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User Name*

Name (JPN)*

Name (ENG)*

Date of Birth（Year）*

Date of Birth（Month）*

Date of Birth（Day）*

Email Address*

Phone Number*

Desired Work Location

Japanese Language Skill*

English Language Skill*

Desired Employment Type*

Current Annual Salary (in 10,000 JPY)*

Most Recent Work Experience

Most Recent Industry

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Employment Status*

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