Fillable 2022 JET PROGRAMME APPLICATION FORM (Embassy of Japan in the Philippines)

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2022 JET PROGRAMME APPLICATION FORM (Embassy of Japan in the Philippines)

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1
2022 JET PROGRAMME APPLICATION FORM
Please download the Form Instructions from the JET NZ website and refer to them when completing this form!
Please complete ALL compulsory fields (you do not need a digital signature) & submit this form to jet@wl.mofa.go.jp.
Then print this form out, hand-sign the spaces on pages 7, 8, and 10 and submit physically as part of your Application Packet.
1. Po
sition Type 2. Interview Location Code and Name
4
0
0
3. Name – Please write your name exactly as it appears in your passport.
Last
Name ONLY (if you have two last names, leave a space between them)
Firs
t Name ONLY (if you have two first names, leave a space between them; do not write middle names)
Mi
ddle Name ONLY (if you have two middle names, leave a space between them)
4. Sex
5. Date of Birth Age as of
(M/F/O (Other))
Year Month Day 1 April 2022
6a. N
ationality 6b. Dual Nationality with Japan (Y/N)
7a. Hom
etown (City/Town Name)
7b. Region
8. Contact Details (If possible, please provide an email address at which you can be contacted at before you leave for
Japan, during your stay in Japan, and after you return home. Correspondence relating to your application will, in
principle, be sent via post and followed up by e-mail)
Address:
Telephone Number:
Email Address:
9. Have you ever been arrested, charged and/or convicted of any crime other than a minor traffic offence (i.e.
speeding or parking ticket), including juvenile offences? Failure to report items in this question, even those which you
believe to have been expunged or otherwise removed from your criminal history that later show up on that
history may result in disqualification.
(Y/N)
If yes, please explain in detail on a separate sheet, providing information regarding the nature and date
of the crime. Please also submit a copy of your complete criminal record at the time of application.
2
10.
C
urrent Status (Students – please include name of university attending)
11a.
Educational Background (If you graduate prior to JET departure, please write “Y” for the degree you will earn)
Bachelor’s Degree (Y/N) Master’s Degree (Y/N) Doctoral Degree (Y/N)
11b.
Academic Specialisation
Major (Please check the “Instruction Form
” for Academic Specialisation codes)
*I
f you specialised in two subjects (double-major) or had a sub-specialisation (minor), list the extra specialisations below
11c. A
cademic Record
Completion of High School (month and year):
Conferment of University Degree (month and year):
Name of Institution and
Location
Duration of
Study
Major Field of
Study
Certificate/Degree
Achieved/Expected
Undergraduate
Level
From:
To
:
Years:
M
onths:
From:
To
:
Years:
M
onths:
Postgraduate
Level
From:
To
:
Years:
M
onths:
From:
To
:
Years:
M
onths:
12. E
mployment History: Begin with your most recent employment (including part-time jobs)
Name of Employer and Location Period
Job Title and Brief Description of
Position/Duties
Hours Per
Week
From:
To
:
From:
To
:
From:
To
:
3
13a. Teaching Background
Name of Organisation
and Location
Period
Job Title and Brief Description of
Position/Duties
Hours Per
Week
Classroom
Teaching
From:
To
:
From:
To
:
Other
Teaching
or
Tutoring
From:
To
:
From:
To
:
Name of Organisation
and Location
Period Course Description
Teacher
Training
From:
To
:
From:
To
:
13b
.Certified Teacher 13c. TEFL/TESL/TESOL/etc. Qualification
(Y/
N) (Y/N/I)
14
.
P
roposed Direction of Career and its Relationship to the JET Programme:
4
15
. J
apan-Related Studies
Name of Institution and Course Title
Period of Study
General Content
Study of Japanese
Language
From:
To:
From:
To:
From:
To:
Study of Japanese
History, Culture,
etc.
From:
To:
From:
To:
From:
To:
16
a.
Japanese Language Proficiency: Evaluate your level and insert an “X” where appropriate in the following blank space.
Introductory
:
Familiar with basic greetings and conversations, and has previous experience with
hiragana
and
katakana
.
