Example

Form

(Attachment 1)

Local Government Officials Training Program in Japan Trainee Application Form ① Applicant Name  Please type or print your name in the standard alphabet format

Photograph (Taken Within the Past 3 Months)

John BROWN Name as it appears officially in your passport

4cm long× 3cm wide

BROWN

/ John

Surname (family name) ② Nationality

Given name(s)

Canadian

③ Sex

✔

Male

④ Date / Place of Birth Date: 1982

✔ Check the appropriate box.

Female Yr/

Jun

Mon/

11

Day

Place: ○ ○ ○ ○ ○

⑤ Dietary Restrictions: Allergic to milk; cannot eat pork for religious reasons (Including those relating to religious reasons) ⑥ Marital Status ⑦ Occupation

✔

Married

✔ Check the appropriate box

Single

(Please clearly type or print your employer’s full contact details in English)

Workplace

Work Address Your Position/ Title Work Telephone

Department Planning Division

Provincial / Municipal Government Name Newbridge City Council

ZIP CODE 111-111 1 Main Avenue, Newbridge Main Province, Canada 2nd Secretary

Legal Officer

01-2345-6789

(Mobile) 012－345－678 Contact Person （Position/Title）Division Manager (Supervisor） （Name）Mary Supervisor

Fax Number

01-111-2222

E－mail

abc @newbridge.gov.ca

Telephone

01－1122－3344

Fax Number

01－2222－3333

⑧ Home Address Full home address, telephone number, and contact information in your home country in case of an emergency Home Address Home Telephone Emergency Contacts (2 people )

ZIP CODE 111-222 2 Suburban Street, Newbridge South Main Province, Canada Fax number 01－9876－5432

Name Bob BROWN Name Mia TANAKA

Your Personal E‐mail Relation Father Relation Friend

01-9876-1234 home @hotmail.com

Tel/Fax 01－5434－5434 Tel/Fax 07－9876－6789

⑨ Do you have a passport? Passport Number

✔

Yes

A1234567890

Date of Expiration

✔ Check the appropriate box.

No Date of Issue

April 1, 2010

Issuing Authority

March 31, 2020

⑩ Have you ever been to Japan? ✔ Yes (If yes, please indicate when, where, and why)

No

Main Province Canada ✔ Check the appropriate box.

I visited Japan on a personal trip from January 30 to February 6, 2001. I traveled to Tokyo, Osaka, and Kyoto.

⑪ Educational Institutions Attended: Name of Institution

Dates Attended

Specialization

Qualification Earned

ABC High School

Apr. 98’ ~ March 01’

General Studies

Diploma

XYZ University

Apr. 01’ ~ March 05’

Law

BA

⑫ Qualifications（please indicate if you have any special language qualifications） Type of Qualification Japanese Proficiency Test, Level 3 TOEIC (Score: 830)

Date Received August 1, 2011 September 23, 2012

⑬ Work Experience Dates April 2005 ～March 2007 April 2007 ～March 2011 April 2011 ～Present Month, Year ～Month, Year Month, Year ～Month, Year

Employer Newbridge City, Mayor’s Office International Relations Division Newbridge City, Mayor’s Office Secretarial Division Newbridge City, Mayor’s Office Planning Division

Position / Description of Work Planning for sister-city exchange projects Secretary to the Mayor Devised plan for City Centre revitalization

⑭ Have you received the overseas training before? ✔ Yes No ✔Check the appropriate box. Country/Hosting Organization Training Period Training Contents (please be specific） Seoul City, Korea Jan 10 2006 ～ Studied the sister-city activities of Seoul City Feb 1 2006

