申請人等作成用３　Ｖ（「特定技能（１号）」・「特定技能（２号）」）

For applicant, part 3 V ("Specified Skilled Worker (i)"・"Specified Skilled Worker (ii)")

在留期間更新用

For extension of status

23 特定技能雇用契約に係る申込みの取次ぎ又は外国における活動準備に関する外国の機関への費用の支払いについて、その額及び内訳を十分に理解して合意していることの有無（当該費用の支払がある場合に記入）

Do you fully understand and agree on the amount and breakdown of expenses to be paid to the organization in a foreign country concerning mediation for the application pertaining to the employment contract for specified skilled workers or preparations for activities in the foreign country? (Fill in this section if there are expenses to be paid.)

有（外国の機関名： 支払額（日本円に換算）：約 円）・無

Yes (Name of the organization in a foreign country: Payment (converted into Japanese yen): Approximately Yen) / No

24 国籍又は住居を有する国又は地域において定められる、本邦で行う活動に関連して遵守すべき手続きを経ていることの有無（当該手続が定められている場合に記入）

Have you followed the procedures to be complied with in relation to the activities to be conducted in Japan prescribed by the country or region of nationality or residence? (Fill in this section if such procedures are prescribed.)

procedures_followed) && $record->procedures_followed == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>有 procedures_followed) && $record->procedures_followed == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>無 Yes / No

25 本邦において定期的に負担する費用について、対価の内容を十分に理解して合意していることの有無（当該費用の負担がある場合に記入）

Do you fully understand and have you agreed to the expenses to be paid on a regular basis in Japan? (Fill in this section if there are expenses to be paid.)

expenses_understood) && $record->expenses_understood == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>有 expenses_understood) && $record->expenses_understood == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>無 Yes / No

26 技能実習によって本邦において修得、習熟又は熟達した技能等の本国への移転に努めることの有無（技能実習の在留資格をもって在留していたことがある場合であって、「特定技能２号」での在留を希望する場合に記入）

Will you endeavor to transfer the skills, etc. you acquire, the skills, etc. for which you increase proficiency or attain proficiency in Japan through the technical intern training? (Fill in this section if you have a previous history of residing in Japan with the status of residence of "Technical Intern Training", and wish to reside in Japan with the status of residence of "Specified Skilled Worker (ii)")

skills_transfer) && $record->skills_transfer == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>有 skills_transfer) && $record->skills_transfer == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>無 Yes / No

27 申請人につき特定産業分野に特有の事情に鑑みて告示で定められる基準に適合していることの有無（当該基準が定められている場合に記入）

Do you meet the criteria prescribed in the public notice in consideration of circumstances specific to the specified industrial field pertaining to you? (Fill in this section if such criteria are prescribed.)

meets_criteria) && $record->meets_criteria == 1 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>有 meets_criteria) && $record->meets_criteria == 2 ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}>無 Yes / No

@for ($i = 0; $i < 3; $i++) @endfor

入社 Date of joining the company

退社 Date of leaving the company

勤務先名称 Place of employment

入社 Date of joining the company

退社 Date of leaving the company

勤務先名称 Place of employment

年 Year

月 Month

年 Year

月 Month

年 Year

月 Month

年 Year

月 Month

29 代理人（法定代理人による申請の場合に記入）Legal representative (in case of legal representative)

以上の記載内容は事実と相違ありません。
I hereby declare that the statement given above is true and correct.

注意Attention

申請書作成後申請までに記載内容に変更が生じた場合、申請人（法定代理人）が変更箇所を訂正し、署名すること。
In cases where descriptions have changed after filling in this application form up until submission of this application, the applicant (legal representative) must correct the part concerned and sign their name.
申請書作成年月日は申請人（法定代理人）が自署すること。
The date of preparation of the application form must be written by the applicant (legal representative).

※ 取次者Agent or other authorized person