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[null,"就労証明書"]
[]
["学校法人みんなのひろば　理事長  ",null,null,null,null,null,null,null,null,"宛",null,null,null,"※本証明書は、保護者本人ではなく、保護者の就労先事業者等にて作成してください。"]
[]
["① 証明書発行事業所名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤ 証明日",null,null,null,null,"西暦",null,null,"年",null,null,"月",null,null,"日"]
["② 証明書発行事業所住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑥ 記載内容の\n　  問合せ先",null,null,"担当部署"]
["③ 証明書発行責任者氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者名"]
["④ 証明書発行責任者役職",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,null,null,"―",null,null,null,"―"]
["　下記の内容について、事実であることを証明いたします（ただし、発行者が証明日時点で把握している情報に限る）。"]
["　※本証明書の内容について、就労先事業者等に無断で作成し又は改変を行ったときは、刑法上の罪に問われる場合があります。"]
["No.","項目",null,null,null,null,"記載欄"]
[1,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,null,null,null,"年",null,"月",null,"日"]
[null,"本人氏名"]
[null,"本人住所"]
["本人の就労状況、就労先（就労予定先の場合も含む）に関する項目"]
[2,"就労状況･予定",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,")"]
[3,"主な就労先事業所名\n※①と異なる場合は記入"]
[4,"主な就労先住所\n※②と異なる場合は記入"]
[null,null,null,null,null,null,"通勤手段",null,null,null,null,null,"自宅の最寄り（",null,null,null,null,null,null,null,")","就労先の最寄り",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,null,null,null,null,"）"]
["本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目\n※実際に働いた時間や支給された給与の額ではなく、雇用契約・就業規則の内容に関する事項を記載してください。"]
[5,"就労形態",null,null,null,null,"役員･自営業主",null,null,null,null," "]
[null,null,null,null,null,null,"被用者",null,null,null,null," "]
[null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,")"]
[null,"働き方"]
[null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,")"]
[6,"就労日数",null,null,null,null,"一月当たり",null,null,null,null,"日","・","一週当たり",null,null,null,null,"日"]
[null,null,null,null,null,null,"土曜勤務",null,null,null,null,null,null,"（ 一月当たり",null,null,null,null,"日 ）",null,null,null,"(",null,null,null,null,null,null,null,")"]
[7,"就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","週",null,null,"時間",null,null,null,"分","※月当たりの平均"]
[null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分","※月当たりの平均"]
[8,"就労時間帯\n※フレックスタイム制、\n裁量労働制の場合は\n標準的な就労時間帯を記入",null,null,null,null,"時間帯①",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"時間帯②",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"時間帯③",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[9,"就労日",null,null,null,null,"時間帯①"]
[null,null,null,null,null,null,"時間帯②"]
[null,null,null,null,null,null,"時間帯③"]
[null,null,null,null,null,null,"備　考"]
[10,"雇用（予定）期間等\n※契約締結日ではなく、\n就労開始（予定）日を記入\n※有期の者は終期も記入",null,null,null,null,"雇用契約状況"]
[null,null,null,null,null,null,"就労開始（予定）日（入社日等、働き始めた日）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～","契約満了日　(有期の場合は記載)"]
[null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","又は",null,null,null,null,null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"満了後の更新の有無"]
[null,null,null,null,null,null,null,null,null,null,null,"雇用予定期間",null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
["本人の就労実績に関する項目　※実績（就労予定等で実績がない場合は、今後の就労見込み）を記載してください。"]
[11,"直近の\n就労実績",null,null,null,null,"年･月",null,null,null,"ⅰ",null,null,null,"年",null,"月","ⅱ",null,null,null,"年",null,"月","ⅲ",null,null,null,"年",null,"月"]
