（令和５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>
園名（在園児）(Nursery name)

生年月日(Date

児童名（Child's name）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 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//Name of employer

STAMPSTAMP

・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)Fixed shift

Type of working timeWorkinghours
・Totalhours
includebreaks.

Rotating shift

Fromam. / pm. To

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 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 )by car / bus / walk / Other(

How to commute to work

Salary/Basic pay of monthly (yen))/ Daily wage(・Write the number of working days in last six months.

yen)/(YYYY/ MM)・If the employee is on the maternity leave, write the situation before
that.

/(YYYY/ MM)・Total pay includes taxes and other reductions except the transport
allowance.

/(YYYY/ MM)

Period of maternity leave

From

Period of child-care leave

From

Date of returning to work
<For official use only>
調査年月日
調査員
Ｈ． ．

Ｈ． ．

相手先担当者//(Oneway)

Commuting distance/ hourly wage(Kmyen)

Days worked

days

Total payyen

Days worked

days

Total payyen

Days worked

days

Total payyen

(MM/ DD / YYYY ) To//////(MM/ DD / YYYY ) To//(MM/ DD / YYYY )調査確認内容宜野湾市役所 子育て支援課 保育児童係 TEL：893-4411 （内線：3312・3313）

（令和５年度保育所入所申込・無償化申請用）

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】

Certificate of Employment
・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 176・178【Working hours】
Write a base basic
working hours onthecontract.(includingbreaks andexcepting over time.)【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.

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

/Days worked(YYYY/
・Write the number of working
days
in lastEmployment
six months.
Totalpay/
Certificate【Rotating shift】
Days ofworked
I (YYYY/
hereby certify thatleave,
the employee( has beentheemployed/ will be employedbefore) as mentionedthat.
below.
・If①Write
the employee
is on the maternity
write
situation
pay/ Total
total workingDaysworked//(MM/DD/YYYY)
Officeaddress(YYYY/
hourspay
perincludes
week taxes and・Totalother reductions
Total pay except the transport allowance.
Name of the person who wrote this form

including breaks.

Office nameSTAMP

②Write usual
working time andtotal working hours
per week.

Name of employer

Employee's
address

Employee's nameDate of employment/

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 phone number
Description of job(Write in detail)W o r kin ghours
・ T o t alhours
in c lu de
br e aks.

Fixed shift/

Rotating shift

Fromam. / pm. To

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 book or timecard（ Yes / No )hours

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

T h e n u m be r o f
wo r kin g 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.

)

Office address

Office nameT ype o f wo r kin g t im e

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

STAMP・The Certificate without date of issue and stamp or signature is invalid.

Expiry date of contract

If the employee has
more than four shift
patterns, pleaseattach the shiftschedule.

【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

From

Date 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 pay

yen///(YYYY/ MM)/(YYYY/ MM)/(YYYY/ MM)Days worked

daysTotal pay

yenDays worked

days

Total payyen

Days worked

days

Total payyen

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

(MM/ DD / YYYY )≪For official use only≫
調査年月日

Ｈ．

．

Ｈ．

．

調査員

相手先担当者

調査確認内容【Number of working
days in last six
month】①Days worked→Including paid
holidays②Total pay→Excepting any
bonus.
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 thematernity leave or childcare leave, please makesure to fill out theseblanks and date of
returning to work.