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Inquiry for The Caregiver Training Course For License

  • STEP1Fill out the form
  • STEP2Confirm information
  • STEP3Completion of inquiry

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Please call us if you have any difficulty in filling out the form. Tel: 0120-94-4165
It could take a couple of days for you to get our response in case of requesting by this application form, so please call us if you are in a hurry.

What do you need ?Required
Full NameRequired
Japanese pronunciation
written in katakana
charactersOptional
SexRequired
Date of birthOptional

e.g., 1945 Year 1 Month 1 Date

Postal codeRequired

※ Please input half-width numbers

※ No hyphen necessary

AddressRequired

  • Prefecture

  • Cities, wards,towns, villages and house numbers

  • Building name and room number, etc.

Phone number
(Half-width numbers)Required

※ Please input half-width numbers

※ No hyphen necessary

E-mail address
(Half-width English alphanumeric characters)Required

e.g., example@azumien.jp

※ Please input half-width English alphanumeric characters

OccupationRequired
Questions or inquiriesOptional
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