Reference Form 1-3 (related to Article 8, Item(iv)of the Ordinance) （Japanese Industrial Standards A Row 4)
Ａ・Ｂ・Ｃ・Ｄ・Ｅ・Ｆ
CURRICULUM VITAE OF THE TECHNICAL INTERN TRAINEE
Prepared on YY/MM/DD
Roman
2 Gender Male / Female
letters
1
Name Kanji
3 Date of Year Month Day (Age:
charact
birth )
ers
4
Nationality 5
Language:
(country or Native language
region)
6
Current address
Period Name of school
7 ～
Educational
background ～
～
Period Name/place of employment (Occupation)
（
～
）
（
～
8 ）
Employment
（
history ～
）
（
～
）
（
～
）
9
Employment
history
Type of work: Type of work:
pertaining to the
No. of years: No. of years:
skills, etc. the
trainee intends to
acquire
10 Previous □Yes (From: to: ) *Eligibility: □Technical intern training □ Others)・□No
□ If you have worked in Japan on a Foreign Construction/Shipbuilding Worker Acceptance
Program:
Duration of return to home country after Technical Intern Training Program II
（from: Year Month Day, to: Year Month Day）
Duration of return to home country after employment in construction/shipbuilding
visits to Japan （from: Year Month Day, to: Year Month Day）
□ If you have worked in Japan on an Acceptance Program for Candidates for Nurses and
Certified Careworkers under the Economic Partnership Agreement (EPA):
Duration of return to home country after working as a nurse/certified careworker candidate
（from: Year Month Day, to: Year Month Day）
□Yes (From: to: ) ・ □No
11
□Ａ (Individual-enterprise-type □Ｄ (Supervising-organization-type
Previous
technical intern training (i)) technical intern training (i))
experience of
□Ｂ (Individual-enterprise-type □Ｅ (Supervising-organization-type
technical intern
technical intern training (ii)) technical intern training (ii))
training and its
□Ｃ (Individual-enterprise-type □Ｆ (Supervising-organization-type
category
technical intern training (iii)) technical intern training (iii))
12 Previous
non-issuance of
□Yes (From: to: ) / □ No
a certificate of
eligibility
13 Others
14 Signature
of the technical
intern trainee
Notes;
For Section 1, please write the name exactly as given in the passport in Roman letters (if a passport has not yet been
issued, the name used in the passport application), and if there is a name in Kanji characters, please write it together with
the Roman letters)
Reference Form 1-10 (related to Article 4, item (viii) of the Ordinance)
(Japanese Industrial Standards A Row 4)
Page D, E, F
WRITTEN PLEDGE OF THE INTERMEDIATING ORGANIZATION ON
ACCREDITATION OF THE TECHNICAL INTERN TRAINING PLAN
I hereby pledge the following matters at the time of mediating supervising-organization-type technical
intern training for the following technical intern trainee of the following applicant.
Name of the applicant
(implementing organization)
Name of the supervising
organization
Name of the technical intern
trainee (nationality)
Details
【Details of the pledge】
1. I pledge that our organization will never collect deposits or otherwise manage the property of
supervising-organization-type technical intern trainees, their relatives, or other related persons,
regardless of the reason therefor.
2. I pledge that our organization will not impose penalties, etc. on the supervising-organization-type
technical intern trainee, the implementing organization of supervising-organization-type technical
intern training, the supervising organization or the preparatory organization in a foreign country in
preparation for the possibility of the non-performance of a contract pertaining to technical intern
training by a supervising-organization-type technical intern trainee.
3. The supervising-organization-type technical intern trainee, etc. has entered into an agreement having
sufficiently understood the amount and the breakdown of expenses to be paid to the applicable
organization in relation to the mediation for the application for supervising-organization-type technical
intern training or the preparations for the supervising-organization-type technical intern training in a
foreign country.
4. In addition to the above, I hereby pledge that our organization will never violate any laws or ordinances
relating to technical intern training.
Prepared on DD/MM/YY
Name of the intermediating organization
Name and title of person preparing this written pledge Seal
Reference Form 1-13 (related to Article 8, item (xii) of the Ordinance)
(Japanese Industrial Standards A Row 4)
Pages A, B, C, D, E, F
WRITTEN SUMMARY AND WRITTEN PLEDGE OF THE PREPARATORY
ORGANIZATION IN A FOREIGN COUNTRY
① Name of the
organization
②Name of the
representative
③ Address
(Tel.: )
(Email: )
④ Date of
Date:
establishment
⑤Connection □ Person involved in implementing pre-entry lectures
to the technical □ Others (Details of preparations: )
intern trainee
⑥Industry,
major products
and key
business
Notes.
