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["   介護福祉士国家試験対策講座　\n申込書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和 3 年 　　　月　  　　日"]
["公益社団法人　横浜市福祉事業経営者会"]
["会長　小倉　徹　様"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"事務連絡先"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（法人名）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（事業所名）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（住所）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（電話番号）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（連絡担当者名）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"注）連絡担当者は、受講希望者とは別の方でお願いします。"]
[]
[]
[]
["ふりがな",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別"]
["氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"男　・　女"]
["生年月日",null,null,null,null,null,null,null,null,"（ 昭和 ・ 平成 ）　　　　　　　年　　　　　　月　　　　　　日　　　　　　　（　　　　　　歳）"]
[]
["住所",null,null,null,null,null,null,null,null,"(〒 　 　　-　　        )"]
[]
["連絡先",null,null,null,null,null,null,null,null,"自宅",null,null,"携帯",null,null,"勤務先",null,null,null,null,null,null,null,"－",null,null,null,null,null,null,"－"]
["現在の勤務先\n（法人名・施設名）"]
["会員区分\n（受講料）\n①②③いずれかに〇",null,null,null,null,null,null,null,null,"①",null,"会員\n（４，４００円税込）",null,null,null,null,null,null,"②",null,"賛助会員\n（４，９５０円税込）",null,null,null,null,null,null,"③",null,"非会員\n（５，５００円税込）"]
[]
["令和4年1月30日(日)\n介護福祉士国家試験",null,null,null,null,null,null,null,null,"受験する　　・　　　受験しない"]
[]
["介護福祉士国家試験受験歴\n（どちらかに○してください）",null,null,null,null,null,null,null,null,"受験経験なし(今回初受験) 　　・　　受験経験あり(　　　　回)"]
[]
[]
["※　枠内は、受講希望者本人がご記入ください。"]
["※　本申込書に記載された事項につきましては、個人情報保護等の規定に則り適正な管理を行い、\n   本研修実施に関する業務以外に使用することはいたしません。\t\t\t\t\t"]