BIODATA

在留資格認定証明書交付申請書（N） · Application for Certificate of Eligibility — Form "N"
Name

I. · Applicant — Personal

Nationality / Region
Date of birth
Name (Family / Given)
Sex
Place of birth (District, Nepal)
Marital status
Occupation
Permanent address (home country)
Current address (Nepal)
Phone No.
Mobile No.
Email
Emergency contact — Name
Emergency contact — Phone
Passport No. / Expiry
Status of residence
技術・人文知識・国際業務 · Engineer / Humanities Specialist / Int'l Services
Past entry / departure
Past CoE applications
Criminal record (incl. traffic)
Deportation / departure order
Family in Japan / cohabitant

II. · Family Details

続柄 Relationship氏名 Name生年月日 DOB国籍 Nationality職業 Occupation現住所 Address
父 Father
母 Mother
兄弟姉妹 Sibling
兄弟姉妹 Sibling

配偶者（妻）は「6. 配偶者の有無」で「既婚」を選択すると上部に入力欄が表示されます。 Spouse (wife) fields appear above when "Married" is selected in item 6.

III. · Education & Work Experience

Education
Level
Name of school
Date of graduation
Major
IT qualification / exam
Japanese proficiency
Employer name
Employer address
Employer phone
Employer email

28. 職歴 Work experience

勤務先名称 Place of employment入社 Joined退社 Left

IV. · TB Screening

Panel Clinic name
Test date (chest X-ray)
Certificate issue date
Expiry (auto)
検査日を入力すると自動計算 / auto from X-ray date
TB clearance