・junior employee・semi full time・others（)

Relative of the applicant? （ yes ・ no ）Type of employment/ Hours of employment
Set Schedule
From AM / PM

Shift Schdule

08 :30To AM / PM 17 : 30
Duty Hours（８）h） Break（ 1hDuty Days per month（In Contract）

Basic SalaryJob
Description

Monthly(from AM / PM:

～ to AM / PM:

Duty hours（h） / Break （）from AM / PM:

～ to AM / PM:

Duty hours（h） / Break （）from AM / PM:

～ to AM / PM:

Duty hours（h） / Break （）days / a month or 5yen) ・ Daily（days of a week （ Mon/Tue/Wed/Thur/Fri/Sat/Sun ）yen） ・ Hourly( 714 yen）*choose the one that applies（plese be speciffic）

CasherTotal work days of a month / total paid salary （including paid leave) in last 3 months

company medical insurance（ yes ・ no ）Month of （ 7）・Days（20 day）・Paid Ammount（114240 yen）

W2 or Income Tax form

（ yes ・ no ）Month of （ 8）・Days（23 day）・Paid Ammount（131376 yen）

Salary Slip

（ yes ・ no ）Month of （ 9）・Days（21 day）・Paid Ammount（119952 yen） working schedule or time card

Period of Maternity Leave

fromy/

m/d/ toy/m/d/Period of Child Care Leave

fromy/

m/d/y/m/d/to（ yes ・ no ）（ for sure / planning to ）Returning to work

□ Planning to return to work as soon as preschool is determined.
Office Address (place of employment)*write only if its different than above office address
Office Name

ABC Industry, Kadena Branch

Office Address 123 Kadena
Company Representitive

Tom Simpson

Company Phone Number

098-300-3000

Tom Simpson

YOMiTANABC*This document will be used for preschool application only.
* For the company`s POC, please fill out all the information. Please use company stamp or company representitive signiture.
Mary Japan

3

Completed Name ofby ParentsChild※以下は記入しないで下さい
H.
調査日.

調査印

age（at point of 4/1 ）Name of current
preschool orage（at point of 4/1 ） Name of #1 wish listof preschoolage（at point of 4/1 ）Yomitan Preschool

勤務確認※If correction、double line with signiture or seal.
*sample*Nahamonth of （ 8 )・Days（ 23 ） Payment Ammount（ Mike180,000円）
190,300様