Elementary
:
Mastered elementary level of grammar, about 100 kanji and 800 words, and demonstrates the ability to
listen to and understand simple conversations and to read short, simple sentences.
Intermediate
:
Mastered basic grammar, about 300 kanji and 1,500 words, and demonstrates the ability to listen to and
understand everyday conversations and to read simple sentences.
Semi-advanced
:
Mastered grammar to a relatively high level, about 1,000 kanji and 6,000 words, and demonstrates
listening and reading comprehension ability about matters of a general nature.
Advanced
:
Mastered grammar to a high level, about 2,000 kanji and 10,000 words, and has an integrated command of
the language sufficient for life in Japanese society and for providing a useful base for study at a Japanese university.
Advanced
Semi-Advanced
Intermediate
Elementary
Introductory
None
Reading
Writing
Speaking
Listening
16b. J
apanese Language 16c. Highest 16d. Year JLPT Attained
Proficiency Test (Y/N) JLPT Level *Please include certification document
17
.
I
nternational/Intercultural Experiences (at home and/or abroad; please list all applicable experiences)
Country
Purpose
Dates/Period (Duration)
From:
To:
Period:
From:
To:
Period:
From:
To:
Period:
From:
To:
Period:
From:
To:
Period:
From:
To:
Period:
5
18a. Language Proficiency: Please write your first language.
18b. Foreign Language Proficiency: Evaluate your level and insert an “X” where appropriate in the following blank space.
*EXCLUDING JAPANESE AND YOUR NATIVE LANGUAGE
Foreign Language
Excellent
Good
Fair
Poor
19. Other activities:
a. Honours, Awards, Scholarships
b. Extra-Curricular/Volunteer Activities, Interests/Hobbies/Sports
20. Are you presently an applicant of, or do you intend to apply for, any other international exchange programmes or
scholarships? Write “Yes” or “No” below. If “Yes”, please give details.
21. JET Programme Participation
a. Have you ever participated in the JET Programme?
(Y/N) If yes, Year Started JET: If yes, Year Completed JET:
If yes, please provide
contracting organisation:
b. Have you ever applied for the JET Programme?
(Y/N) If yes, state year(s) applied for the JET Programme:
c. Have you ever withdrawn from the offer of a JET Programme position?
(Y/N) If yes, state year and reason for withdrawal:
Reason for withdrawal:
22. Marital Status: (Single, Engaged, or Married)
6
23. Accompanying Dependents or Co-habiting Family Members (Provide the following information if you plan to bring any
family members to Japan, or if there are any family members you plan to live with in Japan)
Name
Relationship
Age
JET Applicant?
24. Driv
ing in Japan
If you have a full NZ Driver’s Licence and would consider driving while in Japan, please enter “Y” for Yes. If not, please
enter “N” for No. Please enter “N” if you only possess a motorcycle licence and do not have a full NZ Driver’s Licence.
Applicants that answer “Y” for this question may be required to operate a motor vehicle as part of their work duties.
(Y/N)
25. As
signment Preference
PLEASE NOTE: JET participants are assigned to contracting organisations all over Japan. Assignments may not
necessarily be made according to your placement preferences.
a. Living Area Classification Preference
(Island (small island off mainland Japan), Rural (countryside), Urban (city/suburban), or No Preference)
b.
Placement Preferences (Please check the “Instruction Form
” for Placement Preference codes.)
*If you wish to engage in disaster-recovery volunteer activities, please indicate so below.
Bl
ock Prefecture/City Reason:
First
Choice
Bl
ock Prefecture/City Reason:
Second
Choice
Bl
ock Prefecture/City Reason:
Third
Choice
c. Spec
ific Request for Placement (e.g. Medical Reasons, Family Members in Japan)
26a. Interest in Work Related to International Economic Exchange Affairs (For CIR Applicants only):
Are you interested in work related to international economic exchange affairs, such as cooperating or advising on
planning, designing and implementing international economic exchange projects (e.g. expanding the overseas market for
local products or attracting foreign tourists to Japanese localities etc.)? Assignments may not necessarily be made
according to your placement preferences.