⑮ Details of Desired Field of Training (1) Please provide a detailed and specific description of your work experience focusing upon aspects relating to your desired field of training in Japan. (If the space provided is insufficient, please use additional sheets of paper.) I became a local government official, because I believe that it will be government officials who lead my country into the twenty-first century. As not only an employee of Newbridge City, but also a resident, I feel strongly about the city’s future. I sought employment in Newbridge City because I want to make my community a better place to live for all residents. I want to make it the world's most pleasant city. When I joined the city in April 2005, I was assigned to the International Relations Division of the Mayor's Office. At the International Relations Division, I was in charge of planning friendship and exchange projects, principally with cities with which we have a sister city relationship. For four years beginning in April 2007, I was the Mayor’s secretary. From April 2011 until the present, I have been worked in the Planning Division of the Mayor's Office, where I have been involved in work related to my desired field of training in Japan. The Planning Division, which was newly established in April 2011, is the focal point for setting out a future vision for our city. Fifty people work in this division, which is comprised of three sections: the strategy section (conceptualization of the city’s future), the planning section (preparation of concrete plans based on the strategy section’s vision), and the implementation section (liaison with other departments to bring the plans to fruition). Presently, the division is working on ten projects, and I am in charge of the City Centre Revitalization Program. The City Centre Revitalization Program outlines a plan to eliminate an old section at the heart of the city and replace it with a group of high rise buildings. This plan has already passed through the strategy section and planning section. My task is to coordinate the community consultation process, and liaise with other city departments and contractors who will actually implement the project. In undertaking this assignment I have already faced numerous difficulties which have made my work in this vital position extremely challenging. As the project comes closer to becoming a reality, I have become increasingly determined to make the city where I live a better place. While feeling the weight of these responsibilities, I am honored to be able to contribute to determining the future direction of my city.

(2) Desired Field of Training :

City Planning

Please indicate your desired field of training as well as detailed, specific reasons for your application. (If the space provided is insufficient, please use additional sheets of paper.) (i) Focusing upon your desired field of training, please outline the current situation and pressing issues that must be addressed in your local government area. I work at Newbridge City Council where we are at an important crossroads in deciding the city’s future. We plan to carry out a wide-ranging revitalization programs across the entire city and are in the process of collecting public comments about the process. We foresee that rezoning and land purchases may be a divisive issue in the community. Further issues include formulating a strategy to attract businesses to the planned high-rise district and the formulation of regulations covering the revitalized areas.

(ii) Please indicate specific details of what you would like to learn while in Japan. Please include details of institutions you would like to visit, events you would like to attend, technologies you would like to study, etc) I am aware that a large number of Japanese local governments are in the process of reevaluating their urban design strategies. I am interested to learn about the planning process, the details of the plans themselves, and how problems are tackled by Japanese local governments. I also understand that this reevaluation process involves not only urban design issues, but also encompasses financial reforms. In order to improve the efficiency of Newbridge City, I would like to look into the debate surrounding Japanese local government finance reform. Lastly, I would be interested to study the professional development courses offered to public servants.

(iii) Please indicate how you will apply what you learn while in Japan to your work upon returning to your own country. Through studying the urban design strategy of a Japanese local government, I believe that I will be able to make a greater contribution to the planned changes facing Newbridge City in my role as leader of the City Centre Revitalization Program. I also hope that learning more about financial reforms and staff development will allow me to implement policies in Newbridge that will benefit the city’s efficiency standards.

⑯

Experience in Desired Field of Training（Please summarize item (1) of section ⑮） Years of Experience Details of Experience April, 2011 ～ Present Month, Year ～ Month, Year

⑰

Planning Section, Mayor’s Office, Newbridge City Leader of the City Centre Revitalization Program (No need to list other work experience as it does not relate to City Planning)

Language Ability

Listening

Speaking

Reading

Writing

✔ Check the most appropriate response Japanese

English

□ None □ Greetings □ Daily Conversation ☑ Can understand Japanese radio or TV □ Almost complete understanding □ None □ Greetings ☑ Daily Conversation □ Expressing your opinion about general topics in Japanese □ No trouble communicating in Japanese □ None □ Hiragana □ Katakana □ Some Chinese characters（ letters） ☑ A little understanding of newspapers □ Almost complete understanding of Newspapers □ None □ Hiragana □ Katakana ☑ Some Chinese characters （300letters） □ Simple sentences □ Able to express your opinion completely

