| 1．Name |
（ ） |
| 2．Occupation |
（ ） |
| 3．Employment status |
| □Regular employee |
□Contract employee |
□Part-time |
| □Student |
→With scholarship… □Yes □No |
|
| 4．Expected housemates |
| （ ）Persons |
| □Family |
□Friend |
□Other:（ ） |
|
| 5．Constant earning |
| |
Self
|
| |
|
| |
|
| |
|
| |
Housemate |
| |
|
| |
|
|
| |
|
|
| □Salary |
□Allowance |
□Other: |
| Per month: |
·Less than ¥100,000 ·¥100,000 ～ ¥150,000 |
| |
·¥150,000 ～ ¥200,000 ·¥200,000 ～ ¥250,000 |
| |
·¥250,000 ～ ¥300,000 ·More than ¥300,000 |
| □Salary |
□Allowance |
□Other: |
| Per month: |
·Less than ¥100,000 ·¥100,000 ～ ¥150,000 |
| |
·¥150,000 ～ ¥200,000 ·¥200,000 ～ ¥250,000 |
| |
·¥250,000 ～ ¥300,000 ·More than ¥300,000 |
|
| 6．Japanese proficiency |
| |
Speaking
|
| |
|
| |
Reading |
| |
|
|
| |
| □Can speak |
□Daily-conversation level |
| □Cannot speak |
| □Can read |
□Simple text only |
| □Hiragana only |
□Cannot read |
|
| 7．Presence of cosigner |
| □Yes |
→Relationship:（ ） |
| □No |
→Desire to use guarantor company:
□Yes □No |
|
| 8．Emergency contact info (other than yourself) |
（ ） |
| 9．Identification (ID) |
□Passport □Alien registration certificate
□Other:（ ） |
| 10．Plan for leaving Japan |
□Yes （ ） years from now
□No
□Don’t know |
| 11．Reason for finding housing |
（ ） |