(Y/N)
26b. ALT Placement 26c. Early Placement after April but before July (ALL APPLICANTS):
(For CIR
Applicants only):
Do you wish to be considered for an early placement in
Japan after April, but before July arrival?
(Y/N) (Y/N)
7
APPLICATION DEADLINE: 5:00PM N
ZST, MONDAY 6 DECEMBER 2021
27. Wh
ere did you hear about the JET Programme? (Please check as many as apply)
Professor/Advisor/Instructor
Campus Visit
Newspaper Article
TV
Careers Advisor
Magazine Advertisement
Internet Advertisement
Radio
Former JET Participant
Magazine Article
Internet Article
Poster
Current JET Participant
Newspaper Advertisement
JETAA
Career Fair
Embassy/Consulate
University E-mail
CareerHub
Facebook
Job Search Website
YouTube
Twitter
Reddit
Other (be specific):
28. Em
ergency Contact (Person to be notified in applicant’s home country in case of emergency)
Name in Full:
Physical Address:
Telephone Number:
Email Address:
Occupation:
Relationship to you:
29. Please fill out the attached “Self-Report of Medical Condition(s)”. If you suffer, or have ever suffered from ANY
physical or mental illness, please download the Statement of Physician from our website and have your physician
complete this form stating whether you are fit to participate on the JET Programme and to live and work overseas.
I, the undersigned, certify that the above statements concerning myself and my background are true and accurate to the
best of my knowledge, and that I have read and agree with the application guidelines. Furthermore, if I am selected as a
Coordinator for International Relations or Assistant Language Teacher, I agree to abide by Japanese laws and
regulations and the regulations of my contracting organisation. I agree to carry out my duties to the best of my ability,
as well as not to engage in any activities prohibited by the terms and conditions of my appointment. I understand that
during my stay in Japan I must not participate in any religious or political activities which would affect my duties nor do
anything to disturb the public peace.
PL
EASE RETURN THIS FORM TO: Japan Information and Cultural Centre, Embassy of Japan
(Level 18, Majestic Centre, 100 Willis Street)
PO Box 6340, Marion Square, Wellington 6141
ATTN: JET OFFICER
Signature of Applicant: Date: / / 2021
(DO NOT SIGN DIGITALLY)
8
AUTHORISATION AND RELEASE FORM
(Note: to be completed by ALL APPLICANTS)
I, (Full Name)
born at (Town/City)
(Province)
(Country)
on (Date of Birth)
hav
e applied to participate in the Japan Exchange and Teaching (JET) Programme, and hereby authorise and
request that any law enforcement agency having control of any documents, records or other information
related to me, provides to the Embassy of Japan, the Consulate General of Japan or the Consular Office of
Japan, at its request, any such information. I also allow the Embassy of Japan, Consulate General of Japan or
Consular Office of Japan to make copies of these documents, records or other information.
I
hereby release, discharge, and exonerate the Embassy of Japan, Consulate General of Japan and the
Consular Office of Japan, its agents and representatives and any person who provides information from any
and all liability of every nature and kind arising from the provision or inspection of such documents, records,
and other information.
REFERENCES
Each applicant should arrange for two physical letter references (hand-signed in pen with reference’s
signature, unsealed and collated into the Application Sets properly) which address the applicant’s
personal and professional suitability for the JET Programme. Please write below the details of the people who
have supplied the included references. For more details, please check 2022 JET Application Guidelines
.
REFERENCE ONE
Name
Title/Occupation
Organisation
Telephone
REFERENCE TWO
Name
Title/Occupation
Organisation
Telephone
Signature of Applicant: Date: / / 2021
(DO NOT SIGN DIGITALLY)
9
2022 JET Programme Applicant
Self-Report of Medical Condition(s)
Interview Location Code:
4
0
0
Your application cannot be processed without this form. It is important that you submit accurate information
regarding your medical history. This information will be used when assigning your placement as well as in
serving as a quick reference should any medical emergencies arise while you are participating in the
Programme.
