2 特定技能雇用契約 Employment contract for a specified skilled worker

(1)雇用契約期間 Period of employment contract

年
Year

月
Month

日
Day

から to

年
Year

月
Month

日
Day

(2)従事すべき業務の内容（複数ある場合は全て記入） Contents of work to be engaged in (if there are several types of work, fill in all of the work)

特定産業分野
Specified industrial field

業務区分
Work category

職種 Occupation

occupation_type) && $record->occupation_type == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ○主たる職種を別紙「職種一覧」から選択して番号を記入（１つのみ）
Select the main occupation from the Attachment: "Occupations List", and fill in the number (select only one)

occupation_type) && $record->occupation_type == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ○他に職種あるれは別紙「職種一覧」から選択して番号記入（複数選択可）
If there is any other occupation, select from the Attachment: "Occupations List", and fill in the number (more than one answer may be selected)

（注意）Attention
※別紙「職種一覧」の1～43,45～50,55～81,100～112,999から選択してください。
Please select from 1 to 43, from 45 to 50, from 55 to 81, from 100 to 112 and 999 on the attached "Occupations List."

③所定労働時間(週平均)

Prescribed working hours (weekly average)

時間
hours

所定労働時間(月平均)
Prescribed working hours (monthly average)

時間
hours

有・無
Yes / No

Are the prescribed working hours equivalent to the prescribed working hours of regular workers?

prescribed_hours_equivalent) && $record->prescribed_hours_equivalent == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 Yes prescribed_hours_equivalent) && $record->prescribed_hours_equivalent == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 No

④報酬額 Remuneration

月額報酬
Monthly remuneration

円
Yen

※各種手当(通勤・住宅・扶養等)・実費弁済・支給者の性格を有するものを除く。
Excludes various types of allowances (commuting, housing, dependents, etc.) and personal expenses. Time converted amount of basic salary

基本給の時間換算額
Time converted amount of basic salary 円/Yen

同等の業務に従事する日本人の月額報酬
Monthly remuneration of Japanese national engaging in the same type of work 円/Yen

同等の業務に従事する日本人の月額報酬
Monthly remuneration of Japanese national engaging in same type of work

円
Yen

報酬の額が日本人が従事する場合の報酬の額と同等以上であることの有無
Will the foreign national receive an equal or greater amount of remuneration than a Japanese national would receive for comparable work?

remuneration_equal) && $record->remuneration_equal == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 Yes remuneration_equal) && $record->remuneration_equal == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 No

⑤報酬の支払方法
Payment method of remuneration

payment_cash) && $record->payment_cash == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 現金支給 Paid in cash payment_bank) && $record->payment_bank == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 口座振込み Paid into a bank account

⑥外国人であることを理由として日本人と異なった待遇としている事項の有無

Are any matters stipulated related to treatment that differ from that given to a Japanese national due to the applicant being a foreign national?

special_treatment) && $record->special_treatment == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 Yes special_treatment) && $record->special_treatment == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 No

⑦外国人が一時帰国を希望した場合には、必要な有給休暇を付与させるの有無

Will the foreign national be given the necessary paid holidays in the event of wanting to return temporarily to his/her home country?

paid_holidays) && $record->paid_holidays == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 Yes paid_holidays) && $record->paid_holidays == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 No

⑧雇用関係につき特定産業分野に特有の事項に関する基準が定められている場合の有無

Are the criteria, which are stipulated in a public notice in consideration of circumstances specific to the specified industrial field in terms of the employment relations, being met? (Fill in this section if such criteria are stipulated.)

employment_criteria) && $record->employment_criteria == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 Yes employment_criteria) && $record->employment_criteria == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 No

⑨外国人が特定技能雇用契約終了後の帰国に要する旅費を負担することができない場合の有無

If a foreign national cannot afford the travel expenses for return to his/her home country after the end of the employment contract for specified skilled workers, will the organization of affiliation pay the travel expenses and take necessary measures to ensure smooth departure?

travel_expenses) && $record->travel_expenses == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 Yes travel_expenses) && $record->travel_expenses == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 No

⑩外国人の健康の状況その他の生活の状況を把握するために必要な措置を講じることとしているの有無

Is the organization of affiliation taking the necessary measures to check the state of the foreign national's health and other living conditions?

health_measures) && $record->health_measures == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 Yes health_measures) && $record->health_measures == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 No

