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["第2号様式　長岡京市　"]
["　就 労 (就労見込）証 明 書　（放課後児童クラブ入会申請用） 　　Ｒ3.10.22　改訂"]
["　※この就労証明書は、勤務先の代表者もしくは記入担当者が、事実のとおりに漏れなくご記入願います。訂正した際は、訂正印が必要となります。 \n  ※記入漏れなどがありましたら勤務先等へ問い合わせさせていただきますのでご了承願います。\n　※給与所得者は事業所が証明、自営業等は自己申告（代表者欄は事業主の氏名を記入）、内職従事者は供給先が証明（勤務時間は自己の申告による）してください。 \n　※虚偽の記載を行った場合には、申請者が放課後児童クラブを利用できなくなる場合があります。\n　※この証明書を勤務先に無断で作成・改変した際には、代表者印が押されていない書面であっても、有印私文書偽造罪等に問われる可能性があります。\n  ※記入の際にご不明な点がございましたら、担当課までお問い合わせください。（長岡京市役所生涯学習課 075-955-9546）◎ホームページに記入例を載せています。"]
[]
["証明日",null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,null,null,null,"事業所名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"代表者名"]
[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。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"所在地"]
[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。",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,null,null,null,null,null,null,null,null,null,null,null,null,"記入者名"]
[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。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記入者連絡先"]
[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,"農業・林業"]
[null,"勤務先事業者に関する事項",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,"漁業"]
[1,"業種（仕事の内容）",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,"鉱業・採石業・砂利採取業"]
[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,"建設業・製造業"]
[null,"就労者に関する事項",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,"電気・ガス・熱供給・水道業"]
[2,"ふりがな",null,null,null,null,null,null,null,null,null,null,null,null,null,"就労者住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"情報通信業"]
[null,"就労者氏名",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,"運輸業・郵便業"]
[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,"卸売業・小売業"]
[null,"就労状態等に関する事項　※全ての項目に必ず記入してください。",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,"金融業・保険業"]
[3,"雇用（予定）期間",null,null,null,null,null,"有期：",null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日 (更新予定",null,null,"有","・","無","）",null,null,"不動産業・物品賃貸業"]
[null,null,null,null,null,null,null,"無期：",null,null,null,"年",null,"月",null,"日","開始",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"学術研究・専門・技術サービス業"]
[4,"勤務先事業所名",null,null,null,null,null,null,null,null,null,null,null,null,null,"勤務先住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"宿泊業"]
[5,"雇用の形態",null,null,null,null,null,"自営業　・",null,null,"正社員　・",null," パート,アルバイト 　・",null,null,null,"非常勤,臨時職員 　・",null,null,null,"派遣社員 　・",null,null,"その他（",null,null,null,null,null,null,"）",null,"飲食サービス業・生活関連サービス業・娯楽業"]
[6,"就労日数・時間\n\n※見込証明の場合は\n3カ月経過後に実績\nの証明が必要です。　　",null,null,null,null,null,"　月に",null,null,null,"日勤務（週に",null,null,null,null,"日勤務）",null,"※平均勤務日数を記入(見込みの場合は予定日数を記入)",null,null,null,null,null,null,null,null,null,null,null,null,null,"教育・学習支援業"]
[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,"医療・福祉"]
[null,null,null,null,null,null,null,"　合計時間　（週）",null,null,null,null,null,"時間",null,null,"分",null,"※残業時間含まない・休憩時間含む(見込みの場合は予定時間を記入)",null,null,null,null,null,null,null,null,null,null,null,null,null,"複合サービス"]
[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,"公務"]