□ None □ Greetings and basic sentences □ Basic daily conversation □General topics (simple explanation) ☑ Speech, debate and broadcasting □ None □ Greetings and basic sentences □ Basic daily Conversation □ Basic explanation, report and translation ☑ Expression your opinion without difficulty □ None □ Basic sentences with dictionary □ Basic sentences such as letters □ General sentences used in newspaper ☑ Advanced sentences used in newspaper □ None □ Basic sentences with dictionary □ Basic sentences such as letters □Basic sentences in General topics ☑ Making summary and describing your opinion

⑱ Language Training

（Please type or print in detail）

Period/Frequen Method/Content of Study cy of Study At university～ During my university years, one of my hobbies was studying Japanese. In particular, Present I would watch NHK satellite broadcasts from 1hour every day Japan or read Japanese literature in my spare Japanese time. I have passed the 2nd level of the Japanese Language Proficiency Test. In addition, I understand daily conversations and can respond with little difficulty. 2005～Present (Not necessary if you are from an English-language speaking country) Following my assignment to the International 2hours Relations Division in the Mayor’s Office, I Twice a week realized the necessity of learning English for English work purposes and have since studied diligently. I have received a score of 830 on the TOEIC English test. In addition, I understand daily conversations and have no difficulties with work-related matters. Languages At university Studied French for 4 years in college as a other than second language. Can converse on daily your mother 2 hours per conversational level. tongue week ⑲ Period Available for Training 17/ May/ 2015 ～ / Language

Day

Institution Self Study

Language school

Qualification Earned 2nd level of the Japanese Language Proficiency

Score of 830 on the TOEIC English test

University

/

Month

Year

*Training is provided for between 6 months to 12 months. The exact length of your stay in Japan will be decided by your host institution upon consideration of your individual circumstances. I hereby apply for the position of “Trainee” with the attached Written Pledge and Medical Checkup. I pledge that the above stated information is true and factual. 1 Day Jan Month 2015Year Signature of Applicant

John BROWN

(To be filled out by applicant’s supervisor) I hereby certify that the above application form and Medical Checkup sheet are true, and approve of and recommend the applicant as a suitable cooperation and exchange trainee. 2 Day Jan Month 2015 Year Organization Name Newbridge City Planning Division____________________ Address 1 Main Avenue, Newbridge, Main Province, Canada Tel Name of Department Head Signature of Department Head

01  2222 3333 Fax 01  2222  4444 Maria Lam____________________________

Maria Lam

Written Pledge ( A t t a ch m e n t 2 ) I f I a m s e l e c t e d a s a t r a i n e e o n th e L o ca l G o v e rn m e n t O f f i ci a l s T r a i n i n g P r o g ra m i n J a p a n , I h e r e b y p l e d g e th a t : 1 . I w i l l o b s e r ve J a p a n e s e l a ws . 2 . I w i l l o b s e r v e t h e i n s t r u c ti o n s o f t h e M i n i s tr y o f I n te r n a l A f f a i r s a n d C o m mu n i c a ti o n s ( M I C ) , t h e C o u n c i l o f L o c a l A u th o r i t i e s f o r I n t e rn a ti o n a l R e l a t i o n s ( C L A I R ) , a n d my h o s t i n s t i tu t i o n s i n J a p a n . 3 . I w i l l n o t l i s t a n y f a l s e i n f o r ma t i o n i n d o cu m e n t s s u b mi t t e d t o M I C , C L A I R , a n d th e h o s t i n s t i tu t i o n s i n J a p a n . 4.

I w i l l f a i th f u l l y c a rr y o u t t h e t r a i n i n g a s i n s t ru c t e d , a n d a b i d e b y the rules and regulations of the hos t institution.

5.

I w i l l n o t p a r t i ci p a te i n o r a n y p o l i ti c a l a c t i v i t i e s o r p e r f o rm s i m i l a r acts.