⑪外国人の適正な在留に必要な事項について特定産業分野に特有の事情を踏まえて告示で定められる基準に適合していることの有無

Are the criteria, which are stipulated in a public notice in consideration of circumstances specific to the specified industrial field in terms of the matters necessary to ensure the proper residence of the foreign nationals, being met? (Fill in this section if such criteria are stipulated.)

residence_criteria) && $record->residence_criteria == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 Yes residence_criteria) && $record->residence_criteria == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 No

⑫派遣先 (労働者派遣の対象とする場合に記入)
Dispatch site (Fill in this section if the foreign national may be sent out for worker dispatch)

氏名又は名称
Name of person or organization

法人番号 (13桁)
Corporation no. (combination of 13 numbers and letters)

@for ($i = 0; $i < 13; $i++) @endfor

雇用保険適用事業所番号 (11桁) ※非該当事業所は記入省略
Employment insurance application office number (11 digits) *If not applicable, it should be omitted.

@for ($i = 0; $i < 11; $i++) @endfor

住所 (所在地)
Address

電話番号
Telephone No.

代表者の氏名
Name of the representative

派遣期間
Period of dispatch

from 年月日 to 年月日まで

⑬職業紹介事業者 (特定技能雇用契約の成立をあっせんする職業紹介事業者がある場合に記入)
Employment placement service provider (fill in this section if there is an employment placement service provider that arranges the conclusion of employment contracts for specified skilled workers)

氏名又は名称
Name of person or organization

法人番号 (13桁)
Corporation no. (combination of 13 numbers and letters)

@for ($i = 0; $i < 13; $i++) @endfor

雇用保険適用事業所番号 (11桁) ※非該当事業所は記入省略
Employment insurance application office number (11 digits) *If not applicable, it should be omitted.

@for ($i = 0; $i < 11; $i++) @endfor

住所 (所在地)
Address

電話番号
Telephone No.

許可・届出番号
Permission / notification no.

受理年月日
Date of receipt

年月日

(14) 取次機関（職業紹介事業者があっせんを行う際に、情報の取次ぎを行う者がある場合に記入）
Intermediary organization (fill in this section if there is a person who mediates information at the time of an employment placement service provider acting as an agent)

氏名又は名称
Name of person or organization

住所（所在地）
Address

電話番号
Telephone No.

3　特定技能所属機関
Organization of affiliation of the specified skilled worker

※(3)(及び(8))については、主に勤務させる事業所について記載すること。For sub-items (3) and (8), fill in the information of principal place of business where foreign national is to work

(1) 氏名又は名称
Name of person or organization

※本店又は主たる事務所のみを記入 Fill in the name of head office or principal place of business

(2) 法人番号（13桁）
Corporation no. (combination of 13 numbers)

@for($i = 0; $i < 13; $i++) @endfor

(3) 雇用保険適用事業所番号（11桁）
Employment insurance application office number (11 digits)

※非該当事業所は記入省略 If not applicable, it should be omitted.

@for($i = 0; $i < 11; $i++) @endfor

(4) 業種
Business type

org_business_type_main) && $record->org_business_type_main == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 主たる業種を別紙「業種一覧」から選択して番号を記入（１つのみ）
Select the main business type from the attached sheet "a list of business type" and write the corresponding number (select only one)

org_business_type_main) && $record->org_business_type_main == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 他に業種があれば別紙「業種一覧」から選択して番号を記入（複数選択可）
If there are another other business types, select from the attached sheet "a list of business type" and write the corresponding number (multiple answers possible)

(5) 住所（所在地）
Address of person or organization

※本店又は主たる事務所のものを記入 Fill in the address of head office or principal place of business

電話番号
Telephone No.

(6) 資本金
Capital

円
Yen

(7) 年間売上金額（直近年度）
Annual sales (latest year)

円
Yen

(8) 常勤職員数
Number of full-time employees

名

(9) 代表者の氏名
Name of the representative

(10) 勤務させる事業所名
Name of place of business where foreign national is to work

所在地
Address

健康保険及び厚生年金保険の適用事業所であることの有無
Does the place of business apply health insurance and employees pension insurance?

health_pension_insurance) && $record->health_pension_insurance == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 / Yes

health_pension_insurance) && $record->health_pension_insurance == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 / No

労災保険及び雇用保険の適用事業所であることの有無
Does the place of business apply industrial accident insurance and employment insurance?

industrial_employment_insurance) && $record->industrial_employment_insurance == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 / Yes

industrial_employment_insurance) && $record->industrial_employment_insurance == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 / No

労働保険番号
Labor insurance number

@for ($i = 1; $i <= 18; $i++) @if (in_array($i, [3, 4, 6, 12, 15])) - @endif @endfor

