- TOP
- Policies and Statistics
- Specified Skilled Worker Program
- Specified Skilled Worker Operational Outline, Forms, Etc.
- Reference forms for the Status of Residence "Specified Skilled Worker" (previous versions)
Reference forms for the Status of Residence "Specified Skilled Worker" (previous versions)
The various forms required for applications for residency and notifications for those with the "Specified Skilled Worker" status of residence were revised on January 29, 2021.
- While the documents available on this page have since been retired, anyone currently using them for an application in process may continue to do so.
- When submitting an application, please be sure to use the most recent versions of the various forms.
Items related to applications for residency
| Reference forms | Form name | Forms |
|---|---|---|
| No. 1-1 | Curriculum Vitae of the Specified Skilled Worker | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-2 | Written Assessment of the Technical Intern Trainee | Excel (in Japanese) PDF (in Japanese)Example (in Japanese) |
| No. 1-3 | Health Check Report (Including the "Declaration by Medical Checkup Examinee" attachment.) |
Word (in Japanese) PDF (in Japanese) |
| No. 1-4 | Statement of Remuneration for Foreign National Specified Skilled Workers | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-5 | Employment Contract for Specified Skilled Workers | Word (in Japanese) PDF (in Japanese) |
| No. 1-6 | Written Employment Conditions (Includes the "Payment of Wages" attachment.) |
Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-7 | Confirmation of Advance Guidance | Word (in Japanese) PDF (in Japanese) |
| No. 1-8 | Consent for Payment of Expenses and Written Statement of Expenses | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-9 | Statement of Expense Collection | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-10 | Written Declaration on the Transfer of Skills | Word (in Japanese) PDF (in Japanese) |
| No. 1-11 | Overview of the Affiliated Organization | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-12 | Dispatch Procedure | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-13 | Statement of Employment Conditions | Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-14 | Overiew of the dispatch destination (Agriculture) | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-15 | Overiew of the dispatch destination (Fisheries) | Word (in Japanese) PDF (in Japanese) |
| No. 1-16 | Explanation of Employment Background | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-17 | Support Plan for Specified Skilled Worker (i) | Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-18 | Consignment of Aid Contract | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-19 | Support Supervisor Consent of Assignment and Written Pledge | Word (in Japanese) PDF (in Japanese) |
| No. 1-20 | Curriculum Vitae of the Support Supervisor | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-21 | Support Manager Consent of Assignment and Written Pledge | Word (in Japanese) PDF (in Japanese) |
| No. 1-22 | Curriculum Vitae of the Support Manager | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 1-23 | Written Pledge for Affiliated Organization Staff | Word (in Japanese) PDF (in Japanese) |
| No. 1-24 | Pledge for Total Period of Stay | Word (in Japanese) PDF (in Japanese) |
Items related to registering (or renewing) a registered support organization
| Reference forms | Form name | Forms |
|---|---|---|
| No. 2-1 | Registered Support Organization Written Pledge | Word (in Japanese) PDF (in Japanese) |
| No. 2-2 | Overview of the Registered Support Organization | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 2-3 | Support Supervisor Consent of Assignment and Written Pledge | Word (in Japanese) PDF (in Japanese) |
| No. 2-4 | Curriculum Vitae of the Support Supervisor | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 2-5 | Support Manager Consent of Assignment and Written Pledge | Word (in Japanese) PDF (in Japanese) |
| No. 2-6 | Curriculum Vitae of the Support Manager | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 2-7 | Written Pledge for Registered Support Organization Staff | Word (in Japanese) PDF (in Japanese) |
| No. 2-8 | Explanation of the Fees Related to the Consignment of Aid (Estimated) | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
Items related to ad-hoc and periodic notifications
| Reference forms | Form name | Forms |
|---|---|---|
| No. 3-1 | Notification pertaining to the employment contract of a specified skilled worker | Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 3-1 (Attachment) | Notification pertaining to the employment contract of a specified skilled worker (attachment) | Excel (in Japanese)PDF (in Japanese) |
| No. 3-2 | Notification pertaining to changes to the support plan | Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 3-2 (Attachment) | Notification pertaining to changes to the support plan (attachment) | Excel (in Japanese)PDF (in Japanese) |
| No. 3-3 | Notification pertaining to the support contract of the affiliated organization | Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 3-3 (Attachment) | Notification pertaining to the support contract of the affiliated organization (attachment) | Excel (in Japanese)PDF (in Japanese) |
| No. 3-4 | Notification pertaining to employment difficulties | Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 3-4 (Attachment) | Notification pertaining to employment difficulties (attachment) | Excel (in Japanese)PDF (in Japanese) |
| No. 3-5 | Notification pertaining to unfair acts (misconduct) under immigration/labor laws and regulations |
Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 3-6 | Notification pertaining to status of employment | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 3-7 | Notification pertaining to the status of implementation of a support system | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 3-7 (Attachment) | List of Specified Skilled Workers (i) to be supported | Word (in Japanese) PDF (in Japanese) |
| No. 3-8 | Notification pertaining to an organization's status of activities | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 3-8 (Attachment) | Status of payment of remuneration for foreign national specified skilled workers | Word (in Japanese) PDF (in Japanese) |
| No. 4-1 | Notification pertaining to the suspension or dissolution of support services | Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 4-2 | Notification of the resumption of support services | Excel (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 4-3 | Notification pertaining to the status of implementation of a support system | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 4-3 (Attachment) | List of Specified Skilled Workers (i) to be supported | Word (in Japanese) PDF (in Japanese) |
| No. 4-4 | Notification pertaining to changes in registration matters (Attachment No. 29-16 in the appendix) |
Excel (in Japanese)PDF (in Japanese) |
| No. 5-1 | Improvement Report (pursuant to Article 19-19) | Word (in Japanese) PDF (in Japanese) |
| No. 5-2 | Improvement Report (pursuant to Article 19-21) | Word (in Japanese) PDF (in Japanese) |
| No. 5-3 | Improvement Report (pursuant to Article 19-31) | Word (in Japanese) PDF (in Japanese) |
| No. 5-4 | Consultation Records | Word (in Japanese) PDF (in Japanese) Example (in Japanese) |
| No. 5-5 | Periodic Questionnaire (for Specified Skilled Workers (i)) | Word (in Japanese) PDF (in Japanese) |
| No. 5-6 | Periodic Questionnaire (for Supervisors) | Word (in Japanese) PDF (in Japanese) |
| No. 5-7 | Proof of Payment of Remuneration | Word (in Japanese) PDF (in Japanese) |
| No. 5-8 | Confirmation of Orientation for Life in Japan | Word (in Japanese) PDF (in Japanese) |
Forms available in English (and nine other languages)
Forms which require the applicant's signature and a clear understanding of their contents (*1) have been translated into English and nine other languages.
Please note that with certain system settings, some languages may not display correctly.
| Language | Forms |
|---|---|
| English | Word Excel PDF (*2) |
| Vietnamese | Word Excel PDF (*3) |
| Tagalog | Word Excel PDF (*3) |
| Indonesian | Word Excel PDF (*3) |
| Thai | Word Excel PDF (*3) |
| Myanmar Language | Word Excel PDF (*3) |
| Khmer | Word Excel PDF (*3) |
| Mongolian | Word Excel PDF (*3) |
| Nepali | Word Excel PDF (*3) |
| Chinese | Word Excel PDF (*3) |
(*1)
Form No. 1-1 Curriculum Vitae of the Specified Skilled Worker
Form No. 1-3 Health Check Report
Form No. 1-5 Employment Contract for Specified Skilled Workers
Form No. 1-6 Written Employment Conditions
Form No. 1-7 Confirmation of Advance Guidance
Form No. 1-8 Consent for Payment of Expenses and Written Statement of Expenses
Form No. 1-10 Written Declaration on the Transfer of Skills
Form No. 1-13 Statement of Employment Conditions
Form No. 1-16 Explanation of Employment Background
Form No. 1-17 Support Plan for Specified Skilled Worker (i)
Form No. 1-24 Pledge for Total Period of Stay
Form No. 5-7 Proof of Payment of Remuneration
Form No. 5-8 Confirmation of Orientation for Life in Japan
(*2)
Form No. 1-13 and 1-17 are only available as Excel documents, due to their use of variable data. All other reference forms are available as Word documents.
(*3)
Form No. 1-13 is only available as an Excel document, due to its use of variable data. All other reference forms are available as Word documents.
Residency applications using retired forms
Application for issuance of a Certificate of Eligibility
| Direct employment | Affiliated organization of the specified skilled worker is a corporation | Affiliated organization of the specified skilled worker is an individual | |
|---|---|---|---|
| Workplace covered by social insurance | Workplace not covered by social insurance | ||
| Specified Skilled Worker (i) | PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
| Specified Skilled Worker (ii) | PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
Temporary employment (only for Specified Skilled Workers (i) in the agricultural and fishery fields) → PDF (in Japanese)Excel (in Japanese)
Application for change of status of residence
| Direct employment | Affiliated organization of the specified skilled worker is a corporation | Affiliated organization of the specified skilled worker is an individual | |
|---|---|---|---|
| Workplace covered by social insurance | Workplace not covered by social insurance | ||
| Specified Skilled Worker (i) | PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
| Specified Skilled Worker (ii) | PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
Temporary employment (only for Specified Skilled Workers (i) in the agricultural and fishery fields) → PDF (in Japanese)Excel (in Japanese)
Application for extension of period of stay
| Direct employment | Affiliated organization of the specified skilled worker is a corporation | Affiliated organization of the specified skilled worker is an individual | |
|---|---|---|---|
| Workplace covered by social insurance | Workplace not covered by social insurance | ||
| Specified Skilled Worker (i) | PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
| Specified Skilled Worker (ii) | PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
PDF (in Japanese)Excel (in Japanese) |
Temporary employment (only for Specified Skilled Workers (i) in the agricultural and fishery fields) → PDF (in Japanese)Excel (in Japanese)
You will need Adobe Reader to view PDF documents.
If they do not display correctly, please try using the latest version.