[null,null,null,null,null,null,"就労日数\n※有給休暇含む",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"労働時間\n※休憩・残業時間含む",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"残業実施日数",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"残業時間",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額（税・社会保険等の控除前金額）",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"年・月",null,null,null,"ⅳ",null,null,null,"年",null,"月","ⅴ",null,null,null,"年",null,"月","ⅵ",null,null,null,"年",null,"月"]
[null,null,null,null,null,null,"就労日数\n※有給休暇含む",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"労働時間\n※休憩・残業時間含む",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"残業実施日数",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"残業時間",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額（税・社会保険等の控除前金額）",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
["育児に関する休業・短時間勤務制度に関する項目"]
[12,"産前･産後休業の\n取得(予定)期間",null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[13,"育児休業の\n取得(予定)期間",null,null,null,null,"根拠"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"延長",null,null,null,"任意",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"延長",null,null,null,"任意",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[14,"復職（予定）日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"※証明書発行事業所で育児休業等を取得中等の場合に限る"]
[15,"育児のための短時間勤務制度の利用をはじめとした勤務体制の変更\n（変更中・変更予定）",null,null,null,null,"勤務体制の変更（予定）",null,null,null,null,null,null,null,"体制変更要因"]
[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,null,")"]
[null,null,null,null,null,null,"変更後の就労日"]
[null,null,null,null,null,null,"勤務体制の変更（予定）期間",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"変更後の就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","就労日数",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"変更後の\n就労時間帯",null,null,"時間帯①",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"時間帯②",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"時間帯③",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
["保育士等（保育士、幼稚園教諭又は保育教諭）としての勤務実態の有無"]
[16,"保育士等としての\n勤務実態の有無",null,null,null,null,null,null,null,"勤務先施設等種別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")"]
[]
[null,"資格･免許取得状況"]
["備考"]
["備考"]
["○○市区町村追加項目"]
["その他基本的事項"]
[17,"基本事項",null,null,null,null,"法人番号"]
[null,null,null,null,null,null,"記載内容問合せ先メールアドレス"]
[null,null,null,null,null,null,"社員番号等(任意)"]
[null,null,null,null,null,null,"業種"]
[]
[]
[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,null,"）"]
["本人の就労状況、就労先（就労予定先の場合も含む）に関する項目"]
[18,"就労状況・予定②",null,null,null,null,"単身赴任",null,null,null,null,null,null,"期間",null,"赴任開始日（赴任予定日）",null,null,null,null,null,null,"～","赴任終了日※未定の場合は記載不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,null,null,null,null,"赴任（予定）地"]
[null,null,null,null,null,null,"配偶者控除"]
[null,null,null,null,null,null,"扶養親族"]
[null,null,null,null,null,null,"社会保険加入状況"]
[null,null,null,null,null,null,"雇用保険加入状況"]
[null,null,null,null,null,null,"健康保険加入状況"]
[null,null,null,null,null,null,"源泉徴収税"]
[null,null,null,null,null,null,"主な就労場所"]
[null,null,null,null,null,null,"業務内容"]
[null,null,null,null,null,null,"通勤距離",null,null,null,null,null,null,null,null,"約",null,null,"㎞"]
["本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目\n※実際に働いた時間や支給された給与の額ではなく、雇用契約・就業規則の内容に関する事項を記載してください。"]
[19,"就労形態②",null,null,null,null,"給与形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額",null,null,null,null,null,"円"]
[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,"雇用主との親族関係",null,null,null,null,null,null,null,null,"続柄"]
[null,null,null,null,null,null,"内職者\n関係",null,null,"委託元事業者の業務内容"]