(未尾4桁は割り振られている場合のみ記入)

(11) 労働、社会保険及び租税に関する法令の規定に違反したことの有無
Has the organization ever been in violation of the provisions of laws and regulations concerning labor, social insurance or tax?

org_law_violation) && $record->org_law_violation == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容：
Yes (Details:

org_law_violation) && $record->org_law_violation == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(12) 特定技能雇用契約の締結の日前1年以内又は締結の日以後に、特定技能所属機関の業務と同種の業務に従事していた労働者を非自発的に離職させたことの有無
Has a worker who engaged in work of the same type as that which the foreign national is to engage in ever been forced to leave within one year prior to the date of the foreign national entering into such contract?

org_forced_leave) && $record->org_forced_leave == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・理由：
Yes (Details / Reason):

org_forced_leave) && $record->org_forced_leave == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(13) 特定技能雇用契約の締結の日前1年以内又は締結の日以後に、特定技能所属機関の責めに帰すべき事由により外国人の行方不明者を発生させたことの有無
Has the organization caused a foreign national to disappear due to a cause attributable to the fault of the organization within one year prior to the date of the foreign national entering into the employment contract?

org_missing_foreign) && $record->org_missing_foreign == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容：
Yes (Details):

org_missing_foreign) && $record->org_missing_foreign == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(14) 特定技能所属機関・その役員・支援責任者・支援担当者が法令に違反して刑に処せられたことの有無
Has the organization, its officers, support manager or support staff ever been sentenced to a criminal punishment due to a violation of laws and regulations?

org_criminal_record) && $record->org_criminal_record == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・該当者名：
Yes (Details/Name of applicable person):

org_criminal_record) && $record->org_criminal_record == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(15) 特定技能所属機関・その役員・支援責任者・支援担当者が特定技能雇用契約の適正な履行に影響する精神の障害を有することの有無
Does the organization, its officers, support manager or support staff have a mental disability which will have an impact on proper performance of the employment contract for specified skilled workers?

org_mental_disability) && $record->org_mental_disability == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・該当者名：
Yes (Details/Name of applicable person):

org_mental_disability) && $record->org_mental_disability == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(16) 特定技能所属機関・その役員・支援責任者・支援担当者等が破産手続開始の決定を受けて復権を得ないことの有無
Has the organization, its officers, support manager or support staff become subject to the commencement of bankruptcy procedures and yet to have its rights restored?

org_bankruptcy) && $record->org_bankruptcy == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・該当者名：
Yes (Details/Name of applicable person):

org_bankruptcy) && $record->org_bankruptcy == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(17) 特定技能所属機関・その役員・支援責任者・支援担当者等が技能実習法第16条第1項の規定により実習認定を取り消されたことの有無
Has the organization of affiliation of the specified skilled worker, its officer, support manager or support staff ever had its accreditation of the training revoked as provided for in Article 16, paragraph (1) of the Technical Intern Training Act?

org_accreditation_revoked) && $record->org_accreditation_revoked == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・該当者名：
Yes (Details/Name of applicable person):

org_accreditation_revoked) && $record->org_accreditation_revoked == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(18) 特定技能所属機関・その役員・支援責任者・支援担当者等が技能実習法第16条第1項の規定により実習認定を取り消された法人の役員
Has the organization of affiliation of the specified skilled worker, its officer, support manager or support staff ever been an officer of a corporation that has had its accreditation of training revoked as provided for in Article 16, paragraph (1) of the Technical Intern Training Act?

org_officer_revoked_corp) && $record->org_officer_revoked_corp == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・該当者名：
Yes (Details/Name of applicable person):

org_officer_revoked_corp) && $record->org_officer_revoked_corp == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(19) 特定技能所属機関・その役員・支援責任者・支援担当者等が出入国又は労働に関する法令に違反し、5年以内に刑に処せられたことの有無
Has the organization of affiliation of the specified skilled worker, its officer, support manager or support staff ever committed a wrongful or seriously unjust act in relation to immigration or labor-related laws or regulations within five years of the date of entering into the employment contract for specified skilled workers or after the date of entering into such contract?

org_law_violation_5yrs) && $record->org_law_violation_5yrs == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・該当者名：
Yes (Details/Name of applicable person):

org_law_violation_5yrs) && $record->org_law_violation_5yrs == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(20) 特定技能所属機関・その役員・支援責任者・支援担当者等が暴力団員であること又は過去5年以内に暴力団員であったことの有無
Has the organization of affiliation of the specified skilled worker, its officer, support manager or support staff currently an organized crime member or was it formerly an organized crime member within the past five years?