Sections ⑦ and ⑧. Give the amount in the local currency or USD, and write the amount converted into
Japanese yen in parentheses.
I hereby declare that the statement given above is true and correct. In addition, I hereby pledge that
our organization will never violate any laws or regulations relating to technical intern training in relation
to the preparations for the technical intern training.
Prepared on DD/MM/YY
Name of preparatory organization in a foreign country
Name and title of person preparing this written summary and written pledge Seal
Reference Form 1-19 (related to Article 8, item(xvii)of the Ordinance) (Japanese Industrial Standards A Row 4)
Ａ・Ｄ
WRITTEN EXPLANATION OF IMPORTANT MATTERS RELATING TO TREATMENT
DURING THE PERIOD OF THE TECHNICAL INTERN TRAINING
To:
I hereby explain the treatment given to technical intern trainees during the period of the technical intern
training as given below. Since the contents are important, we ask that you take time to fully understood
each section.
1 Treatment during intern training
The period of employment contract, place of employment (technical intern training), contents of work to be
engaged in (occupation and operations), work hours, etc., holidays, vacation, wages, matters concerning
resignation, social insurance, labor insurance, accommodation, and other matters are as indicated in the
accompanying sheet, “written employment conditions.”
（Note） Attach a picture or floor plan of the accommodation in order to illustrate the outline of said accommodation.
2 Treatment during the post-entry lectures
1 Lectures ①Payment of an ☐ Yes(Allowance amount / Details of the allowance: ）☐ No
allowance (per allowance
month) ②Remarks
①Payment of an
☐Yes (Details of allowance: ) □No
allowance
②Expenses to
2 Food allowance
be paid by the
(per month) ☐Yes (Details of the expenses: ) □No
technical intern
trainee
③Remarks
3 ①Payment of an
Accommodation allowance □Yes (Details of allowance: ) □No
allowance (per
②Expenses to
month)
be paid by the
□Yes (Details of the expenses: ) □No
technical intern
trainee
③Type of
□Dormitory (boarding)/ □Rented housing/ □Others ( )
accommodation
④Name of
accommodation
⑤Address 〒 －
(Tel.: ― ― )
⑥Size Area ( m2), Capacity (No. of persons: ), Room size per person ( m2)
４ Others
（Note）For Section 4, please give a description if there are any special details such as an allowance other than those listed in
Sections 1 to 3
3 Changes in the training site (for supervising-organization-type)
Changes in the training site are possible, except for cases where there are unavoidable
circumstances, if the technical intern trainee wishes to engage in technical intern training that
corresponds to the item iii, having achieved the goal of technical intern training that corresponds to the
item ii, (passing the practical skills test of the Grade 3 Trade Skills Test), and moreover, an excellent
implementing organization of technical intern training or an excellent supervising organization agrees
to accept the technical intern trainee.
4 Other matters
（Note） Please give a description if there are any special details that need to be noted.
I have given an explanation of the above contents.
Year Month Day
Name of person giving the explanation: Seal
(Relation to the applicant (Implementing Organization): )
I hereby declare that I received an explanation on the above contents from the abovementioned person
giving the explanation, and fully understood the contents.
Year Month Day
Signature of the Technical Intern Trainee
Reference Form 1-19 (related to Article 8, item(xvii)of the Ordinance) (Japanese Industrial Standards A Row 4)
Ｂ・Ｃ・Ｅ・Ｆ
WRITTEN EXPLANATION OF IMPORTANT MATTERS RELATING TO TREATMENT
DURING THE PERIOD OF THE TECHNICAL INTERN TRAINING
To:
I hereby explain the treatment given to technical intern trainees during the period of the technical intern
training as given below. Since the contents are important, we ask that you take time to fully understood
each section.
1 Treatment during intern training
The period of employment contract, place of employment (technical intern training), contents of work to
be engaged in (occupation and operations), work hours, etc., holidays, vacation, wages, matters
concerning resignation, social insurance, labor insurance, accommodation, and other matters are as
indicated in the accompanying sheet, “written employment conditions.”
（Note） Attach a picture or floor plan of the accommodation in order to illustrate the outline of said accommodation.