[null,null,null,null,null,null,null,null,null,"作業日数",null,"月",null,null,"日","作業時間帯",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分"]
[null,null,null,null,null,null,"月２回以上の夜間勤務の有無",null,null,null,null,null,null,null,null,null,null,"※宿直や宿泊を伴う出張を含み、残業は含まない\n※夜間勤務とは、夜24時を含む勤務"]
[null,null,null,null,null,null,"週２回以上の夜間勤務の有無",null,null,null,null,null,null,null,null,null,null,"※宿直や宿泊を伴う出張を含み、残業は含まない\n※夜間勤務とは、夜24時を含む勤務"]
[null,null,null,null,null,null,"（新規雇用・復帰等の場合）\n時間外勤務予定",null,null,null,null,null,null,null," １日当たり",null,null,null,null,"時間程度（見込み）"]
[null,null,null,null,null,null,"土日祝の就労予定数",null,null,null,null,null,"月",null,null,"日",null,"休業日"]
["本人の就労実績に関する項目　※実績（就労予定等で実績がない場合は、今後の就労見込み）を記載してください。 "]
[20,"直近の就労実績②",null,null,null,null,"締日",null,null,null,null,"日","支払日",null,null,null,null,"日","給与支給実績",null,null,null,"平均\n(直近３か月)",null,null,"月",null,null,null,null,"円"]
[21,"産休・育休以外の\n休業の取得期間",null,null,null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"期間",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
["育児・短時間勤務制度に関する項目"]
[22,"出産(予定)日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[23,"職場内託児所",null,null,null,null,"託児所",null,null,null,null,"利用有無",null,null,null,null,null,"利用料"]
[null,null,null,null,null,null,"施設名"]
[24,"育児休業の短縮・\n延長への同意",null,null,null,null,"育児休業の取得(予定)期間終了前であっても、保育所等入所の内定があった場合に育児休業を短縮し、保育所等入所月内に職場復帰すること"]
[null,null,null,null,null,null,"育児休業の取得(予定)期間終了後については、育児休業(に準ずる措置）を延長し、保育所等入所の内定があった時点で保育所等入所月内に職場復帰すること"]
[25,"育児休業給付金\n受給資格の有無"]
[26,"育児のための短時間勤務制度の利用をはじめとした勤務体制の変更実績",null,null,null,null,"体制変更要因"]
[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,"）"]
[null,null,null,null,null,null,"勤務体制の変更期間（実績）",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"変更後の就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","就労日数",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分",null,"（うち休憩時間",null,null,null,null,"分）"]
["医師・看護師等としての勤務実態の有無"]
[27,"医師・看護師等としての勤務実態の有無",null,null,null,null,null,null,null,null,null,null,"資格･免許取得状況"]
[null,"介護士等としての\n勤務実態の有無",null,null,null,null,null,null,null,null,null,null,"資格･免許取得状況"]
[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,null,"）"]
[28,"施設等種別",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,"）"]
["個人事業に関する項目"]
[29,"個人事業形態",null,null,null,null,"経営者との関係",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄\n※「専従者」、「家族従業者」、「その他」にチェックを入れた場合に記載"]
[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,"就労日"]
[null,null,null,null,null,null,"仕事関連の資格の有無",null,null,null,null,null,null,null,null,"資格名"]
[null,null,null,null,null,null,"給与形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")","平均月収",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"前年分年間\n総収入額",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"営業(開業･\n就労)時間",null,null,"平日",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"土曜",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"日曜",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"店舗の\n有無",null,null,null,"純利益",null,null,null,null,"円","開業\n期間",null,null,"年",null,"月",null,"日","～",null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,"取引開始(予定)日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[30,"個人農業者",null,null,null,null,"耕作面積",null,null,null,null,null,null,null,"a","作付内容"]
[null,null,null,null,null,null,"農閑期",null,null,null,"月","～",null,null,"月","農閑期の仕事内容"]
[31,"民生・児童委員\n※自営業の方は民生・児童委員の確認が必要です",null,null,null,null,"　　上記のとおり確認いたしました。"]