org_crime_member) && $record->org_crime_member == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・該当者名：
Yes (Details/Name of applicable person):

org_crime_member) && $record->org_crime_member == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(21) 特定技能所属機関の法定代理人（法人である場合はその役員）が(14)から(20)のいずれかに該当すること又は未成年者であることの有無
Does the statutory agent (its officer in the case of a corporation) of the organization of affiliation of the specified skilled worker, its officer, support manager or support staff fall under any of (14) to (20)? (Fill in this section if the statutory agent of the specified skilled worker, its officer, support manager or support staff is a minor who does not have the same capacity to act as a person who has reached the age of majority in relation to business.)

org_statutory_agent_minor) && $record->org_statutory_agent_minor == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容・該当者名：
Yes (Details/Name of applicable person):

org_statutory_agent_minor) && $record->org_statutory_agent_minor == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(22) 暴力団員又は5年以内に暴力団員であった者がその事業活動を支配する者であることの有無
Is an organized crime member or a person who was formerly an organized crime member within the past five years controlling the business activities of the organization of affiliation of specified skilled workers?

org_crime_control) && $record->org_crime_control == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容：
Yes (Details):

org_crime_control) && $record->org_crime_control == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(23) 外国人の活動内容に関する文書を作成し、活動させる事業所に特定技能雇用契約の終了の日から1年以上備えて置くこととしていることの有無
Is the organization taking measures to prepare documents on the contents of the activities of the foreign national, and to keep them at the place of business where the foreign national is engaging in the activities for at least one year from the date of termination of the contract?

org_activity_docs) && $record->org_activity_docs == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

org_activity_docs) && $record->org_activity_docs == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(24) 特定技能雇用契約に係る保証金の徴収等管理費や違約金等の支払契約を締結していることの有無
Has the organization entered into an employment contract for specified skilled workers knowing about the existence of an agreement to collect a deposit or to control property or to demand payment of penalties pertaining to the employment contract for specified skilled workers?

org_penalty_agreement) && $record->org_penalty_agreement == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容：
Yes (Details):

org_penalty_agreement) && $record->org_penalty_agreement == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(25) 特定技能雇用契約の不履行について違約金等の支払契約を締結していることの有無
Has the organization entered into an agreement on the payment of penalties, etc. with regard to non-performance of the employment contract for specified skilled workers?

org_nonperformance_penalty) && $record->org_nonperformance_penalty == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容：
Yes (Details):

org_nonperformance_penalty) && $record->org_nonperformance_penalty == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(26) 特定技能外国人支援に要する費用について、直接又は間接に外国人に負担させないこととしていることの有無（申請人が「特定技能1号」の入国を希望する場合に記入）
Has the organization established practical measures to ensure the foreign national is not being made to pay either directly or indirectly for the costs required for support for Specified Skilled Worker (i)? (Fill in this section if the applicant wishes to enter Japan under the status of residence of "Specified Skilled Worker (i)")

org_support_costs) && $record->org_support_costs == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

org_support_costs) && $record->org_support_costs == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(27) 次のいずれかに該当することの有無
Whether it falls under any of the following cases:

yes_no) && $record->yes_no == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有・ yes_no) && $record->yes_no == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無
Yes / No

（「有」の場合は該当するものを選択）
If "Yes", choose the corresponding item

dispatch_case_1) && $record->dispatch_case_1 == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>

① 派遣先において従事する業務の属する特定産業分野に係る業務又はこれに関連する業務を行っていること
A dispatch site conducting work pertaining to a specified industrial field to which the work the foreign national is to engage in at the dispatch site belongs or related work

（内容：Details:

dispatch_case_2) && $record->dispatch_case_2 == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>

② 地方公共団体又は①に該当する者が資本金の過半数を出資していること
A local government or a person who falls under ① who has invested a majority of the stated capital

（内容：Details:

dispatch_case_3) && $record->dispatch_case_3 == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>

③ 地方公共団体又は①に該当する者が業務執行に実質的に関与していること
A local government or a person who falls under ① who is substantially involved in execution of the business

（内容：Details:

dispatch_case_4) && $record->dispatch_case_4 == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>

④ 派遣先において従事する業務の属する分野が農業であり、派遣先が国家戦略特別区域法第16条の5第1項に規定する特定機関であること
The field of work the foreign national is to engage in at the dispatch site is agriculture, and the organization is the specified organization prescribed in Article 16-5, paragraph (1) of the National Strategy Special Zone Act.

