Заявка на стажировку в Японию j_2013

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Japan's Assistance for the Management Training Program in the Russian Federation

Application Form

(Please print in block letters in English)

Photo

3x4 cm

1	Name (Last name. First name, Middle name)	English (as in passport)
		Russian
2	Home address
3	Home telephone, mobile telephone, fax number and e-mail
4	Sex and citizenship	male		female,
5	Date of birth							(_____yrs old)
6	Marital status	single		married		____children
7	Religion (if any)
8	Ex-serviceman, reservist?
9	Type, number and date of expiry of travel passport
10	Departure airport on the way to Japan	Moscow Khabarovsk Vladivostok Yuzhno-Sakhalinsk
11	Past overseas studies
12	Foreign language proficiency	English	Speaking Reading Writing		excellent excellent excellent		good good good		poor poor poor
		Japanese	Speaking Reading Writing		excellent excellent excellent		good good good		poor poor poor
13	Most recent academic institution attended
13.1	Degrees as written in the Diploma on retraining within the Presidential Program
13.2	Principal academic institution attended
14	Date at graduation
15	Name of employer company	English
		Russian
16	Date of employment
17	Address of employer
18	Telephone and fax number of employer
19	Number of employees
20	Present rank and position	English
		Russian
21	Date of appointment to present position
22	Description of company's business and applicant's responsibilities
23	What would you most like to learn through this program?
24	How would you apply your learning experience from this program at your job?

Date: _____________________,

Signature: __________________

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