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2012 JET Programme Application Form

This document is an application form for the 2012 JET Programme. It requests information such as the applicant's name, date of birth, nationality, education history, teaching experience, Japanese language ability, emergency contacts, and a self-assessment medical report. The applicant must certify that the information provided is accurate and agree to abide by Japanese laws and regulations if selected for the program.

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0% found this document useful (0 votes)
50 views12 pages

2012 JET Programme Application Form

This document is an application form for the 2012 JET Programme. It requests information such as the applicant's name, date of birth, nationality, education history, teaching experience, Japanese language ability, emergency contacts, and a self-assessment medical report. The applicant must certify that the information provided is accurate and agree to abide by Japanese laws and regulations if selected for the program.

Uploaded by

Sizzlez
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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For use by CIRs, ALTs

2012 JET

2012 JET Programme Application Form


Please print the information requested using CAPITAL LETTERS for questions 1-17. For the remaining questions, please type or print your answers clearly. Please see the instructions to answer the questions. 1. Interview Location 2a. Position Type 2b. ALT placement (CIR Applicants only) n/a 2c. April placement, or placement after April and before Group A/B departure

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)

Middle Initial (one initial for each middle name)

4.

Sex M/F

5.

Nationality

6.

Date of Birth Year

Month

Day

1 9
7a. Hometown

7b. Home state/province/county/department/district/prefecture (use an abbreviation if possible)

...................................... 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?

11b. How many people are going to accompany you?

11c. Are your children going to accompany you?

For use by CIRs, ALTs

2012 JET

12a. Marital Status

12b. Is your partner a JET applicant? Location Code

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.)

13a. Education Level

13b. Academic Specialisation Major

Major / Minor

14a. Certified Teacher

14b. TEFL/TESL Qualification

15. Drivers License

16. Placement 16a. Request

16b. Living Area Classification

16c. First Choice Block Prefecture./Designated City

Specific Placement Request (Please give reason on next page.)

Second Choice Block Prefecture./Designated City

Third Choice ( if possible, choose a different block from your 1st or 2nd choice ) Block Prefecture./Designated City office use only

17a. Primary School

17b. International Economic Exchange

17c. Support for Foreign Population

For use by CIRs, ALTs

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.

For use by CIRs, ALTs

2012 JET

23. Permanent Address (Please use your domestic address only.)

Telephone E-mail Address

Fax Number

24. Temporary Address & Effective Dates (Effective from

to

.)

Telephone: Fax Number: E-mail Address:

(Home) (Home)

(Work) (Work) Other Daytime Contact

25. Higher Educational Institutions Attended: Name of Institution Dates attended

Specialisation (including both major and minor)

Degree/Diploma, Date earned or expected

26. Teaching Background Institution a. Classroom Teaching

Subject / Course

Grade / Level

Dates

Hours/ Week

b. Other Teaching or Tutoring

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.

For use by CIRs, ALTs

2012 JET

27. International / Intercultural Experience (at home or abroad): Country Purpose

Dates

28. Present or Most Recent Occupation Name, Address, Telephone and Fax Number of Employer

Dates

Full-time

Part-time or Temporary Position and Description of Full-time Job:

Position and Description of Part-time/Temporary Job:

......................................

For use by CIRs, ALTs

2012 JET

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

Study of Japanese Language a) Formal

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

semiadvanced advanced semiadvanced

intermediate intermediate intermediate intermediate

elementary elementary elementary elementary

introductory introductory introductory introductory

none none

semiadvanced advanced semiadvanced

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

For use by CIRs, ALTs

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.)

For use by CIRs, ALTs

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

TV Radio Poster Career Fair JET Alumni Other:

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

2012 JET

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_______________________________

2012 JET Programme Application Self-Assessment Medical Report


Interview Location: 9410

Please type or handprint clearly.

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:

(as printed in passport)

Last DATE OF BIRTH:

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.)

The answers I have given are correct to the best of my knowledge.

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

THE 2012 JAPAN EXCHANGE AND TEACHING PROGRAMME (JET Programme)

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:

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