(28) 労働者派遣をすることとしている派遣先が(11)から(22)に該当していることの有無
Will the organization be sending dispatch workers to a dispatch site that comes under (11) to (22) above?

dispatch_site_eligibility) && $record->dispatch_site_eligibility == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容：
Yes (Details):

dispatch_site_eligibility) && $record->dispatch_site_eligibility == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(29) 災保険加入等の措置の有無
Have measures been taken for coverage of industrial accident insurance, etc.?

industrial_insurance) && $record->industrial_insurance == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有（内容：
Yes (Details):

industrial_insurance) && $record->industrial_insurance == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(30) 特定技能雇用契約を継続して履行する体制が適切に整備されていることの有無
Is there an appropriate structure in place to ensure continuous implementation of the employment contract for specified skilled workers?

continuous_contract_structure) && $record->continuous_contract_structure == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes:

continuous_contract_structure) && $record->continuous_contract_structure == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(31) 外国人の報酬が、当該外国人の口座や預貯金の名義での振込その他の方法により支払われることの確認及び、やむを得ない場合には、出入国在留管理庁長官に対する支払を裏付ける資料の提出と、その確認
by the foreign national or using a method where the actual amount that must be paid as remuneration be paid by wire transfer for the account of a bank or other financial institution specified by the foreign national, and in the case, will objective materials proving the payment of remuneration be submitted to the Commissioner of the Immigration Services Agency in order to confirm the payment?

remuneration_confirmation) && $record->remuneration_confirmation == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

remuneration_confirmation) && $record->remuneration_confirmation == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(32) 特定技能雇用契約の当事者である外国人の活動に対する地方公共団体等に対する協力要請に対し、必要な協力をすることとしていることの有無
Does the organization provide the necessary cooperation for harmonious coexistence measures as requested by a local government for the foreign national who is a party to the employment contract for specified skilled workers?

cooperation_measures) && $record->cooperation_measures == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

cooperation_measures) && $record->cooperation_measures == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

organization_submitted_letter) && $record->organization_submitted_letter == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 当該外国人が活動する事業所の所在地の市町村の長に対する協力依頼の有無
Has the organization submitted a letter of confirmation of cooperation to the mayor of the place of business at which the foreign national is engaged in his/her activities is located?

提出年月日・提出先名（Submitted: DD/MM/ YYYY
City/Ward/Town/Village）

has_the_organization) && $record->has_the_organization == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 / Yes

has_the_organization) && $record->has_the_organization == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 / No

organization_submitted_letter) && $record->organization_submitted_letter == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 当該外国人の居住地の市町村の長に対する協力依頼の有無
Has an organization submitted a letter of confirmation of cooperation to the mayor of the city/town/village where the foreign national lives?

提出年月日・提出先名（Submitted: DD/MM/ YYYY
City/Ward/Town/Village）

has_an_organization_sub) && $record->has_an_organization_sub == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 / Yes

has_an_organization_sub) && $record->has_an_organization_sub == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 / No

(33) 特定技能雇用契約の適正な履行の確保について特定産業分野に特有の事情に照らして告示で定められる基準に適合していることの有無
Does the organization meet the criteria stipulated in the public notice in consideration of circumstances specific to the specified industrial field in terms of securing the proper performance of the employment contract for specified skilled workers? (Fill in this section if such criteria are stipulated.)

有・無
Yes / No

proper_performance_criteria) && $record->proper_performance_criteria == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

proper_performance_criteria) && $record->proper_performance_criteria == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

（以下(34)から(42)は申請人が「特定技能1号」の入国を希望する場合であって、契約により支援機関に1号特定技能外国人支援計画の全部の実施を委託しない場合に記入）
(Fill in sections (34) to (42) if the applicant wishes to enter Japan with the status of residence of "Specified Skilled Worker (i)", and not all of the support plans for specified skilled workers (i) are to be entrusted to a registered support organization based on a contract.)