[null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"　　住所"]
[null,null,null,null,null,null,"　　氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,null,null,"―",null,null,"―"]
["（問い合わせ先）  Fuji赤とんぼ保育園　042-595-8555 / Fujiれもん保育園　042-548-5333"]

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[null,"就労証明書"]
[]
["学校法人みんなのひろば　理事長  \n立　川　市　長",null,null,null,null,null,null,null,null,"宛",null,null,null,"※本証明書は、保護者本人ではなく、保護者の就労先事業者等にて作成してください。"]
[]
["① 証明書発行事業所名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤ 証明日",null,null,null,null,"西暦",null,null,"年",null,null,"月",null,null,"日"]
["② 証明書発行事業所住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑥ 記載内容の\n　  問合せ先",null,null,"担当部署"]
["③ 証明書発行責任者氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者名"]
["④ 証明書発行責任者役職",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,null,null,"―",null,null,null,"―"]
["　下記の内容について、事実であることを証明いたします（ただし、発行者が証明日時点で把握している情報に限る）。"]
["　※本証明書の内容について、就労先事業者等に無断で作成し又は改変を行ったときは、刑法上の罪に問われる場合があります。"]
["No.","項目",null,null,null,null,"記載欄"]
[1,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,null,null,null,"年",null,"月",null,"日"]
[null,"本人氏名"]
[null,"本人住所"]
["本人の就労状況、就労先（就労予定先の場合も含む）に関する項目"]
[2,"就労状況･予定",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,")"]
[3,"主な就労先事業所名\n※①と異なる場合は記入"]
[4,"主な就労先住所\n※②と異なる場合は記入"]
[null,null,null,null,null,null,"通勤手段",null,null,null,null,null,"自宅の最寄り（",null,null,null,null,null,null,null,")","就労先の最寄り",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,null,null,null,null,"）"]
["本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目\n※実際に働いた時間や支給された給与の額ではなく、雇用契約・就業規則の内容に関する事項を記載してください。"]
[5,"就労形態",null,null,null,null,"役員･自営業主",null,null,null,null," "]
[null,null,null,null,null,null,"被用者",null,null,null,null," "]
[null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,")"]
[null,"働き方"]
[null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,")"]
[6,"就労日数",null,null,null,null,"一月当たり",null,null,null,null,"日","・","一週当たり",null,null,null,null,"日"]
[null,null,null,null,null,null,"土曜勤務",null,null,null,null,null,null,"（ 一月当たり",null,null,null,null,"日 ）",null,null,null,"(",null,null,null,null,null,null,null,")"]
[7,"就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","週",null,null,"時間",null,null,null,"分","※月当たりの平均"]
[null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分","※月当たりの平均"]
[8,"就労時間帯\n※フレックスタイム制、\n裁量労働制の場合は\n標準的な就労時間帯を記入",null,null,null,null,"時間帯①",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"時間帯②",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"時間帯③",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[9,"就労日",null,null,null,null,"時間帯①"]
[null,null,null,null,null,null,"時間帯②"]
[null,null,null,null,null,null,"時間帯③"]
[null,null,null,null,null,null,"備　考"]
[10,"雇用（予定）期間等\n※契約締結日ではなく、\n就労開始（予定）日を記入\n※有期の者は終期も記入",null,null,null,null,"雇用契約状況"]
[null,null,null,null,null,null,"就労開始（予定）日（入社日等、働き始めた日）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～","契約満了日　(有期の場合は記載)"]
[null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","又は",null,null,null,null,null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"満了後の更新の有無"]
[null,null,null,null,null,null,null,null,null,null,null,"雇用予定期間",null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
["本人の就労実績に関する項目　※実績（就労予定等で実績がない場合は、今後の就労見込み）を記載してください。"]
