Japan's Assistance for the Management Training Program in the Russian Federation

Application Form ( '12 program)

(Please type or print in block letters in English)

Name (Last name. First name, Middle name)

English (as in passport) Russian

Photo 3x4 cm

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Home address and telephone number Mobile number and e-mail address Sex and citizenship Date of birth Marital status Religion (if any) Ex-serviceman, reservist? Type, number and date of expiry of travel passport Departure airport on the way to Japan Past overseas studies Foreign language proficiency English Speaking Reading Writing Japanese Speaking Reading Writing excellent excellent excellent excellent excellent excellent good good good good good good poor poor poor poor poor poor Moscow Khabarovsk Vladivostok Yuzhno-Sakhalinsk single married male female, (____yrs old) ___children

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Most recent academic institution attended Date at graduation Name of employer Date of English Russian

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employment 17 18 19 20 Address of employer Telephone and fax number of employer Number of employees Present rank and position Date of appointment to present position Description of company's business and applicant's responsibilities What would you most like to learn through this program? How would you apply your learning experience from this program at your job? English Russian

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Date: ___________________, Signature: _______________