Application for joining SSW Nursing Care Group

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

Input Procedure:

1) Complete this form
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 representative Mr. Bunji Inoue at .

Also, please note that our members of Specified.Skills.Visa.For.CareWorker will automatically become a member of our associated organization of "International Nursing Care Staff Association" of which the representative is Mr. Bunji Inoue. Its official site is

Which online do you want to join? *
Please select our free Facebook online study groups.

Name *
I hereby apply for online study group and agree to the privacy policy in .

Order of writing your name:
First Name -> Family Name -> Middle Name
Your FB Name *
Do not write your email address here. We need to know your fb name (account name) to find you in fb. If you write email address here, your application will be rejected.
Your FB page(profile) URL
Birthday *
Age *
Sex *

Nationality *
Your visa type in Japan or Your residing country *
Zip Code
Address *
Incomplete address will lead to rejection of your application.
Mobile Phone Number *
Gmail or mobile E-mail Address *
Please input 2 times your mobile or gmail email address. No Yahoo mail is accepted.

Nihongo Proficiensy Level *

Caregiver License *

Caregiver job experience *
Please write your caregiver work experience in Japan or abroad with some briefings such as how long. If you do not have, just write "No experience".
When is your test? *
Please tell us when you are going to take Prometric test.

Your current job *
For Japan Resident only: How long?
How many years have you been in Japan?
Are you already a member of any of our FB groups? *
Check one or more.

Message to Us *