(34) 支援責任者
Support manager

所属・役職
Title and department

役員又は職員の中から支援責任者を選任していることの有無
Has a support manager been appointed from among the officers or employees?

support_manager_appointed) && $record->support_manager_appointed == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

support_manager_appointed) && $record->support_manager_appointed == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(35) 支援担当者
Support staff

所属・役職
Title and department

役員又は職員の中から、活動をさせる事業所ごとに1名以上の支援担当者を選任していることの有無
Has at least one support staff member been appointed from among the officers and employees for each place of business where the specified skilled worker is engaged in his/her activities?

support_staff_appointed) && $record->support_staff_appointed == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

support_staff_appointed) && $record->support_staff_appointed == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(36) 次のいずれかに該当することの有無
Whether it falls under any of the following cases:
(If "Yes", choose the corresponding item)

case_36_yesno) && $record->case_36_yesno == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

case_36_yesno) && $record->case_36_yesno == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

case_36_1) && $record->case_36_1 == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>

① 過去2年間において特別永住者の1の表、2の表又は5の表の上欄の在留資格（収入を伴う事業を運営する活動又は報酬を受ける活動を行う資格欄に限る）をもって在留した経験があること
It has a past record of properly accepting or managing mid to long-term residents residing with one of the statuses of residence in the left-hand column of Appended Table I (1), (2) or (5) over the past two years (limited to the statuses of residence where the foreign national is permitted to engage in activities related to management of business involving income or activities for which he or she receives remuneration).

case_36_2) && $record->case_36_2 == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>

② 支援責任者及び支援担当者が過去2年間において特別永住者の1の表、2の表又は5の表の上欄の在留資格（収入を伴う事業を運営する活動又は報酬を受ける活動を行う資格欄に限る）をもって在留した経験があること
The support manager and support staff have experience of engaging in the work of providing advice on living for mid to long-term residents with a status of residence in the left-hand column of Appended Table I (1), (2) and (5) (limited to the statuses of residence where the foreign national is permitted to engage in activities related to the management of business involving income or activities for which he or she receives remuneration).

case_36_3) && $record->case_36_3 == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>

③ その他支援策等の適正に実施できる体制を有すること（内容：）
Other conditions to ensure support is properly implemented (Details: )

(37) 1号特定技能外国人支援計画に基づく支援を、外国人が十分に理解することができる言語により行うことができる体制を有していることの有無
Do you have a structure in place where support based on the support plan for specified skilled workers (i) will be provided in a language that the foreign national is able to fully understand?

support_language_structure) && $record->support_language_structure == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

support_language_structure) && $record->support_language_structure == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(38) 1号特定技能外国人支援の状況に関する文書を作成し、1号特定技能外国人を支援する事業所において1号特定技能雇用契約終了の日から1年以上備えて置くこととしていることの有無
Has the organization taken measures to prepare documents on the status of support for specified skilled workers (i) and to keep them at the place of business where the support for specified skilled workers (i) is to be implemented for at least one year from the date of termination of the employment contract for specified skilled workers?

support_documentation) && $record->support_documentation == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

support_documentation) && $record->support_documentation == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(39) 支援責任者及び支援担当者が、1号特定技能外国人支援計画の中立な実施者であることの有無
Are the support manager and support staff in a position where they are able to implement the support plan for specified skilled workers (i) in a neutral manner?

neutral_support) && $record->neutral_support == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

neutral_support) && $record->neutral_support == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(40) 特定技能雇用契約締結の日前5年以内又は契約締結の日以後に適合1号特定技能外国人支援を怠ったことの有無
Has the organization failed to implement support for specified skilled workers (i) based on a suitable support plan for specified skilled workers (i) within five years prior to the date of entering into the employment contract for specified skilled workers or after the date of entering into such contract?

support_failed) && $record->support_failed == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

support_failed) && $record->support_failed == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

内容： Details:

(41) 支援責任者又は支援担当者が外国人及びその監督をする立場にある者と定期的な面談を実施できる体制を有していることの有無
Is there a system in place to ensure the support manager and support staff are able to conduct periodic interviews with the foreign nationals and their supervisors?

periodic_interview) && $record->periodic_interview == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

periodic_interview) && $record->periodic_interview == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(42) 当該1号特定技能外国人支援計画の適正な実施の確保に係る特定産業分野に特有の事情に基づく告示で定められる基準に適合していることの有無（当該基準が定められている場合に記入）
Does the organization conform to the criteria stipulated in a public notice in consideration of circumstances specific to the specified industrial field in terms of ensuring proper implementation of the support plan for specified skilled workers (i)? (Fill in this section if such criteria are stipulated.)

criteria_conform) && $record->criteria_conform == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

criteria_conform) && $record->criteria_conform == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

4 １号特定技能外国人支援計画（申請人が特定技能１号での入国を希望する場合に記入）
Support plan for specified skilled workers (ii*) (Fill in this section if the applicant wishes to enter Japan with the status of residence of "Specified Skilled Worker (ii*)")

