Application for SSW Study Course & INA Free Membership

IMPORTNAT! We will send you our email right after you send your application. If you do not read and follow that email, we will not accept your application.

This application form is to enroll in our free SSW study course and to be registered as a free regular member of INA.

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 INA (International Nursing Care Workers Association) of which the representative is Mr. Bunji Inoue. Its official site is

Study course and membership *
Please check it.

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 *
Write your fb name. DO NOT WRITE your email address here. If you do not write correct fb name, your application will be rejected.
Your FB page(profile) URL
Birthday *
Age *
Sex *

Nationality *
Your residing country and if in Japan, your type of visa also *
Zip Code
Postal Address *
Incomplete address will lead to rejection of your application.
Mobile Phone Number *
Gmail or mobile E-mail Address *
You will receive our confirmation email immediately after you send this application form. 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 Prometric 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 *