Attached Sheet 1

Curriculum Vitae (CV) [Employment History]

Attach Photo *Confirmation of Total Contract Period pursuant to Article 18 of the Labor Contract Act (Circle the applicable item to confirm the
As of (year) (month) (day) time of eligibility to apply for a change to an indefinite labor contract.)
Furigana (kana over or beside kanji to indicate pronunciation)

Gender Attach a clear photo taken ◎Have you been employed by the University from April 1, 2013 (any position, including part-time lecturers, TAs, RAs and short-term support assistants)?
within the last 6 months
Name (head and shoulders, facing forward, no
hat) ・ Yes → Please provide full details of your employment history at this University. ・ No
Male / Female
Height: 35-40 ㎜ Year Month Day Employment history
Width: 25-30 ㎜

Birth Date Year Month Day ( years of age ) Place of employment / Affiliation / Job title:

Maiden name to be used (Fill in if you wish to use your maiden name and it is not your legal name.) - Details of duties (specific)
Furigana (kana over or beside kanji to indicate pronunciation)

Phone Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Current address Postal Code Place of employment / Affiliation / Job title:

- Details of duties (specific)

Furigana (kana over or beside kanji to indicate pronunciation)
(Fill in if you wish to be contacted at an address other than your current address.) Phone Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Contact address Postal Code Place of employment / Affiliation / Job title:

- Details of duties (specific)

Nationality Visa status Period of stay 　　　 (year) (month) (day) - (year) (month) (day) Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

[Academic history] Place of employment / Affiliation / Job title:

Year Month Day Academic history (Fill out all academic history from high school graduation. If you studied overseas prior to this, write your academic history from commencement of compulsory education.) - Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

[Degree] Place of employment / Affiliation / Job title:

Year Month Day Degree School where obtained - Details of duties (specific)

　　　Master / Master ( ) of____________/ PhD / PhD ( ) in____________ Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

　　　Master / Master ( ) of____________/ PhD / PhD ( ) in____________ Place of employment / Affiliation / Job title:

[Licenses / Qualifications / Examinations] - Details of duties (specific)

Year Month Day License / qualification / examination Registration number Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Registration number: Place of employment / Affiliation / Job title:

Registration number: - Details of duties (specific)

Registration number: Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

[Awards and Penalties] * Attention when filling out: 1. Be sure to write your name in your own handwriting. Write all characters in block letters and use numerals for numbers.

Year Month Day Award / penalty 2. Be sure to write your full legal name and date of birth (as they appear in your family register if applicable.)
3. Write accurate dates, including day, month, and year for all items.
4. Please note that if this CV is found to contain incorrect or fraudulent information,
the University may take measures as it sees fit.

National University Corporation Hokkaido University

 (Translated Version, Nov. 2013) Attached Sheet 1
SAMPLE FORM [Employment History]
Curriculum Vitae (CV) Attach Photo *Confirmation of Total Contract Period pursuant to Article 18 of the Labor Contract Act (Circle the applicable item to confirm the
As of 2014 (year) March (month) 5 (day) time of eligibility to apply for a change to an indefinite labor contract.)
Furigana (kana over or beside kanji to indicate pronunciation)

Gender Attach a clear photo taken ◎Have you been employed by the University from April 1, 2013 (any position, including part-time lecturers, TAs, RAs and short-term support assistants)?
within the last 6 months
Name (head and shoulders, facing forward, no
・ Yes → Please provide full details of your employment history at this University. ・ No
Taro Hokudai Male / Female
hat)

Height: 35-40 ㎜ Year Month Day Employment history

Width: 25-30 ㎜

Birth Date 1975 Year 8 Month 10 Day ( 38 years of age ) 2002 4 1 Place of employment / Affiliation / Job title: Visiting Researcher, _____ Graduate School, _____ University Graduate School
Maiden name to be used (Fill in if you wish to use your maiden name and it is not your legal name.) - Details of duties (specific) Engaged in research related to______
Furigana (kana over or beside kanji to indicate pronunciation)