[11,"直近の\n就労実績",null,null,null,null,"年･月",null,null,null,"ⅰ",null,null,null,"年",null,"月","ⅱ",null,null,null,"年",null,"月","ⅲ",null,null,null,"年",null,"月"]
[null,null,null,null,null,null,"就労日数\n※有給休暇含む",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"労働時間\n※休憩・残業時間含む",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"残業実施日数",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"残業時間",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額（税・社会保険等の控除前金額）",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"年・月",null,null,null,"ⅳ",null,null,null,"年",null,"月","ⅴ",null,null,null,"年",null,"月","ⅵ",null,null,null,"年",null,"月"]
[null,null,null,null,null,null,"就労日数\n※有給休暇含む",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"労働時間\n※休憩・残業時間含む",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"残業実施日数",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"残業時間",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額（税・社会保険等の控除前金額）",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
["育児に関する休業・短時間勤務制度に関する項目"]
[12,"産前･産後休業の\n取得(予定)期間",null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[13,"育児休業の\n取得(予定)期間",null,null,null,null,"根拠"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"延長",null,null,null,"任意",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"延長",null,null,null,"任意",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[14,"復職（予定）日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"※証明書発行事業所で育児休業等を取得中等の場合に限る"]
[15,"育児のための短時間勤務制度の利用をはじめとした勤務体制の変更\n（変更中・変更予定）",null,null,null,null,"勤務体制の変更（予定）",null,null,null,null,null,null,null,"体制変更要因"]
[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,null,")"]
[null,null,null,null,null,null,"変更後の就労日"]
[null,null,null,null,null,null,"勤務体制の変更（予定）期間",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"変更後の就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","就労日数",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"変更後の\n就労時間帯",null,null,"時間帯①",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"時間帯②",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"時間帯③",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
["保育士等（保育士、幼稚園教諭又は保育教諭）としての勤務実態の有無"]
[16,"保育士等としての\n勤務実態の有無",null,null,null,null,null,null,null,"勤務先施設等種別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")"]
[]
[null,"資格･免許取得状況"]
["備考"]
["備考"]
["○○市区町村追加項目"]
["その他基本的事項"]
[17,"基本事項",null,null,null,null,"法人番号"]
[null,null,null,null,null,null,"記載内容問合せ先メールアドレス"]
[null,null,null,null,null,null,"社員番号等(任意)"]
[null,null,null,null,null,null,"業種"]
[]
[]
[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,null,"）"]
["本人の就労状況、就労先（就労予定先の場合も含む）に関する項目"]
[18,"就労状況・予定②",null,null,null,null,"単身赴任",null,null,null,null,null,null,"期間",null,"赴任開始日（赴任予定日）",null,null,null,null,null,null,"～","赴任終了日※未定の場合は記載不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,null,null,null,null,"赴任（予定）地"]
[null,null,null,null,null,null,"配偶者控除"]
[null,null,null,null,null,null,"扶養親族"]
[null,null,null,null,null,null,"社会保険加入状況"]
[null,null,null,null,null,null,"雇用保険加入状況"]
[null,null,null,null,null,null,"健康保険加入状況"]
[null,null,null,null,null,null,"源泉徴収税"]
[null,null,null,null,null,null,"主な就労場所"]
[null,null,null,null,null,null,"業務内容"]
[null,null,null,null,null,null,"通勤距離",null,null,null,null,null,null,null,null,"約",null,null,"㎞"]
["本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目\n※実際に働いた時間や支給された給与の額ではなく、雇用契約・就業規則の内容に関する事項を記載してください。"]