6.

I will not receive any remuneration for work.

7.

I w i l l p e r s o n a l l y b e a r a n y e xp e n s e s i n cu r r e d i n e x c e s s o f th e a m o u n t o f a l l o wa n ce s p r o vi d e d t o m e b y th e h o s t i n s t i t u ti o n a n d w i l l n o t r e q u e s t a n i n c re a s e i n a l l o w a n c e s p a i d t o m e b y t h e h o s t i n s t i t u t i o n . A l s o , i f I d i s co n ti n u e m y t r a i n i n g b e fo r e t h e d e s i gn a t e d p e r i o d i s c o m p l e t e d a n d r e tu r n t o m y h o m e co u n t r y w i th o u t a c o m p e l l i n g r e a s o n , I w i l l p e rs o n a l l y b e a r a l l e x p e n s e s i n c u r r e d d u r i n g t h e training.

8.

I w i l l p e rs o n a l l y r e p a y a l l d e b ts i n cu r re d d u ri n g m y s t a y i n J a p a n .

9.

I w i l l n o t r a i s e o b j e c t i o n s s h o u l d MI C , C L A I R , o r t h e h o s t i n s t i tu t i o n d e ci d e t o d i s c o n t i n u e m y t e n u r e a s a t r a i n e e , e i th e r b e ca u s e t h e y d e e m me u n fi t t o c o n t i n u e , o r d u e t o u n f o r e s e e n c i r cu m s ta n c e s th a t m a k e i t d i f f i cu l t t o c o n t i n u e t h e p r o g r a m .

1 0 . A f t e r r e tu rn i n g t o m y h o m e c o u n tr y, I w i l l a p p l y t h e kn o w l e d g e a n d t e c h n i c a l s k i l l s a cq u i r e d d u r i n g t h e t r a i n i n g t o m y w o r k i n m y h o m e c o u n tr y i n o rd e r to c o n t r i b u t e t o i ts p r o s p e ri t y , a s w e l l a s t o p r o mo t e f r i e n d l y ti e s b e t w e e n m y co u n tr y , l o c a l go v e rn m e n t , J a p a n a n d J a p a n e s e h o s t i n s t i tu t i o n . N a m e o f A p p l i ca n t :

John 1

S i g n a tu r e :

Day

Jan

Month

BROWN 2015

J o h n BROW N

Year

( A t t a ch m e n t 3 )

Medical Checkup Sheet Name

John

D a t e o f B i r th

BROWN

1982

June

／

Year

Sex

Male

Female

Current Address

date

( P l e a s e c i rc l e o n e )

1 M a i n A v e n u e , N e w b r i d g e , M a i n P ro v i n c e , C a n a d a

1.

Weight

70Kg

2.

Height

10. Hearing

3.

Abdominal Palpation/ Stethoscope Test Normal

185cm

4.

X-Ray

5.

Chest Problem

6.

None Eyesight With glasses

Normal

11. Blood Sedimentation None 12. Tuberculin Reaction

Normal

Positive

Negative

13. Past Illnesses None 14. Chronic Illnesses

Left Right Without glasses 7.

Left 1.0 Right Color Blindness

8.

None Blood Pressure

None 15. Allergies

1.0

Milk, pollen

16. Dietary restrictions

Cannot eat pork 17. Blood type

120 /80 9. Urine Test

11

／

month

O positive

Normal 18. Other

None 19. Alcohol

□ Don’t Drink

☑ Drink (Amount: 350ml

per day/week/month)

20. Smoke

□ Yes

☑ No

per day/week/month)

(Amount:

I hereby certify that the above details are correct. Hospital

Newbridge General Hospital

Address Date

1 0 0 A v e ra g e A v e n u e , N e w b ri d g e , M a i n P r o v i n c e , C a n a d a 2015／ January ／ Year

month

1 date

C e r ti f i e d b y

Dr.

Sarah

S i g n a tu r e

D r.

S a ra h

Sm i t h

S mi t h