J1 visa Application Form


    下のフォームに必要事項を記入ください。*は必須です。

    1. Applicant Information

    *Full Name:

    *Have you studied or lived in the US?:


       

    If Yes, what kind of visa and the date you entered in the US?:

    *Have you applied for J-1 visa before? :


       

    *Passport Number:

    *Passport Issued Date(mm/dd/yyyy):

    *Passport Expired Date(mm/dd/yyyy):

    *Date of Birth(mm/dd/yyyy):

    *Birth City:

    *Current Address(現住所)郵便番号もご入力下さい:

    *Current Phone Number:

    *Permanent Address(実家住所)郵便番号もご入力下さい:

    *Permanent Phone Number(実家電話番号):

    *E-mail address:

    *Skype ID:

    *Emergency Contact Name 1(Family):

    *Emergency Contact Relationship 1:

    *Emergency Contact Phone Number 1:

    *Emergency Contact E-mail 1:

    *Emergency Contact Name 2(Family):

    *Emergency Contact Relationship 2:

    *Emergency Contact Phone Number 2:

    *Emergency Contact E-mail 2:

    *Emergency Contact Name 3(non-Family):

    *Emergency Contact Relationship 3:

    *Emergency Contact Phone Number 3:

    *Emergency Contact E-mail 3:

    2. Academic Background (Outside of the US)

    *Type of Degree:


       

    *Name of the School you completed:

    *Major:

    *Attended Period(mm/yy~mm/yy):

    *(Expected)Graduation Date(mm/dd/yy):

    3. Work Experience (Outside of the US) * 職歴がある方は必ずご記入ください。

    Name of Company(1):

    Company Address:

    Work Period(mm/yy~mm/yy):

    Supervisor's Full Name(上司のフルネーム):

    Supervisor's Title(上司の役職名):

    Job Description(仕事内容):

    Name of Company(2):

    Company Address:

    Work Period(mm/yy~mm/yy):

    Supervisor's Full Name:

    Supervisor's Title:

    Job Description:

    Name of Company(3):

    Company Address:

    Work Period(mm/yy~mm/yy):

    Supervisor's Full Name:

    Supervisor's Title:

    Job Description:

    Name of Company(4):

    Company Address:

    Work Period(mm/yy~mm/yy):

    Supervisor's Full Name:

    Supervisor's Title:

    Job Description:

    ご記入ありがとうございました。

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