[19,"就労形態②",null,null,null,null,"給与形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額",null,null,null,null,null,"円"]
[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,"雇用主との親族関係",null,null,null,null,null,null,null,null,"続柄"]
[null,null,null,null,null,null,"内職者\n関係",null,null,"委託元事業者の業務内容"]
[null,null,null,null,null,null,null,null,null,"作業日数",null,"月",null,null,"日","作業時間帯",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分"]
[null,null,null,null,null,null,"月２回以上の夜間勤務の有無",null,null,null,null,null,null,null,null,null,null,"※宿直や宿泊を伴う出張を含み、残業は含まない\n※夜間勤務とは、夜24時を含む勤務"]
[null,null,null,null,null,null,"週２回以上の夜間勤務の有無",null,null,null,null,null,null,null,null,null,null,"※宿直や宿泊を伴う出張を含み、残業は含まない\n※夜間勤務とは、夜24時を含む勤務"]
[null,null,null,null,null,null,"（新規雇用・復帰等の場合）\n時間外勤務予定",null,null,null,null,null,null,null," １日当たり",null,null,null,null,"時間程度（見込み）"]
[null,null,null,null,null,null,"土日祝の就労予定数",null,null,null,null,null,"月",null,null,"日",null,"休業日"]
["本人の就労実績に関する項目　※実績（就労予定等で実績がない場合は、今後の就労見込み）を記載してください。 "]
[20,"直近の就労実績②",null,null,null,null,"締日",null,null,null,null,"日","支払日",null,null,null,null,"日","給与支給実績",null,null,null,"平均\n(直近３か月)",null,null,"月",null,null,null,null,"円"]
[21,"産休・育休以外の\n休業の取得期間",null,null,null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"期間",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
["育児・短時間勤務制度に関する項目"]
[22,"出産(予定)日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[23,"職場内託児所",null,null,null,null,"託児所",null,null,null,null,"利用有無",null,null,null,null,null,"利用料"]
[null,null,null,null,null,null,"施設名"]
[24,"育児休業の短縮・\n延長への同意",null,null,null,null,"育児休業の取得(予定)期間終了前であっても、保育所等入所の内定があった場合に育児休業を短縮し、保育所等入所月内に職場復帰すること"]
[null,null,null,null,null,null,"育児休業の取得(予定)期間終了後については、育児休業(に準ずる措置）を延長し、保育所等入所の内定があった時点で保育所等入所月内に職場復帰すること"]
[25,"育児休業給付金\n受給資格の有無"]
[26,"育児のための短時間勤務制度の利用をはじめとした勤務体制の変更実績",null,null,null,null,"体制変更要因"]
[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,"）"]
[null,null,null,null,null,null,"勤務体制の変更期間（実績）",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"変更後の就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","就労日数",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分",null,"（うち休憩時間",null,null,null,null,"分）"]
["医師・看護師等としての勤務実態の有無"]
[27,"医師・看護師等としての勤務実態の有無",null,null,null,null,null,null,null,null,null,null,"資格･免許取得状況"]
[null,"介護士等としての\n勤務実態の有無",null,null,null,null,null,null,null,null,null,null,"資格･免許取得状況"]
[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,null,"）"]
[28,"施設等種別",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,"）"]
["個人事業に関する項目"]
[29,"個人事業形態",null,null,null,null,"経営者との関係",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄\n※「専従者」、「家族従業者」、「その他」にチェックを入れた場合に記載"]
[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,"就労日"]
[null,null,null,null,null,null,"仕事関連の資格の有無",null,null,null,null,null,null,null,null,"資格名"]
[null,null,null,null,null,null,"給与形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")","平均月収",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"前年分年間\n総収入額",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"営業(開業･\n就労)時間",null,null,"平日",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"土曜",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"日曜",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"店舗の\n有無",null,null,null,"純利益",null,null,null,null,"円","開業\n期間",null,null,"年",null,"月",null,"日","～",null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,"取引開始(予定)日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[30,"個人農業者",null,null,null,null,"耕作面積",null,null,null,null,null,null,null,"a","作付内容"]