Phone 2003 3 31 Employment type: Full employee / Other ( Transfer Researcher [paid / unpaid] ) (average 20 days per month, 5 days per week, 8 hours per day)
Current address Postal Code 080-2213 011-706-1234 2003 4 1 Place of employment / Affiliation / Job title: Researcher, _____ Group, _____ Prefecture _____ Research Institute
Kita WX-jo Nishi YZ-chome A-B, Kita-ku, Sapporo City - Details of duties (specific) Engaged in research related to______
Furigana (kana over or beside kanji to indicate pronunciation)
(Fill in if you wish to be contacted at an address other than your current address.) Phone 2006 3 31 Employment type: Full employee / Other ( part-time employee [paid / unpaid] ) (average 20 days per month, 5 days per week, 8 hours per day)
Contact address Postal Code 2006 4 1 Place of employment / Affiliation / Job title: Researcher, Research and Development Division, _____ Co., Ltd. Research Institute
- Details of duties (specific) Engaged in research related to______
Nationality Visa status Period of stay 　　　 (year) (month) (day) - (year) (month) (day) 2013 3 31 Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

[Academic history] Place of employment / Affiliation / Job title:

Year Month Day Academic history (Fill out all academic history from high school graduation. If you studied overseas prior to this, write your academic history from commencement of compulsory education.) - Details of duties (specific)

1992 3 10 Graduated _____ Prefectural High School, Hokkaido Prefecture Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

1992 4 1 Entered Department of _____, School of _____, _____ University Place of employment / Affiliation / Job title:

1996 3 25 Graduated from the above. - Details of duties (specific)

1996 4 1 Entered Master's course, _____ Division, _____ Graduate School, _____ University Graduate School Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

1998 3 25 Completed the above. Place of employment / Affiliation / Job title:

1998 4 1 Entered Ph.D. course, _____ Division, _____ Graduate School, _____ University Graduate School - Details of duties (specific)

2000 4 1 Took leave of absence from the above (until March 31, 2001) Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

2002 3 25 Completed the above. Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

[Degree] Place of employment / Affiliation / Job title:

Year Month Day Degree School where obtained - Details of duties (specific)

1998 3 25 　　　Master / Master ( ) of____________/ PhD / PhD ( ) in____________ Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

2002 3 25 　　　Master / Master ( ) of____________/ PhD / PhD ( ) in____________ Place of employment / Affiliation / Job title:

[Licenses / Qualifications / Examinations] - Details of duties (specific)

Year Month Day License / qualification / examination Registration number Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

2011 11 15 License for Person in Charge of Radiation Handling, Type 1 Registration number: 00000 Place of employment / Affiliation / Job title:

Registration number: - Details of duties (specific)

Registration number: Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

[Awards and Penalties] * Attention when filling out: 1. Be sure to write your name in your own handwriting. Write all characters in block letters and use numerals for numbers.

Year Month Day Award / penalty 2. Be sure to write your full legal name and date of birth (as they appear in your family register if applicable.)
2007 10 5 _____ Society Encouragement Prize 3. Write accurate dates, including day, month, and year for all items.
4. Please note that if this CV is found to contain incorrect or fraudulent information,
the University may take measures as it sees fit.

※The English translation of this document is provided solely for reference purposes. The original Japanese document remains the official text.
National University Corporation Hokkaido University
Employment History (Continued)

As of (year) (month) (day)

Furigana (kana over or beside kanji to indicate pronunciation)

Name

Year Month Day Employment history, etc.

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

Place of employment / Affiliation / Job title:

- Details of duties (specific)

Employment type: Full employee / Other ( [paid / unpaid] ) (average days per month, days per week, hours per day)

* Attention when filling out: 1. Be sure to write your name in your own handwriting. Write your full legal name in block letters (as it appears in your family register if applicable.)

2. Write accurate dates, including day, month, and year for all items.
3. Please note that if this CV is found to contain incorrect or fraudulent information,
the University may take measures as it sees fit.

National University Corporation Hokkaido University