FY2015 Young Core Leaders of Civil Society Groups Development Program
Resume of Invitee
(Bust)
Country / Nationality
Name (as shown on your passport):
Mr □ Ms. □
First Name / Family Name
Gender / □ Male □Female
Date of Birth / Age
Address: / Date photographed:
Tel: / Fax:
Mobile: / Email:
Passport / Number: / Expires:
Emergency Contact / Name:
Relationship:
Address:
Tel: / Fax:
Mobile: / Email:
Occupation / Employee (Private Company) □ Teacher □
Employee (organisations NPO)) □ Student □
Official (central government, public administration) □
Other (please specify) □
Specialised Field / □ Activities for elderly people
□ Activities for people with disabilities
□ Activities for youth
Name and type of your organisation / Name of your organisation:
Type:
□ Government agency
□ Municipal agency (local government)
□ Non-profit organisations (inc. voluntary organisations)
□ Private company
□ Others (please specify) / Work Details:
Tel:
Fax:
Website:
Email:
Position/Title / Position/Title
□ Administration/Management
□ Leader in the activity fields
□ Volunteer staff
□ Others (please specify
Description of your job (What do you do exactly?) / (Approx. 200 Words)
Major services/activities your organisation provides / (Approx. 200 Words)
Organisations involved/you belong to in your specialised field (other than your job) / (Approx. 200 Words)
Description of your activities within the organisation involved/you belong to / (Approx. 200 Words)
Final Schooling / Subject
Experience of international exchange (Name of country, details etc.)
Language(s) you use / Religion
Dietary or other special requirements
Chronic disease (including allergies), Medication taken for daily or constant conditions/assistant required for your participation in the program
Smoking (for homestay matching) / □ Smoker □ Non Smoker
Special skills
Matters of interest about Japan
Experience of travel to Japan / □ Yes □ No
Date:
Purpose of Visit:
Nearest International airport
(also nearest local airport, if transfer necessary)
Criminal Convictions / □ Yes □ No
You have:
-Been convicted of a crime or offence in any country.
-Been sentenced to imprisonment for 1 year or more in any country
-Been deported or removed from Japan or any country for overstaying your visa or violating any law or regulation
-Been convicted and sentenced for a drug offence in any country in violation of law concerning narcotics, marijuana, opium, stimulants or psychotropic substances.
-Engaged in prostitution, or in the intermediation or solicitation of a prostitute for other persons, or in the provision of a place for prostitution, or any other activity connected to prostitution.
-Committed trafficking in persons or incited or aided another to commit such an offence.
*Under the Immigration Control and Refugee Recognition Act, a person who may be applicable to one of these items above cannot enter Japan in principle.
If applicable to any of these items above, please consult a person in charge of the matter of your government as a special request may be necessary for an entrance.
(These items are the same as the ones appearing in an ordinary visa application).
The information you provide will only be used for the purposes of this program.
As for the actual invitees, necessary information may be used for 1) execution of the program and 2) the establishment and maintenance of the network of ex-participants. Further, this information may be shared with other invitees and those who are concerned with the program for the purposes of provision of post-program activities organisation (e.g. International Youth Exchange Organisation of Japan (IYEO)).
All data is securely held in accordance with the ‘Act of Protection of Personal Data Held by Administrative Organs.’