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[]
["柏原市社会福祉協議会職員採用試験受験申込書(保健師・正看護師)"]
[]
[]
["ふ　り　が　な",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別(任意記載)",null,null,null,null,null,null,null,"受験番号　※"]
[]
["氏　　　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記入しないこと",null,null,null,null,null,null,null,"番"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"写真欄"]
["生　年　月　日"]
[null,null,null,null,null,null,null,null,null,null,null,null,"昭和・平成　　　　年　　　月　　　　日　　　年齢　満　　　　歳",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"写真は申込み前\n3ヶ月以内のもの\n　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　（上半身脱帽正面向き\nタテ４ｃｍ、ヨコ３ｃｍ）"]
[]
[]
["現　住　所",null,null,null,null,null,null,null,null,null,null,null,"（〒　　　－　　　　　）"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"電話　自宅（　　　）　  　－　　　　　携帯　　　 －　　　－　　"]
[]
["連　絡　先",null,null,null,null,null,null,null,null,null,null,null,"（〒　　　－　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話（　　　）　　　－"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"あなたとの関係（自宅・下宿など）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"学校名（学部・学科名を含む）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在学期間",null,null,null,null,null,null,null,null,"卒業等区分"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月",null,null,null,null,null,null,null,null,null,"卒業"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"中学校",null,null,null,null,null,null,null,"～"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月",null,null,null,null,null,null,null,null,null,null,null,null,"卒業"]
[null,null,"学　　　歴"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月",null,null,null,null,null,null,null,null,null,null,null,null,"年中退"]
[null,"中学校卒業以降の"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月",null,null,null,null,null,null,null,null,null,null,null,null,"卒業"]
[]
[null,"学歴（受験予備校等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月",null,null,null,null,null,null,null,null,null,null,null,null,"年中退"]
[null,"を含む）を記入のこと"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月",null,null,null,null,null,null,null,null,null,null,null,null,"卒業"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月",null,null,null,null,null,null,null,null,null,null,null,null,"年中退"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"勤務先の名称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"職務内容",null,null,null,null,null,null,null,null,null,null,null,"在職期間"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[null,null,"職　　　歴"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[null,"職業上の経歴を最初"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[]
[null,"から順に記入すること",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[null,"　なお、アルバイト・"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[]
[null,"無職の期間について",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[]
[null,"も記入のこと",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月"]
[]
[]
[null,"※記入事項が枠におさまらない場合は別の用紙にご記入いただき貼り付けて下さい。"]
[]
[]
["資格・免許等（取得見込みも記入のこと）",null,null,null,null,null,null,null,"取得年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名　称"]
[]
[]
[null,null,null,null,null,null,null,null,"昭・平・令　　　年　　月　　日"]
[]
[]
[null,null,null,null,null,null,null,null,"昭・平・令　　　年　　月　　日"]
[]
[]
[null,null,null,null,null,null,null,null,"昭・平・令　　　年　　月　　日"]
[]
[]
[null,null,null,null,null,null,null,null,"昭・平・令　　　年　　月　　日"]
[]
[]
[null,null,null,null,null,null,null,null,"昭・平・令　　　年　　月　　日"]
[]
[]
[]
[null,null,null,"◎裏面も記入のこと"]
[]
[]
[]
[]
["柏原市社会福祉協議会を志望する理由"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["希望する仕事の内容"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["自分をＰＲできるようなこと"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["趣味・特技等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健康状態"]
[]
[]
[]
[]
[]
[]
["クラブ活動",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ボランティア活動"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"　私は、柏原市社会福祉協議会職員採用試験の受験申込みをしますが、次の各号のどれにも"]
[]
[null,null,"該当しておりません。"]
[]
[]
[null,null,null,null,"(1)",null,"　禁錮以上の刑に処せられ、その執行を終わるまでの者、又はその執行を受けることが"]
[]
[null,null,null,null,null,null,"なくなるまでの者"]
[]
[null,null,null,null,"(2)",null,"　日本国憲法又はその下に成立した政府を暴力で破壊することを主張する政党その他"]
[]
[null,null,null,null,null,null,"の団体を結成し、又はこれに加入した者"]
[]
[]
[null,null,null,null,null,null,"記載事項のとおり相違ありません。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和　　　年　　　月　　　日"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名　　　　　　　　　　　　　　　　印"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・署名、捺印してください。"]
[]
[]
["記　入　上　の　注　意"]
[]
[]
[]
["１　記入事項に虚偽又は不正があると採用が取消されます。"]
[]
["２　※印欄を除いて、すべての欄にもれなくインク又はボールペン（黒又は青）を用い、楷書でていねいに"]
[]
["　　記入してください。"]