(1) 在留資格認定証明書交付申請前の、特定技能雇用契約等の内容、特定技能雇用契約に基づき従事することができる活動の内容、上陸及び在留のための条件その他の入国時・在留中に上陸する際の留意事項について十分に理解することができる言語による情報提供の実施の有無
Did the organization provide information to the specified skilled worker (i) in a language that can be fully understood by the specified skilled worker (i) before their application for certificate of eligibility the contents of the employment contract for specified skilled workers, the contents of the activities that may be conducted in Japan, the conditions for landing and residence, and other points to be noted when landing and staying in Japan?

info_provided) && $record->info_provided == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

info_provided) && $record->info_provided == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(2) 上記(1)について、対面により、又はテレビ電話装置その他の方法により行うことの有無
With regard to (1) above, will this be conducted face-to-face, using a video call device, or by another method?

face_to_face) && $record->face_to_face == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

face_to_face) && $record->face_to_face == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(3) 出入国時に港又は飛行場等への送迎をすることとしていることの有無
Will the organization be picking up and dropping off the foreign national at the seaport or airport when he/she will be entering or departing from Japan?

pickup) && $record->pickup == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

pickup) && $record->pickup == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(4) 適切な住居の確保に係る支援をすることとしていることの有無
Will the organization be providing support to secure suitable accommodation for the foreign national?

accommodation) && $record->accommodation == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

accommodation) && $record->accommodation == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(5) 生活に関する預金口座等の開設及び携帯電話の利用に関する契約等その他の必要な契約に係る支援をすることとしていることの有無
Will the organization be providing support related to contracts concerning the opening of bank accounts, the use of mobile phones and other contracts necessary for living?

living_contracts) && $record->living_contracts == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

living_contracts) && $record->living_contracts == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(6) 外国人配偶者、父母等の本邦一時居住に関する事項、又は日本における共用的な通知、相談又は苦情申立てに関する事項、相違又は苦情の申出に関する連絡先、十分に理解することができる言語で医療受診にかかる事項、医療・災害に関する事項、緊急時における対応に関する事項及び外国人の法的保護に必要な事項の情報を、外国人が十分に理解することができる言語により実施することとしていることの有無
Will the organization be providing information after the specified skilled worker (i) has entered Japan in a language which the specified skilled worker (i) is fully able to understand on matters concerning general living in Japan, notifications to national or local government agencies and other procedures, contact information for consultations or filing of complaints, matters concerning medical institutions capable of providing medical care in a language that the specified skilled worker (i) is fully able to understand, matters on disaster prevention and other necessary matters for responses in case of emergency, and necessary matters for legal protection of foreign nationals?

post_entry_info) && $record->post_entry_info == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

post_entry_info) && $record->post_entry_info == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(7) 外国人が関又は地方公共団体の機関への届出その他の手続きを履行するに当たり、必要に応じ、関係機関への同行その他の必要な措置を講ずることとしていることの有無
Will the organization take necessary measures to accompany the foreign national, where necessary, to the relevant agency in order to submit a notification to a national or local government agency or for other procedures that need to be followed?

accompany_procedure) && $record->accompany_procedure == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

accompany_procedure) && $record->accompany_procedure == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(8) 日本語を学習する機会を提供することとしていることの有無
Will the organization be providing the foreign national with opportunities to learn Japanese?

japanese_learning) && $record->japanese_learning == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

japanese_learning) && $record->japanese_learning == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(9) 外国人が十分に理解することができる言語により、相談又は苦情の申出に対して、適切に対応し、通訳対応をし、必要な措置を講ずることとしていることの有無
Will the organization respond appropriately to requests or consultations or complaints without delay, and take necessary measures in a language which the specified skilled worker (i) is fully able to understand?

complaint_response) && $record->complaint_response == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

complaint_response) && $record->complaint_response == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(10) 外国人と日本人の交流の促進に係る支援をすることとしていることの有無
Will the organization provide support for the promotion of exchanges between foreign nationals and Japanese?

exchange_support) && $record->exchange_support == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

exchange_support) && $record->exchange_support == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(11) 外国人が、やむを得ずに解雇された場合において、特定技能雇用契約が解除された場合においても外国人の責めに帰すべき事由によらない場合に限り、特定技能雇用契約の締結及び支援をすることとしていることの有無
Will the organization provide support to foreign nationals whose employment contract for specified skilled workers has been cancelled due to causes not attributable to the fault of the foreign national so as to enable the foreign national to change jobs?