If you suffer, or have ever suffered from any physical or mental illness, please attach an
explanation from your physician, using the 2022 JET Programme “Statement of Physician” Form,
stating whether you are fit to participate in the 2022 JET Programme and, as such, to live and
work overseas.
1. Current Treatment of Any Physical Condition(s): Are you currently seeing a physician and/or
undergoing treatment? (other than acne, common colds, fevers, visits to OB/GYN facilities or consultations
for requesting contraception) If yes, you must provide details below as to when, why, and for how long
you have been receiving treatment AND have your doctor fill out the “Statement of Physician” Form.
2a. Physical Condition(s) in the Past Five (5) Years: What, if any, serious diseases, injuries and/or
medical conditions have you had in the past five years? If any of these resulted in hospitalisation, please
provide details below as to when, why, and for how long you received treatment AND have your doctor
fill out the “Statement of Physician” Form.
2b. Other Undisclosed Condition(s): Other than those stated in 2a, have you ever been treated for any
serious diseases, injuries and/or medical conditions, including but not limited to heart disease, blood
disease, autoimmune disease, cancer, epilepsy, congenital disease, recurrent disease, or any other disease,
injury, or medical condition involving chronic or lifelong effects? If yes, you must provide details below
AND have your doctor fill out the “Statement of Physician” Form.
Personal Details (as printed in passport)
NAME:
Last First Middle
DATE OF BIRTH (mm/dd/yyyy): _________________________________________
10
3. History of Mental Health of Development Disorders in Your Lifetime: Have you ever been
diagnosed with any mental health or development disorders? If yes, you must provide details below AND
have your doctor fill out the “Statement of Physician” Form. Note that we may contact your consulate or
embassy if further information is required.
Anxiety
Depression
Obsessive-Compulsive Disorder
Bipolar Disorder
Attention Deficit Disorder (ADD)
Attention Deficit/Hyperactivity Disorder (ADHD)
Eating Disorder
Post-Traumatic Stress Disorder (PTSD)
Autism Spectrum Disorder (ASD)
Other:
4. Foreseeable Difficulty in Navigating Stairs: Do you foresee any physical challenges resulting from the
need to go up and down several flights of stairs on a daily basis? If yes, please explain.
5. Allergies: What allergies do you have, if any? Are you currently undergoing treatment? If yes, please
provide details below.
6. Medication(s): If you are currently taking, or have taken in the last five years, any prescription medication,
(other than for common colds/viruses, oral contraceptives, or acne medications), please give details
including the name of the medication, purpose, and period taken. Make sure to describe the conditions for
which you take any medications listed here in questions 1, 2a, 2b, and 3, above.
7. Eyesight and Hearing: Are you colour blind or have any disabilities related to your eyesight or hearing
(excluding the use of prescription glasses and contact lenses to correct vision)?
Legally Blind
Colour Blind
Hearing Impaired
Please provide details below.
If you wrote yes for question 7 AND have a driver’s licence, does this affect your ability to drive?
Yes
No
8. Dietary Restrictions: Are there any foods or substances that, for medical or personal reasons, you do not
eat? If so, please give reasons. (e.g. medical, religious, personal reasons, etc.) Check all that apply.
Foods:
Reasons:
Beef
Chicken
Dairy Products
Eggs
Allergies
Gluten
Tree Nuts
Peanuts
Pork
Religion
Wheat
Shellfish
Soy
Fish
Other medical reasons:
Fruit
Other:
Other:
9. Other Health-Related Issues or Disabilities: Please explain any other health-related issues or
disabilities. (e.g. use of a wheelchair, pending medical treatment, etc.)
I understand that false statements may result in disqualification from the JET Programme.
I also understand that if I suffer, or have ever suffered from any physical or mental illness, I must
also submit the “Statement of Physician” Form in which my physician clearly states my ability to
live and work overseas on the JET Programme.
Signature of Applicant: Date: / / 2021
(DO NOT SIGN DIGITALLY)
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2022 JET PROGRAMME APPLICATION FORM (Embassy of Japan in the Philippines)

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Completed 4 December 2021

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