Application for INA Membership

This application form is for INA free caregiver membership for foreign caregivers working already in Japan, except for TITP trainees who are waiting for documentation and preparing to come to Japan in their home countries. Also, foreign students who are studying at school for kaigofukushishi can join our free membership

Qualification for INA membership:
1) Foreign nationality
2) Residing in Japan
3) Working as a caregiver
*TITP trainees waiting for their documentation to come to Japan are also qualified.

All the items marked with 「*」must be filled otherwise your application form will be an error.

Input Procedure:

1) Complete this form
*We suggest you to check the button at the end of "対応する項目の入力内容をクッキーに保存する" for a case your form results in error. This button will keep your input data for re-writing.
2) Click button of 内容確認(confirmation of input contents)
3) Click button of 送信(send)
4) Click button of 終了(end)

Please note that we will contact you later basically via Facebook messenger from our representatives so that you shall check your inbox.

After filling out this form and sending it by clicking "終了" button, you will see INA's Facebook page. Please drop your message saying that you have sent your application in that fb page, otherwise we may not be able to contact you to confirm your membership.

INA Facebook is here

After sending this form, do not forget to follow the procedure which we will send you by email also. (Check your email.)

There are 2 important steps to join us as below.

1) Please visit our INA Facebook page and send us your message saying that you have just sent us your application.


2) Come to our INA Caregiver Member Group and request group join.


Please kindly be noted that this application form is created by FCS (Foreign Caregivers Support Center Inst.) on behalf of INA while waiting for new application form to be replaced. FCS website is

Thank you.

Which group you want to join? *
Please check it.

Name in alphabet and nihongo *
Your full name in alphabet and nihongo both. かならず ローマ字と にほんごの 2つの なまえを かいてください。
Your fb name as appears in fb *
Write your fb name as it appears in fb. DO NOT WRITE your email address here. If you do not write correct fb name, your application will be rejected.
あなたの フェイスブックでの なまえを かいてください。
Age *
Birthday(year/month/day) *
Sex *

Your prefecture (living area) in nihongo
Please select your prefecture in Japanese.
Zip code *
Your postal address *
If possible, write in nihongo. できるだけ にほんごで かいてください。
Nationality *
Residential status in Japan *

How long you are in Japan *

Mobile Phone Number *
Mobile phone in Japan
Gmail or mobile E-mail Address (No Yahoo mail accepted) *
Please write twice your mobile or gmail email address twice. Do not copy and paste it. かくにんのため 2かい かいてください。

Your caregiver license in Japan *

Nihongo Proficiency Level *

For SSW caregiver only: Date of passing Prometric skills test
For SSW caregiver only
For SSW caregiver only: Date of passing Prometric Japanese test
For SSW caregiver only
Total caregiver experience in Japan *

Name of nursing care company/name of senmongakkou where you are working or studying *
いま はたらいている しょくばの なまえを かいてください。りゅうがくせいは がっこうの なまえを かいてください。If you are still in your country, please write your agency name or hiring company name.
How long in your current company *
How long have you been working with your current company? いまの しょくばで 何年ぐらい はたらいていますか?
What do you want to study? Any message? *
なにを べんきょうしたいですか?かならず なにか メッセージを おねがいします。