[null,null,null,null,null,null,"農閑期",null,null,null,"月","～",null,null,"月","農閑期の仕事内容"]
[31,"民生・児童委員\n※自営業の方は民生・児童委員の確認が必要です",null,null,null,null,"　　上記のとおり確認いたしました。"]
[null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"　　住所"]
[null,null,null,null,null,null,"　　氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,null,null,"―",null,null,"―"]
["（問い合わせ先）  Fuji赤とんぼ保育園　042-595-8555 / Fujiれもん保育園　042-548-5333"]

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["【就労証明書】記載要領（簡易)"]
[]
["■各証明事項について記載漏れの無いようにご記入ください。"]
["■雇用形態が派遣の場合の証明者は、派遣元・派遣先のどちらでご記入いただいてもかまいません。"]
["■支店等で証明する場合は、代表者に代わり支店長等の氏名でご記入いただいてもかまいません。"]
["■訂正するときは、二重線にて訂正してください。修正液・修正テープ等での訂正は認められません。"]
["■ご記入いただいた内容について就労先へ照会させていただくことがあります。あらかじめご了承ください。"]
["■記載内容に虚偽があった場合は、申込みを無効としたり、入所を取り消したりすることがあります。"]
[]
["■本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目"]
[]
[null,"№6\n№7","就労日数\n就労時間\n※休憩時間含む",null,null,null,"・雇用契約に基づく就労日数・時間であり、実際に就労した時間（実績）ではありません。\n育児短時間勤務制度等を利用している場合でも、制度利用前の就労日数・時間数を記載してください。\n・土曜勤務の有無を記載してください。不定期で勤務がある場合はその他の欄に詳細を記載してください。"]
[null,"№8","就労時間帯",null,null,null,"・短時間勤務制度を利用している場合は、制度利用前の雇用契約・就業規則上の就労時間帯を記載してください。\n・フレックスタイム制、裁量労働制の場合は、標準的な就労時間帯を記載してください。\n・曜日等により標準的な時間帯が異なるなど、定期的に異なる就業時間帯を組み合わせている場合は、３パターンまで、各パターンごとに標準的な就労時間帯を記載してください。\n・複数パターンの就労時間帯を記載する場合、主たる労働時間帯が決まっている場合は当該時間帯を①に、決まっていない場合は一月当たりの勤務回数の多い時間帯を①としてください。"]
[null,"№10","雇用（予定）期間等",null,null,null,"・「□有期」を選択し、契約満了後も更新予定がある場合は、備考欄に「契約満了後も更新予定あり」と記載してください。"]
[]
["■本人の就労実績に関する項目"]
[]
[null,"№11","直近の就労実績",null,"・就労見込みの実績を記載する場合は見込みの内容に必ず()を記載してください。\n・産前・産後休業又は育児休業を取得中の場合は、休業前の就労実績を記載してください。\n・育児短時間制度を利用している実績を記載する場合は、備考欄に育児短時間制度利用中の就労日数・時間数・休憩時間を記載してください。"]
[null,null,null,null,"年・月 ",null,"・直近の就労実績のある「年・月」を新しい順に記載してください。\n　　（例：○○年６月、○○年５月、○○年４月）"]
[null,null,null,null,"就労日数\n※有給休暇含む",null,"・有給休暇取得日数、休日出勤等を含めて記載してください。\n・1時間でも働いた日は1日として計上してください。\n・育児休業等により直近期間において、一月分の就労実績がない場合は、育児休業等取得月を除き、育児休業等取得前の就労実績も合わせて記載してください。新規採用等で就労実績がない場合は今後の就労見込みの部分を（）内に入れて記載してください。"]
[null,null,null,null,"労働時間\n※休憩・残業時間含む",null,"・就業規則上の就労時間のほか、残業時間（時間外労働分）についても含めた実労働時間としてください。\n・休憩時間（就業規則等で定められている休憩に限る。）は含めてください。\n・有給休暇（時間休含む）取得の場合は雇用契約・就業規則上の就労時間労働したものとみなします。"]
[null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額\n（税・社会保険料等の控除金額）",null,"・締日・支給日等の関係で、当該月分の労働時間の実績に給与支給実績が合致しない場合については、証明書を発行する事業者において当該月分として支給している給与額を支給実績として記載し、その旨備考欄に記載してください。\n・賞与一時金、通勤手当を除いた給与額（税・社会保険料等の控除前の額）を記載してください。\n・締日・支給日等の関係で、対応する給与支給実績が未確定の場合は、当該月分についてのみ空欄として構いません。"]
[]
["■育児に関する休業・短時間勤務制度に関する項目"]
[]
[null,"№12","産前･産後休業の取得(予定)期間",null,null,null,"・取得済みの場合は実績を記入してください。"]
[null,"№13","育児休業の取得\n(予定)期間",null,"期間",null,"・取得済みの場合は実績を記入してください。"]
[null,"№14","復職（予定）日",null,null,null,"・証明書発行事業所において取得した育児休業等から復職済みの場合は、復職した日を記載してください。"]
[]
["■備考"]
[]
[null,null,"備考",null,null,null,"・No.6～10において、過去または未来で契約変更がある場合、「契約変更日・変更前後の就労日数・時間数・休憩時間・給与」を記載してください。\n・No.11に記載された就労実績がNo.6～10に記載された契約の内容よりも少ない場合は「実就労実績が少ない期間・理由」を記載し、直近3か月より前で、契約内容を超えた実績（できるだけ直近）を記載してください。\n・No.10雇用期間等において、有期雇用の場合は契約満了後の更新の有無について記載してください。\n・No.11における給与支給実績につき、当該月分の労働時間数と必ずしも一致しない場合はその旨を記載してください。\n・二子以上連続して産前・産後休業及び育児休業を取得している場合は、No.12及びNo.13には直近の休業期間を記載の上、先に取得した産前・産後休業及び育児休業期間を記載してください。\n・就労先が保育園・幼稚園等の場合は、仕事内容（保育士・幼稚園教諭・保育補助・栄養士・看護師・事務・調理等）を記載してください。\n・特記事項があれば、この欄に記載してください。"]