2 Changes in the training site (for supervising-organization-type)
Changes in the training site are possible, except for cases where there are unavoidable
circumstances, if the technical intern trainee wishes to engage in technical intern training that
corresponds to the item iii, having achieved the goal of technical intern training that corresponds to the
item ii, (passing the practical skills test of the Grade 3 Trade Skills Test), and moreover, an excellent
implementing organization of technical intern training or an excellent supervising organization agrees
to accept the technical intern trainee.
3 Other matters
（Note） Please give a description if there are any special details that need to be noted.
I have given an explanation of the above contents.
Year Month Day
Name of person giving the explanation Seal
(Relation to the applicant (Implementing Organization): )
I hereby declare that I received an explanation on the above contents from the above-mentioned person
giving the explanation, and fully understood the contents.
Year Month Day
Signature of the Technical Intern Trainee
Reference Form 1-20 (related to Article 8, item (xviii) of the Ordinance)
(Japanese Industrial Standards A Row 4)
Pages A, B, C, D, E, F
WRITTEN DECLARATION OF THE TECHNICAL INTERN TRAINEE
I hereby declare the following matters.
Details
I am aware that the purpose of the technical intern training program in Japan is to promote international
cooperation by transferring skills, etc. to developing regions etc.
I wish to acquire skills, etc. pertaining to ________________ that would be difficult to acquire, etc. in
my home country of ___________________, and when I return to my home country after completing the
technical intern training, I would like to work on transferring the skills, etc. to my home country through
_____________________.
In order to engage in the technical intern training in Japan, neither I nor any person related to me has
entered a contract giving a deposit to another person. In addition, I do not expect to enter into such a
contract in the future.
In order to engage in the technical intern training in Japan, neither I nor any person related to me is
having money or other property controlled by another person. In addition, I do not expect to enter into
such a contract in the future.
In order to engage in the technical intern training in Japan, neither I nor any person related to me has
entered into a contract to pay a penalty in cases of non-performance of the contract pertaining to the
technical intern training such as when the prescribed technical intern training has not been completed as
planned. In addition, I do not expect to enter into such a contract in the future.
I hereby declare that the statement given above is true and correct.
Date:
Signature of the technical intern trainee _________________
Reference Form 1-21 (related to Article 8, item (xix) of the Ordinance)
(Japanese Industrial Standards A Row 4)
Pages D, E, F
WRITTEN STATEMENT OF EXPENSES PAID IN THE HOME COUNTRY RELATING TO
PREPARATIONS FOR THE TECHNICAL INTERN TRAINING
1. Summary of sending a technical intern trainee to Japan
Roman
① Name of the letters
technical intern
trainee Kanji
characters
② Name of the intermediating
sending organization
③ Name of the implementing
organization of the technical intern
training
④ Name of the supervising
organization
Notes.
Section ①. Write the name exactly as given in the passport in Roman letters (if a passport has not yet been issued, the
name used in the passport application), and if there is a name in kanji characters, give it together with the Roman letters).
2. Items and amounts of expenses collected by the intermediating sending organization
Item Date of collection Amount
１ DD/MM/YY ( yen)
２ DD/MM/YY ( yen)
３ DD/MM/YY ( yen)
４ DD/MM/YY ( yen)
５ DD/MM/YY ( yen)
Total ( yen)
Notes.
Give the amount in the local currency or USD, and write the amount converted into Japanese yen in
parentheses.
3. Items and amounts of expenses collected by the preparatory organization in a foreign country
Name of the organization collecting the Item Date of Amount
expenses (role in sending the technical intern
collection
trainee)
1 （ ） DD/MM/YY ( yen)
2 （ ） DD/MM/YY ( yen)
3 （ ） DD/MM/YY ( yen)
4 （ ） DD/MM/YY ( yen)
5 （ ） DD/MM/YY ( yen)
Total ( yen)
Notes.
1. Preparatory organizations in a foreign country include all organizations involved in the preparations of the technical
intern training such as the place of employment in the home country of the technical intern trainee and the
organization that conducts the pre-entry lectures.
2. In addition to the name, describe the role played by the organization collecting the expenses in sending the technical
intern trainee in parentheses.
3. Give the amount in the local currency or USD, and write the amount converted into Japanese yen in parentheses.
We have collected expenses of the amounts given in 2 from the technical intern trainee, and have
ensured that the technical intern trainee sufficiently understands the breakdown of the expenses, and we
are also aware that another organization involved in sending the technical intern trainee has collected the
expenses given in 3 from the technical intern trainee. In addition, we have confirmed that no other
expenses except for those given in 2 and 3 are being collected from the technical intern trainee.
