2012 JET Programme Application Form
2012 JET Programme Application Form
2012 JET
9 4 1 0
3.
A L T
Last Name ONLY (if you have two last names, leave a space between them)
First Name ONLY (if you have two first names, leave a space between them. Do not write middle names)
4.
Sex M/F
5.
Nationality
6.
Month
Day
1 9
7a. Hometown
...................................... 8. Dual Nationality with Japan 9a. Have you ever been offered a position on the JET Programme? 9b. Have you ever participated in the JET Programme?
10. Have you ever been arrested, charged and/or convicted of any crime other than a minor traffic offense (ie. Speeding or parking ticket), including juvenile offences? Failure to report items in this question and
question 19, even those which you believe to have been expunged or otherwise removed from your record that later show up on that history will result in disqualification in principle.
11a. Accompanied?
2012 JET
12c. Partners
12d. Partner's Last Name, if applicable (Please use the same spelling as your partner uses on their application form.)
Partner's First Name (Please use the same spelling as your partner uses on their application form. Do not write middle names.)
Major / Minor
Third Choice ( if possible, choose a different block from your 1st or 2nd choice ) Block Prefecture./Designated City office use only
2012 JET
18a. If you answered yes to question 9a please give the year and the interview location. Also, explain in detail the reasons why you did not accept the position if your application was successful.
18b. If you answered yes to question 9b please give the year(s) and the name of the contracting organisation you worked at as a JET Programme participant.
19. If you answered yes to question 10, 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 which documents the incident at the time of the application or by the end of February at the latest. This will be examined to decide your short-list candidacy described in Section 10 of the application form. If you cannot obtain your complete criminal record for statutory reason, please read and sign the "Authorisation and Release" form in order to enable the Japanese Embassy or Consulate General to access your criminal record, which will be examined to decide your short-list candidacy. Please also note that short-list candidates and alternates who answered no to question 10 must obtain and submit your criminal record to the Japanese Embassy or Consulate General where they interviewed by June 28, 2012. (Please refer to the Application Procedures section for further details on this.)
20. If you will be accompanied by family dependents, please write their relationship (spouse/daughter/son) to you and their ages if they are under 18 years old.
21. If someone is applying for the 2012-2013 programme and you wish to be placed with or near them, please write their name here (as spelled on their application form) and write your relationship to them.
22. If you have strong reasons for a placement request (answer 16c) please make note of the reason here. This includes such cases as medical reasons for a specific placement, or your partner being a current JET Programme participant.
2012 JET
Fax Number
to
.)
(Home) (Home)
Subject / Course
Grade / Level
Dates
Hours/ Week
c.Teacher Training
IMPORTANT: Please provide an official transcript of all courses taken at your under graduate college/university and post-graduate school if applicable, as well as any relevant certifications for questions 25 and 26.
2012 JET
Dates
28. Present or Most Recent Occupation Name, Address, Telephone and Fax Number of Employer
Dates
Full-time
......................................
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29. Proposed Direction of Current or Future Profession and Its Relationship to the JET Programme.
30. Japan-related Studies Institution and Course Study of Japanese History, Culture, etc. Dates Grade
b) Informal
Please give an honest Reading: evaluation of your Japanese language proficiency. Circle the Writing: most appropriate word in each category, according to Speaking: the guidelines written below: Listening:
advanced
none none
advanced
none none
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
2012 JET
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. 31. Do you have any certification of Japanese language proficiency? YES / NO (circle one). If yes, please list the names of the certificates and also the applicable dates.
32. Please evaluate any abilities you have in other languages according to the criteria below: 1=basic 2=elementary 3=intermediate 4=semi-advanced 5=advanced LANGUAGE: Reading: LANGUAGE: Reading: Writing: Speaking: Listening: Writing: Speaking: Listening:
33. Please list any honours, awards, scholarships, offices held and achievements gained and the dates you received them. (Avoid acronyms and abbreviations.)
34. Please list any extra-curricular/volunteer activities, interests/hobbies/sports. List dates of involvement in each activity, club or team. (Avoid acronyms and abbreviations.)
35. Are you presently an applicant, or do you intend to apply for any other international exchange programmes or scholarships? YES / NO (circle one) If yes, please give details. (Your answers will not affect your qualification for participation on the JET Programme.)
2012 JET
36. Where did you hear about the JET Programme? Professor/Advisor/Instructor Magazine Advertisement Placement Office Magazine Article Former JET Participant Newspaper Advertisement Current JET Participant Newspaper Article Embassy/Consulate Internet Advertisement Campus Visit Internet Article
37. Emergency Contacts (Please list two people who should be contacted in case of emergency.): Name Address Telephone & Relationship Fax Number to Applicant (Tel) (Fax) (Tel) (Fax)
38. Please fill out the attached Self Assessment Medical Report. If you suffer, or have ever suffered from any physical or mental illness, please attach an explanation and a letter from your physician stating whether you are fit to participate in the JET Programme and, as such, 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 an Assistant Language Teacher or Coordinator for International Relations, 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 political activities which would affect my duties nor do anything to disturb the public peace.