[null,null,null,null,null,null,null,null," 固  定  勤  務   :",null,null,null,"月　・","火　・","水　・","木　・","金　・","土　・","日　・","　祝祭日",null,"※勤務(予定)の曜日に〇、休みに×",null,null,null,null,null,null,null,null,null,null,"その他"]
[null,null,null,null,null,null,null,null,"平日：",null,null,"時",null,"分","～",null,"時",null,"分","備考"]
[null,null,null,null,null,null,null,null,"土曜：",null,null,"時",null,"分","～",null,"時",null,"分"]
[null,null,null,null,null,null,null,null,"曜日が変則勤務 :  ",null,null,null,"月　・","火　・","水　・","木　・","金　・","土　・","日　・","　祝祭日",null,"※勤務(予定)の全ての曜日に〇、休みに×"]
[null,null,null,null,null,null,null,null,"平日：",null,null,"時",null,"分","～",null,"時",null,"分","備考"]
[null,null,null,null,null,null,null,null,"土曜：",null,null,"時",null,"分","～",null,"時",null,"分"]
[null,null,null,null,null,null,null,null,"時間が変則勤務 ※シフト表などを添付してください。(曜日と時間が変則勤務の方も添付してください。)"]
[null,"就労時間\n（変則就労の場合）",null,null,null,null,null,"年間、 　 月間、　  週間",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"時間",null,null,"分"]
[7,"就労実績\n(直近3か月) \n(有給休暇を含む)",null,null,null,null,null,null,null,null,"年",null,"月",null,null,null,"年",null,"月",null,null,null,"年",null,"月","※見込みの方は就労実績の記入は不要です。"]
[null,null,null,null,null,null,null,null,null,null,null,"日／月",null,null,null,null,null,"日／月",null,null,null,null,null,"日／月"]
[null,null,null,null,null,null,null,"※通常よりも勤務日数が少ない場合：(",null,null,null,null,null,null,"コロナ　・",null,"病気　・",null,"その他(",null,null,null,"))の影響で日数が減少、通常",null,null,null,null,null,null,"日勤務予定"]
[]
[]
[8,"該当者のみ","産前・産後休業の\n取得",null,null,null,null,"取得予定　・",null,null,null,"取得中　・",null,"期間終了",null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
[null,null,"育児休業の取得",null,null,null,null,null,"取得予定 　",null,null,"・","取得中",null,null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
[null,null,"復職(予定)年月日",null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,"保育園・放課後児童クラブに入所した場合",null,null,null,null,null,null,null,"：","短縮不可",null," ・","短縮可能（",null,null,null,null,"年",null,"月",null,"日に変更）"]
[null,"その他"]
[9,"備考欄"]
[]
[null,"１ヶ月または１週間\n当たりの就労状況",null,null,null,null,null,null,null,null,"　月20日以上かつ週40時間以上、または週5日以上かつ１日8時間以上の勤務を常態とする。"]
[null,null,null,null,null,null,null,null,null,null,"　月20日以上かつ週35時間以上、または週5日以上かつ１日7時間以上の勤務を常態とする。"]
[null,null,null,null,null,null,null,null,null,null,"　月20日以上かつ週30時間以上、または週5日以上かつ１日6時間以上の勤務を常態とする。"]
[null,null,null,null,null,null,null,null,null,null,"　月16日以上かつ週24時間以上、または週4日以上かつ１日6時間以上の勤務を常態とする。"]
[null,null,null,null,null,null,null,null,null,null,"　上記には当てはまらないが、月64時間以上の勤務を常態としている。"]
[]
["保護者記入欄"]
[null,"児　童　氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入会（予定）クラブ名"]
[null,"①",null,null,null,null,null,null,null,"②",null,null,null,null,null,"③",null,null,null,null,null,"　\n小放課後児童クラブ（ A ・ B ）\n　"]
[]
[null," 主な通勤経路",null,null,null,null,"※　(　　)内には通勤方法が変わる地点(駅名等）、[　　]内には通勤方法（徒歩・車・電車等）とそれぞれの所要時間を記載願います。"]
[null,"自宅　→　（　　　　　 　　　　　　　　）　→　（　　　　　 　　　　　　　　）　→　（　　　　　　　　　 　　　　）　→　（　　　 　　　　　　　　　　）　→　勤務先",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,"総所要\n時間"]
[null,"方法",null,"　[　　　　　　　　　　　　　]　　[　　　　　　　　　　　　　]　　[　　　　　　　　　　　　　]　　[　　　　　　　　　　　　　]　　[　　　　　　　　　　　　　]"]
[null,"時間",null,"　[　　　　　　　　　　　　分　　[　　　　　　　　　　　　分　　[　　　　　　　　　　　　分　　[　　　　　　　　　　　　分　　[　　　　　　　　　　　　分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"分"]