Prepared on DD/MM/YY:
Name of intermediating sending organization
Name and title of person preparing this written statement Seal
I paid the amounts described in 2 and 3 to the intermediating sending organization and other
organization involved in sending me to Japan, and understand the breakdown of the expenses. In addition,
I have not been paid any expenses other than the expenses listed in 2 and 3.
Prepared on DD/MM/YY:
Signature of the technical intern trainee _________________
Reference Form 1-23 (related to Article 8, item (xxi) of the Ordinance)
(Japanese Industrial Standards A Row 4)
Pages D, E, F
LETTER OF RECOMMENDATION FOR THE TECHNICAL INTERN TRAINEE
We hereby recommend that _________________________, the technical intern trainee to be sent by
_________________________, the sending organization of our country engage in technical intern
training pertaining to ___________________ from (MM/YY ) to be accepted by
___________________________, the implementing organization via
_____________________________, the supervising organization in Japan.
This letter of recommendation shall be valid for one year from the date of issue.
Prepared on DD/MM/YY:
Name of public organization:
Name and title of person preparing this letter of recommendation Seal
(Official seal)
Reference Form 2-9 (related to Article 27, paragraph (1), item (xi)(a) of the Ordinance)
(Japanese Industrial Standards A Row 4)
No.
WRITTEN SUMMARY OF THE SENDING ORGANIZATION IN A FOREIGN COUNTRY
① Name of
the
organization
② Name of
the
representative
③ Address
(Tel.: )
(Email: )
④Date of
DD/MM/YY:
establishment
⑤ Industry
and key
business
⑥Capital
( yen)
amount
⑦Sales (most
( yen)
recent year)
⑧No. of full-
time No.:
employees
⑨ Name of
administrator
I Name
Postal code -
II Address
(Tel.: - - )
⑩Contact III Name of
details in Japan representative (in
cases of a
juridical person)
IV No. of
employees
Notes.
1. Do not write anything in sections that have this mark ※.
2. Sections ⑥ and ⑦. Give the amount in the local currency or USD, and write the amount converted into Japanese yen
in parentheses.
3. Section ⑨. Write details of the person responsible for conducting the business relating to the technical intern training.
4. Section ⑩. Fill this section in if you have a place of business in Japan.
I hereby declare that the statement given above is true and correct.
Prepared on DD/MM/YY:
Name of sending organization in a foreign country
Name and title of person preparing this written summary Seal
Reference Form 2-10 (related to Article 27, paragraph (1), item (xi) (d) of the Ordinance)
(Japanese Industrial Standards A Row 4)
WRITTEN STATEMENT OF EXPENSES COLLECTED BY THE SENDING ORGANIZATION
IN A FOREIGN COUNTRY
Expenses collected by the sending organization in a foreign country
Item Timing of collection Amount and calculation method
( yen)
1
( yen)
2
( yen)
3
( yen)
4
( yen)
5
Total ( yen)
Notes.
1. Give the amount in the local currency or USD, and write the amount converted into Japanese yen in
parentheses.
2. If the amount cannot be given due to such reason as the amounts differing for each technical intern,
describe the method used to calculate the amount.
I hereby declare that the statement given above is true and correct. In addition, when collecting the
expenses in the amounts stated above from the technical intern trainee, we will ensure that the technical
intern trainee fully understands the breakdown of the expenses.
Prepared on DD/MM/YY:
Name of sending organization in a foreign country:
Name of person preparing this written statement: Seal
Reference Form 2-11 (related to Article 27, paragraph (1), item (xi) of the Ordinance)
(Japanese Industrial Standards A Row 4)
WRITTEN PLEDGE OF THE SENDING ORGANIZATION IN A FOREIGN COUNTRY
RELATING TO THE LICENSE FOR SUPERVISING ORGANIZATIONS
I hereby pledge the following matters at the time of mediating the applications for supervising-
organization-type technical intern training for the supervising organization given below.
Name of the applicant
(supervising organization)
Details
【Details of the pledge】
1. I pledge that our organization has been recommended by a public organization of the country or region
in which the place of business conducting business relating to sending supervising-organization-type
technical intern trainees to Japan is located as a sending organization which is able to appropriately
mediate the applications for supervising-organization-type technical intern training for the supervising
organization in Japan.