job_change_support) && $record->job_change_support == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

job_change_support) && $record->job_change_support == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(12) 支援責任者又は支援担当者が外国人及びその監督をする立場にある者と定期的な面談を実施し、外国人が十分に理解することができる言語により、問題を把握した場合には関係行政機関に報告することとしていることの有無
Will the support manager or support staff conduct periodic interviews with foreign nationals and their supervisors, in a language which the foreign national is fully able to understand, and when they learn about a problem, report the problem to the relevant administrative agency?

periodic_interview_2) && $record->periodic_interview_2 == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

periodic_interview_2) && $record->periodic_interview_2 == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(13) 号特定技能外国人支援計画を日本語及び外国人が十分に理解することができる言語により作成し、当該外国人にその写しを交付することの有無
Will the support plan for specified skilled workers be prepared in Japanese and in a foreign language that can be fully understood by the foreign national, and a copy be provided to the foreign national?

plan_copy) && $record->plan_copy == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

plan_copy) && $record->plan_copy == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(14) 特定産業分野特有の事情に鑑みて告示で定められている事項が支援計画に記載されていることの有無（当該事項が定められている場合に記入）
Have the matters stipulated in a public notice in consideration of circumstances specific to the specified industrial field been given in the support plan for specified skilled workers (ii*)? (Fill in this section if such matters are stipulated.)

public_notice_matters) && $record->public_notice_matters == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

public_notice_matters) && $record->public_notice_matters == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

(15) 支援の内容が居住地の適正な確保に資するものであって、かつ、支援を実施する者が適切に実施することができるものであることの有無
Will the contents of the support contribute to the proper residence of the foreign nationals, and can they be appropriately implemented by those providing the support?

proper_residence_support) && $record->proper_residence_support == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有
Yes

proper_residence_support) && $record->proper_residence_support == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> ・無
No

（１６）１号特定技能外国人支援計画の内容につき特定産業分野に特有の事情に鑑みて告示で定められる基準に適合していることの有無（当該基準が定められている場合に記入）
Will the organization conform to the criteria stipulated in a public notice in consideration of the circumstances specific to the specified industrial field in terms of the contents of the support plan for specified skilled workers (i)? (Fill in this section if such criteria are stipulated.)

criteria_conformity) && $record->criteria_conformity == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 有 / Yes

criteria_conformity) && $record->criteria_conformity == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 無 / No

５登録支援機関（申請人が「特定技能１号」での入国を希望し本邦へ在留する場合であって、契約に基づき登録支援機関に１号特定技能外国人支援計画の全部の実施を委託する場合に記入）
Registered support organization
(Fill in this section for applicant wishes to enter Japan with the status of residence of "Specific Skilled Worker (i)", and all of the support plans for specified skilled workers (i) are to be entrusted to a registered support organization based on a contract.)

(1)氏名又は名称
Name of person or organization

(2)法人番号（13桁）
Corporation no. (combination of 13 numbers and letters)

@for ($i = 0; $i < 13; $i++) @endfor

(3)雇用保険適用事業所番号（11桁）
Employment insurance application office number (11 digits) *If not applicable, it should be omitted.

@for ($i = 0; $i < 11; $i++) @endfor

(4)住所（所在地）
Address

(5)代表者の氏名
Name of the representative

電話番号
Telephone No.

(6)登録番号
Reg. no.

(7)登録年月日
Date of Registration

(9)所在地
Address

(8)支援を行う事業所の名称
Name of place of business/implementing support

(10)支援責任者名
Support manager

(11)支援担当者名
Support staff

(12)対応可能言語
Available languages

(13)支援委託手数料（月額／人）
Support commission fee (person per month)

円 / Yen

以上の記載内容は事実と相違ありません。
I hereby declare that the statement given above is true and correct.

特定技能所属機関名、代表者氏名の記名
Name of the organization and representative of the organization

申請書作成年月日
Date of filling in this form

注意
Attention

申請書作成後申請までに記載内容に変更が生じた場合、特定技能所属機関が変更箇所を修正すること。
In cases where descriptions have changed after filling in this application form up until submission of this application, the organization must correct the changed part.

別記第六号の三様式（第六条の二関係）

在留資格認定証明書交付申請書

33 職歴（外国におけるものを含む）Work experience (including those in a foreign country)
入社 Date of joining the company		退社 Date of leaving the company		勤務先名称 Place of employment	入社 Date of joining the company		退社 Date of leaving the company		勤務先名称 Place of employment
年 Year	月 Month	年 Year	月 Month		年 Year	月 Month	年 Year	月 Month