多文化通訳派遣「ことさぽ」お申し込み・ご相談フォーム_en
KOTOSAPO Application Form (Interpreter Dispatch Service)
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Essential items to be filled
Name
*
Sex
Male
Female
Age
up to 9years old
teens (10's)
twenties (20's)
thirties (30's)
forties (40's)
fifties (50's)
sixties (60's)
more than 70's
Address
Phone Number (Home)
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-
-
Phone Number (Mobile)
-
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Available time to receive phone-call (Office staff will call you for confirmation later.)
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Monday AM(10:00-12:00)
Monday PM (12:00-15:00)
Monday evening(15:00-18:00)
Tuesday AM(10:00-12:00)
Tuesday PM(12:00-15:00)
Tuesday evening(15:00-18:00)
Wednesday AM(10:00-12:00)
Wednesday PM (12:00-15:00)
Wednesday evening(15:00-18:00)
Thirsday AM(10:00-12:00)
Thirsday PM(12:00-15:00)
Thirsday evening(15:00-18:00)
Friday AM(10:00-12:00)
Friday PM(12:00-15:00)
Friday evening (15:00-18:00)
Others
FAX Number
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-
e-mail address
*
for confirmation
Mother Language
Japanese
English
Chinese
Korean
Portuguese
Spanish
Tagalog (Filipino)
Thai
Indonesian
Malay
Vietnamese
French
Germany
Others
Please select.
Language for interpretation
Japanese⇔English
Japanese⇔Chinese
Date and time for employment of interpreter(as far as you know)
Ex) Nov. 27, 10:00~12:00
Place to visit
Ex) ○○Hospital, City Government, Healthcare Center in Ward Sakyo, Kyoto, etc.
Purpose (Contents)
Ex) 3month medical check-up, want to put contact lenses, toothache (first visit), etc.
Where did you know our interpreter dispatch service?
Already utilized the service before
Introduction from friends or
other groups
Check the leaflet
Web site
Others
Please write down if you have any questions.
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