2. I pledge that our organization will appropriately select and send to Japan only those persons, who
intend to engage in supervising-organization-type technical intern training having understood the
purpose of the system.
3. I pledge that our organization will clearly state and make the method of calculating the fees and other
expenses to be collected from the supervising-organization-type technical intern trainees, etc. public,
and will also clearly explain these expenses to the supervising-organization-type technical intern
trainees to ensure they are fully understood.
4. I pledge that our organization will provide assistance for employment placement and other necessary
support so that those who have completed the supervising-organization-type technical intern training
and who have returned to their home country are able to appropriately utilize the skills, etc. that they
have acquired.
5. I pledge that our organization will cooperate with any surveys conducted by the Minister of Justice and
the Minister of Health, Labor and Welfare, or OTIT on the status of transfer, etc. of the skills etc. by
persons who have completed the supervising-organization-type technical intern training, and any other
requests relating to proper implementation of technical intern training and protection of the technical
intern trainees received from the Minister of Justice and the Minister of Health, Labor and Welfare, or
OTIT.
6. I pledge that neither our organization nor any of our officers are persons who have been sentenced to
imprisonment or a greater punishment (including equivalent punishments imposed in accordance with
foreign laws and regulations), and for whom five years have not yet passed since the completion of the
sentence or since the date on which the person ceased to be subject to the execution of the sentence.
7. I pledge that our organization will conduct business related to the technical intern training in
accordance with the laws and regulations of the country or region where the place of business
conducting business relating to sending the supervising-organization-type technical intern trainees to
Japan is located.
8. I pledge that neither our organization nor our officers have collected a deposit in relation to the
technical intern training from a technical intern trainee or his or her relative or any other person who
has a close relationship with the technical intern trainee in terms of a social life, or have otherwise
managed their property within the past five years regardless of the reason therefor, nor will we do so in
the future.
9. I pledge that neither our organization nor our officers have entered into a contract stipulating penalties
with regard to non-performance of a contract pertaining to the technical intern training or some other
contract which otherwise expects the transfer of undue money or property within the past five years,
nor will we do so in the future.
10. I pledge that neither our organization nor our officers have committed assault, intimidation, restriction
of freedom or any other acts of infringement of human rights against a supervising-organization-type
technical intern trainee, etc. within the past five years, nor will we do so in the future.
11. I pledge that neither our organization nor our officers have used or provided a forged or altered
document, etc. for the purpose of illegally obtaining accreditation of a technical intern training plan,
the purpose of illegally obtaining the license of a supervising organization, or the purpose of
concealing facts in violation of the provisions of laws and regulations relating to immigration or labor,
nor will we do so in the future.
12. I pledge that in mediating the application for supervising-organization-type technical intern training,
our organization has checked with the person who intends to become a supervising-organization-type
technical intern trainee that the supervising-organization-type technical intern trainee, etc. his or her
relative or any other person who has a close relationship with the technical intern trainee in terms of a
social life have not been subjected to the acts given in the abovementioned 8 and 9 in relation to the
technical intern training.
13. In addition to those matters listed in 1 to 12, I pledge that our organization possesses the necessary
capability to appropriately mediate applications for supervising-organization-type technical intern
training for the supervising organization in Japan.
Prepared on DD/MM/YY:
Name of sending organization in a foreign country
Name and title of person preparing this written pledge Seal
Reference Form 2-12 (related to Article 27, paragraph (1), item (xi)(f) of the Ordinance)
(Japanese Industrial Standards A Row 4)
LETTER OF RECOMMENDATION FOR THE SENDING ORGANIZATION IN A FOREIGN
COUNTRY
I hereby recommend _______________________, a sending organization of our country as an
organization to mediate applications for supervising-organization-type technical intern training for a
supervising organization in Japan since it has been recognized:
- To appropriately select and send to Japan persons who intend to engage in supervising-organization-
type technical intern training having understood the purpose of the program.
- To clearly stipulate and make the method of calculating fees and other expenses collected from the
supervising-organization-type technical intern trainees, etc. public, and to clearly explain these
expenses to the supervising-organization-type technical intern trainees, etc. to ensure they are
understood.
- To provide assistance for employment placement and other support so that those who have completed
the supervising-organization-type technical intern training are able to appropriately utilize the skills,
etc. that they have acquired, etc.
The valid period of this letter of recommendation shall be for one year from the date of issue.
Prepared on DD/MM/YY:
Name of public organization:
Signature _________________________________
(Official stamp including the date)
