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[null,"就労証明書"]
[]
["千代田区教育委員会教育長",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所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、就労先事業所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"]
[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"]
["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,"―"]
["（※事業者証明欄はここまで）"]
[]
[]
["保護者\n記載欄",null,"児童との続柄"]
[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,"児童名",null,null,null,null,null,"生年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"児童№",null,null,null,null,null,"希望保育\n時間"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　","施設名"]
[null,null,"児童名",null,null,null,null,null,"生年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"児童№",null,null,null,null,null,"希望保育\n時間"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"就労先への通勤時間",null,null,null,null,null,"時間",null,null,"分（往復）"]
[null,null,"その他の状況",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,"ひとり親世帯",null,null,null,"事由",null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"）","養育費等経済援助"]
[null,null,null,null,null,null,"事由発生年月日",null,null,null,null,null,"年",null,null,"月",null,null,"日",null,null,null,"援助金額",null,null,"月額",null,null,null,null,"円"]
[]
[]
["※　証明内容について、就労先事業所へ電話で確認いたします。"]
["※　勤務証明書の有効期間は、証明日から３か月です。証明日の記載のないものは無効です。"]
["※　就労証明書様式、記載例、記載要領は千代田区のHPよりダウンロードができます。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"【お問い合わせ先】　千代田区 教育委員会事務局 子ども部 学務課 学務係　　電話03（5211）4284"]
[]
[null,"添付書類が剝がれないようにしっかり貼り付けてください。"]
[]
[]
[null,null,"源泉徴収票または確定申告書の写し貼り付け欄"]
[null,null,"（修正液の使用や黒塗り等により、加工・修正されている場合は、無効となります。）"]