Signature:
Date:
PLEASE RETURN THIS FORM TO: The JET Programme Cultural Section Embassy of Japan NCB Towers, North Tower, 6th Floor 2 Oxford Road, Kingston 5 DEADLINE: 1 p.m., December 2, 2011
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AuthorisationandReleaseForm
I,(Name)___________________________________________________________________, bornat(City)__________________(Province)_______________(Country)___________, on(DateofBirth)_______________________,haveappliedtoparticipateintheJapan ExchangeandTeaching(JET)Programme,andherebyauthoriseandrequestthatany law enforcement agency having control of any documents, records or other information related to me, provides to the Embassy of Japan or the Consulate GeneralofJapan,atitsrequest,anysuchinformation.IalsoallowtheEmbassyof JapanortheConsulateGeneralofJapantomakecopiesofthesedocuments,records orotherinformation. I hereby release, discharge, and exonerate the Embassy of Japan or the Consulate General 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 provisionorinspectionofsuchdocuments,records,andotherinformation. SignatureofApplicant_______________________________________ Date_______________________________
To the applicant: Please fill out the reference data below. Your application cannot be processed without this form. Successful applicants will be required to submit a JET Programme Certificate of Health, including a chest x-ray, from their physician in April 2012. It is important that you submit correct information regarding your medical history. If you now have or have ever had any physical or mental condition/illness, you must use the attached letter to provide an explanation from your physician stating whether you are fit to participate in the JET Programme and, as such, to live and work overseas. This information will be used to your benefit in deciding your placement as well as in serving as a quick reference should any medical emergencies arise while you are participating in the JET Programme.
Personal Details
NAME:
First
Middle
1.
When and for what reason did you last consult a physician? (Colds, fevers may be omitted. Also visits to OB/GYN facilities or consultations for the requesting of contraception may be omitted.)
2a.
What diseases, ailments or injuries have you had in the past five years? If any of these resulted in hospitalisation, please give details as to when, why and the duration of the treatment.
2b.
What is your current status with regard to the condition(s) described in 2a.?
3.
Are you currently seeing a physician and/or undergoing treatment? If yes, you must detail below, AND have your doctor fill out the Physicians Report.
4.
Have you ever been treated for any nervous or mental disorders (including, but not limited to anxiety, depression, ADD, ADHD and eating disorders)? If yes, you must detail below AND have your doctor fill out the Physicians Report. Please note that we may contact your doctor if further information is necessary.
5.
Have you ever been treated for any other illness or condition previously undisclosed on this Medical Report? If yes, you must detail below AND have your doctor fill out the Physicians Report.
6.
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.
7.
What allergies do you have, if any? Are you currently undergoing treatment?
8.
If you are currently taking, or have taken in the last five years, any prescription medication, other than oral contraceptives, please give details including medications name, purpose and dates taken. Make sure to describe the conditions for which you take any medications listed here in questions 4 and/or 5, above.
9.
Are there any foods or substances which, for medical or personal reasons, you do not eat? If so, please give details.
10.
Please explain any other health-related issues or disabilities. (ex. Legally blind, hearing impaired, confined to wheelchair, pending medical treatment etc.)
Signature:
Date:
PLEASE RETURN THIS FORM TO: The JET Programme Cultural Section Embassy of Japan NCB Towers, North Tower, 6th Floor 2 Oxford Road, Kingston 5 DEADLINE: 1 p.m., December 2, 2011
Statement of Physician
Explanation of items mentioned by patient on self-assessment medical form
To the Physician: The patient presenting this form is applying to the JET Programme and must provide a physicians statement concerning his/her medical health as indicated on his/her Self Assessment Medical Form. Based on your current examination/evaluation and knowledge of the patients medical history, please describe his/her medical condition and state whether or not you think the applicant is physically and mentally fit to work in Japan as a participant on the JET Programme. Note: Participants of the JET Programme undertake year-long contracts and work at schools and public offices in Japan as Assistant Language Teachers (ALTs) or Coordinators for International Relations (CIRs). JET Programme participants work for 35 hours per week. Below is a list of general duties for ALTs and CIRs. For more detail on the programme, please visit the website: http://www.jetprogramme.org.
ALTs are assigned to local boards of education or primary, junior high and senior high schools and their duties are generally as follows: 1. Assistance in classes taught by Japanese foreign language teachers in primary/elementary, junior and senior high schools. 2. Assistance in preparation of materials for teaching a foreign language. 3. Assistance in language training of Japanese teachers of foreign languages. 5. Assistance in extra-curricular activities such as foreign language clubs. 6. Assisting other teachers with foreign language-related information (e.g. word usage, pronunciation). 7. Engagement in local international exchange activities. CIRs are assigned to local public offices and their duties are generally as follows: 1. Assistance in projects related to international activities carried out by the public offices, such as editing, translating and compiling brochures; assisting in planning, designing and implementing international exchange programmes; assisting in hosting official guests from abroad and interpreting at events. 2. Assistance in language instruction of other public office employees. 3. Assistance in planning and participating in activities of local private groups or organisations engaging in international exchange. 4. Assistance in exchange activities (including school visits) related to community members cross-cultural awareness & understanding as well as in support activities for other foreign nationals residing in Japan.
To be completed and signed by examining physician. Physician must not be a relative of applicant.
Do you foresee the need for this applicant to take medication during his/her participation on the JET Programme? (If yes, please list medications and give details if not listed above.)
YES
NO
**Japanese law may prohibit importation of certain medication. In this case, the applicant may need to use an alternative medication. Additionally, it may be necessary for the applicant to complete medical import forms for importation of certain medication.
Date: Physicians Name in Print: Office/ Institution: Address: Tel: Signature:
Fax:
e-mail: