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[null,"就労証明書"]
[]
["鹿島市長",null,null,null,null,null,null,null,null,"宛",null,null,null,"※本証明書は、保護者本人ではなく、保護者の就労先事業者等にて作成してください。"]
[]
["① 証明書発行事業所名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤ 証明日",null,null,null,null,"西暦",null,null,"年",null,null,"月",null,null,"日"]
["② 証明書発行事業所住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑥ 記載内容の\n　  問合せ先",null,null,"担当部署"]
["③ 証明書発行責任者氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者名"]
["④ 証明書発行責任者役職",null,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,"―"]
["　下記の内容について、事実であることを証明いたします（ただし、発行者が証明日時点で把握している情報に限る）。"]
["　※発行者からの正式な発出であることを証する書類（本証明発行に係るメール送受信画面等）を添付する必要があります。添付が無い場合、発行者に本証明の内容を確認します。"]
["　※原則、押印不要ですが、発行者が正式な発出であることを証するために押印することを妨げるものではありません（電子印可）。"]
["　※本証明書の内容について、就労先事業者等に無断で作成し又は改変を行ったときは、刑法上の罪に問われる場合があります。"]
["No.","項目",null,null,null,null,"記載欄"]
[1,"フリガナ"]
[null,"本人氏名"]
[null,"本人住所"]
["本人の就労状況、就労先（就労予定先の場合も含む）に関する項目"]
[2,"就労状況･予定",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,")"]
[3,"主な就労先事業所名\n※①と異なる場合は記入"]
[4,"主な就労先住所\n※②と異なる場合は記入"]
[null,null,null,null,null,null,"通勤手段",null,null,null,null,null,"自宅の最寄り（",null,null,null,null,null,null,null,")","就労先の最寄り",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,"）"]
["本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目\n※実際に働いた時間や支給された給与の額ではなく、雇用契約・就業規則の内容に関する事項を記載してください。"]
[5,"就労形態",null,null,null,null,"役員･自営業主",null,null,null,null," "]
[null,null,null,null,null,null,"被用者",null,null,null,null," "]
[null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,")"]
[null,"働き方"]
[null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,")"]
[6,"就労日数",null,null,null,null,"一月当たり",null,null,null,null,"日","・","一週当たり",null,null,null,null,"日"]
[7,"就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","週",null,null,"時間",null,null,null,"分","※月当たりの平均"]
[null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分","※月当たりの平均"]
[8,"就労時間帯\n※フレックスタイム制、\n裁量労働制の場合は\n標準的な就労時間帯を記入",null,null,null,null,"時間帯①",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"時間帯②",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[9,"就労日",null,null,null,null,"時間帯①"]
[null,null,null,null,null,null,"時間帯②"]
[10,"雇用（予定）期間等\n※契約締結日ではなく、\n就労開始（予定）日を記入\n※有期の者は終期も記入",null,null,null,null,"雇用契約状況"]
[null,null,null,null,null,null,"就労開始（予定）日（入社日等、働き始めた日）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～","契約満了日　(有期の場合は記載)"]
[null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","又は",null,null,null,null,null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"満了後の更新の有無"]
[null,null,null,null,null,null,null,null,null,null,null,"雇用予定期間",null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
["本人の就労実績に関する項目　※実績（就労予定等で実績がない場合は、今後の就労見込み）を記載してください。"]
[11,"直近の\n就労実績",null,null,null,null,"年･月",null,null,null,"ⅰ",null,null,null,"年",null,"月","ⅱ",null,null,null,"年",null,"月","ⅲ",null,null,null,"年",null,"月"]
[null,null,null,null,null,null,"就労日数\n※有給休暇含む",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"労働時間\n※休憩・残業時間含む",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"残業実施日数",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"残業時間",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額（税・社会保険等の控除前金額）",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"年・月",null,null,null,"ⅳ",null,null,null,"年",null,"月","ⅴ",null,null,null,"年",null,"月","ⅵ",null,null,null,"年",null,"月"]
[null,null,null,null,null,null,"就労日数\n※有給休暇含む",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"労働時間\n※休憩・残業時間含む",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"残業実施日数",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"残業時間",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額（税・社会保険等の控除前金額）",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
["育児に関する休業・短時間勤務制度に関する項目"]
[12,"産前･産後休業の\n取得(予定)期間",null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[13,"育児休業の\n取得(予定)期間",null,null,null,null,"根拠"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"延長",null,null,null,"任意",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"延長",null,null,null,"任意",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"入所が内定した場合の育児休業の短縮可否"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[14,"復職（予定）日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"※証明書発行事業所で育児休業等を取得中等の場合に限る"]
[15,"育児のための短時間勤務制度の利用をはじめとした勤務体制の変更\n（変更中・変更予定）",null,null,null,null,"勤務体制の変更（予定）",null,null,null,null,null,null,null,"体制変更要因"]
[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,null,null,null,"変更後の就労日"]
[null,null,null,null,null,null,"勤務体制の変更（予定）期間",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"変更後の就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","就労日数",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"変更後の\n就労時間帯",null,null,"時間帯①",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"時間帯②",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"時間帯③",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
["保育士等（保育士、幼稚園教諭又は保育教諭）としての勤務実態の有無"]
[16,"保育士等としての\n勤務実態の有無",null,null,null,null,null,null,null,"勤務先施設等種別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")"]
[]
[null,"資格･免許取得状況"]
["備考"]
["備考"]
["鹿島市追加項目"]
["その他基本的事項"]
[17,"基本事項",null,null,null,null,"法人番号"]
[null,null,null,null,null,null,"記載内容問合せ先メールアドレス"]
[null,null,null,null,null,null,"社員番号等(任意)"]
[null,null,null,null,null,null,"業種"]
[]
[]
[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,"）"]
["本人の就労状況、就労先（就労予定先の場合も含む）に関する項目"]
[18,"就労状況・予定②",null,null,null,null,"単身赴任",null,null,null,null,null,null,"期間",null,"赴任開始日（赴任予定日）",null,null,null,null,null,null,"～","赴任終了日※未定の場合は記載不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,null,null,null,null,"赴任（予定）地"]
[null,null,null,null,null,null,"配偶者控除"]
[null,null,null,null,null,null,"扶養親族"]
[null,null,null,null,null,null,"社会保険加入状況"]
[null,null,null,null,null,null,"雇用保険加入状況"]
[null,null,null,null,null,null,"健康保険加入状況"]
[null,null,null,null,null,null,"源泉徴収税"]
[null,null,null,null,null,null,"主な就労場所"]
[null,null,null,null,null,null,"業務内容"]
[null,null,null,null,null,null,"通勤距離",null,null,null,null,null,null,null,null,"約",null,null,"㎞"]
["本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目\n※実際に働いた時間や支給された給与の額ではなく、雇用契約・就業規則の内容に関する事項を記載してください。"]
[19,"就労形態②",null,null,null,null,"給与形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額",null,null,null,null,null,"円"]
[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,"雇用主との親族関係",null,null,null,null,null,null,null,null,"続柄"]
[null,null,null,null,null,null,"内職者\n関係",null,null,"委託元事業者の業務内容"]
[null,null,null,null,null,null,null,null,null,"作業日数",null,"月",null,null,"日","作業時間帯",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分"]
[null,null,null,null,null,null,"月２回以上の夜間勤務の有無",null,null,null,null,null,null,null,null,null,null,"※宿直や宿泊を伴う出張を含み、残業は含まない\n※夜間勤務とは、夜24時を含む勤務"]
[null,null,null,null,null,null,"週２回以上の夜間勤務の有無",null,null,null,null,null,null,null,null,null,null,"※宿直や宿泊を伴う出張を含み、残業は含まない\n※夜間勤務とは、夜24時を含む勤務"]
[null,null,null,null,null,null,"（新規雇用・復帰等の場合）\n時間外勤務予定",null,null,null,null,null,null,null," １日当たり",null,null,null,null,"時間程度（見込み）"]
[null,null,null,null,null,null,"土日祝の就労予定数",null,null,null,null,null,"月",null,null,"日",null,"休業日"]
["本人の就労実績に関する項目　※実績（就労予定等で実績がない場合は、今後の就労見込み）を記載してください。 "]
[20,"直近の就労実績②",null,null,null,null,"締日",null,null,null,null,"日","支払日",null,null,null,null,"日","給与支給実績",null,null,null,"平均\n(直近３か月)",null,null,"月",null,null,null,null,"円"]
[21,"産休・育休以外の\n休業の取得期間",null,null,null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"期間",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
["育児・短時間勤務制度に関する項目"]
[22,"出産(予定)日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[23,"職場内託児所",null,null,null,null,"託児所",null,null,null,null,"利用有無",null,null,null,null,null,"利用料"]
[null,null,null,null,null,null,"施設名"]
[24,"育児休業の短縮・\n延長への同意",null,null,null,null,"育児休業の取得(予定)期間終了前であっても、保育所等入所の内定があった場合に育児休業を短縮し、保育所等入所月内に職場復帰すること"]
[null,null,null,null,null,null,"育児休業の取得(予定)期間終了後については、育児休業(に準ずる措置）を延長し、保育所等入所の内定があった時点で保育所等入所月内に職場復帰すること"]
[25,"育児休業給付金\n受給資格の有無"]
[26,"育児のための短時間勤務制度の利用をはじめとした勤務体制の変更実績",null,null,null,null,"体制変更要因"]
[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,null,null,"勤務体制の変更期間（実績）",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"変更後の就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","就労日数",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分",null,"（うち休憩時間",null,null,null,null,"分）"]
["医師・看護師等としての勤務実態の有無"]
[27,"医師・看護師等としての勤務実態の有無",null,null,null,null,null,null,null,null,null,null,"資格･免許取得状況"]
[null,"介護士等としての\n勤務実態の有無",null,null,null,null,null,null,null,null,null,null,"資格･免許取得状況"]
[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,"）"]
[28,"施設等種別",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,"）"]
["個人事業に関する項目"]
[29,"個人事業形態",null,null,null,null,"経営者との関係",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄\n※「専従者」、「家族従業者」、「その他」にチェックを入れた場合に記載"]
[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,"就労日"]
[null,null,null,null,null,null,"仕事関連の資格の有無",null,null,null,null,null,null,null,null,"資格名"]
[null,null,null,null,null,null,"給与形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")","平均月収",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"前年分年間\n総収入額",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"営業(開業･\n就労)時間",null,null,"平日",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"土曜",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"日曜",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"店舗の\n有無",null,null,null,"純利益",null,null,null,null,"円","開業\n期間",null,null,"年",null,"月",null,"日","～",null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,"取引開始(予定)日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[30,"個人農業者",null,null,null,null,"耕作面積",null,null,null,null,null,null,null,"a","作付内容"]
[null,null,null,null,null,null,"農閑期",null,null,null,"月","～",null,null,"月","農閑期の仕事内容"]
[31,"区長又は民生・児童委員\n※第一次産業及び自営業の方は区長又は民生・児童委員の確認が必要です",null,null,null,null,"　　上記のとおり確認いたしました。"]
[null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"　　住所"]
[null,null,null,null,null,null,"　　氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,null,null,"―",null,null,"―"]
["（※事業者証明欄はここまで）"]
[]
[]
["保護者\n記載欄",null,"児童との続柄"]
[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,"児童名",null,null,null,null,null,"生年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"児童№",null,null,null,null,null,"希望保育\n時間"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　","施設名"]
[null,null,"児童名",null,null,null,null,null,"生年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"児童№",null,null,null,null,null,"希望保育\n時間"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"就労先への通勤時間",null,null,null,null,null,"時間",null,null,"分（往復）"]
[null,null,"その他の状況",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,"ひとり親世帯",null,null,null,"事由",null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"）","養育費等経済援助"]
[null,null,null,null,null,null,"事由発生年月日",null,null,null,null,null,"年",null,null,"月",null,null,"日",null,null,null,"援助金額",null,null,"月額",null,null,null,null,"円"]
["※就労証明書様式の記載要領は当BOOKの「記載要領」シートを参照してください。"]
["保護者記入欄"]
["入所児童氏名",null,null,null,null,null,null,"生年月日",null,null,null,null,null,null,"利用（希望）保育所等名",null,null,null,null,null,null,"利用（希望）クラブ名"]
[null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,null,null,null,null,null,null,null,null,"クラブ"]
[null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,null,null,null,null,null,null,null,null,"クラブ"]
[null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,null,null,null,null,null,null,null,null,"クラブ"]
["※この就労証明書の内容は、放課後児童クラブ・保育所入所事務及び入所申込書の添付書類として福祉課・申込施設でのみ使用し、それ以外の目的では使用いたしません。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"鹿島市役所　　福祉課",null,null,null,"0954-63-2119（直通）"]

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["市区町村名","施設名","年","年（児童生年）","年（実績/過去）","年（生年月日）","予定・実績混在","月","日","時","分","休憩時間","日数"]
[null,null,{"$f":"YEAR(TODAY())","v":2021},{"$f":"YEAR(TODAY())","v":2021},{"$f":"YEAR(TODAY())","v":2021},{"$f":"YEAR(TODAY())","v":2021},{"$f":"G3+1","v":2023},1,1,0,0,15,0]
[null,null,{"$f":"C2+1","v":2022},{"$f":"D2-1","v":2020},{"$f":"E2-1","v":2020},{"$f":"F2-1","v":2020},{"$f":"G4+1","v":2022},2,2,1,1,30,1]
[null,null,{"$f":"C3+1","v":2023},{"$f":"D3-1","v":2019},{"$f":"E3-1","v":2019},{"$f":"F3-1","v":2019},{"$f":"YEAR(TODAY())","v":2021},3,3,2,2,45,2]
[null,null,2024,2018,2018,2018,{"$f":"G4-1","v":2020},4,4,3,3,60,3]
[null,null,2025,2017,2017,2017,{"$f":"G5-1","v":2019},5,5,4,4,75,4]
[null,null,2026,2016,2016,2016,2018,6,6,5,5,90,5]
[null,null,2027,2015,2015,2015,2017,7,7,6,6,105,6]
[null,null,2028,2014,2014,2014,2016,8,8,7,7,120,7]
[null,null,2029,2013,2013,2013,2015,9,9,8,8,135,8]
[null,null,2030,2012,2012,2012,2014,10,10,9,9,150,9]
[null,null,2031,2011,2011,2011,2013,11,11,10,10,165,10]
[null,null,2032,2010,2010,2010,2012,12,12,11,11,180,11]
[null,null,2033,2009,2009,2009,2011,null,13,12,12,195,12]
[null,null,2034,2008,2008,2008,2010,null,14,13,13,210,13]
[null,null,2035,2007,2007,2007,2009,null,15,14,14,225,14]
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[null,"就労証明書"]
[]
["鹿島市長",null,null,null,null,null,null,null,null,"宛",null,null,null,"※本証明書は、保護者本人ではなく、保護者の就労先事業者等にて作成してください。"]
[]
["① 証明書発行事業所名",null,null,null,null,null,"株式会社　〇〇〇〇",null,null,null,null,null,null,null,null,null,"⑤ 証明日",null,null,null,null,"西暦",2021,null,"年",10,null,"月",1,null,"日"]
["② 証明書発行事業所住所",null,null,null,null,null,"佐賀県〇〇市●●番地",null,null,null,null,null,null,null,null,null,"⑥ 記載内容の\n　  問合せ先",null,null,"担当部署",null,"人事部"]
["③ 証明書発行責任者氏名",null,null,null,null,null,"鹿島　太郎",null,null,null,null,null,null,null,null,null,null,null,null,"担当者名",null,"鹿島　花子"]
["④ 証明書発行責任者役職",null,null,null,null,null,"代表取締役",null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,"△△△△",null,"―","□□",null,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（ただし、発行者が証明日時点で把握している情報に限る）。"]
["　※発行者からの正式な発出であることを証する書類（本証明発行に係るメール送受信画面等）を添付する必要があります。添付が無い場合、発行者に本証明の内容を確認します。"]
["　※原則、押印不要ですが、発行者が正式な発出であることを証するために押印することを妨げるものではありません（電子印可）。"]
["　※本証明書の内容について、就労先事業者等に無断で作成し又は改変を行ったときは、刑法上の罪に問われる場合があります。"]
["No.","項目",null,null,null,null,"記載欄"]
[1,"フリガナ",null,null,null,null,"フジツ　　イクミ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,null,null,null,"年",null,"月",null,"日"]
[null,"本人氏名",null,null,null,null,"藤津　育美"]
[null,"本人住所",null,null,null,null,"佐賀県△△△市☆☆☆番地"]
["本人の就労状況、就労先（就労予定先の場合も含む）に関する項目"]
[2,"就労状況･予定",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,")"]
[3,"主な就労先事業所名\n※①と異なる場合は記入",null,null,null,null,"株式会社　〇〇〇〇　　　　▲▲▲支店"]
[4,"主な就労先住所\n※②と異なる場合は記入",null,null,null,null,"佐賀県▲▲▲市×××番地"]
[null,null,null,null,null,null,"通勤手段",null,null,null,null,null,"自宅の最寄り（",null,null,null,null,null,null,null,")","就労先の最寄り",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,"）"]
["本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目\n※実際に働いた時間や支給された給与の額ではなく、雇用契約・就業規則の内容に関する事項を記載してください。"]
[5,"就労形態",null,null,null,null,"役員･自営業主",null,null,null,null," "]
[null,null,null,null,null,null,"被用者",null,null,null,null," "]
[null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,")"]
[null,"働き方"]
[null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,")"]
[6,"就労日数",null,null,null,null,"一月当たり",null,null,null,null,"日","・","一週当たり",null,null,null,null,"日"]
[7,"就労時間\n※休憩時間含む",null,null,null,null,"月",180,null,"時間",null,0,null,"分","週",45,null,"時間",null,0,null,"分","※月当たりの平均"]
[null,null,null,null,null,null,"日",9,null,"時間",null,0,null,"分","※月当たりの平均"]
[8,"就労時間帯\n※フレックスタイム制、\n裁量労働制の場合は\n標準的な就労時間帯を記入",null,null,null,null,"時間帯①",null,null,8,null,"時",30,null,"分","～",17,null,"時",30,null,"分","（うち休憩時間",null,null,60,null,"分）"]
[null,null,null,null,null,null,"時間帯②",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[9,"就労日",null,null,null,null,"時間帯①"]
[null,null,null,null,null,null,"時間帯②"]
[10,"雇用（予定）期間等\n※契約締結日ではなく、\n就労開始（予定）日を記入\n※有期の者は終期も記入",null,null,null,null,"雇用契約状況"]
[null,null,null,null,null,null,"就労開始（予定）日（入社日等、働き始めた日）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～","契約満了日　(有期の場合は記載)"]
[null,null,null,null,null,null,2021,null,"年",4,null,"月",1,null,"日","又は",null,null,null,null,null,"～",2022,null,"年",3,null,"月",31,null,"日"]
[null,null,null,null,null,null,"満了後の更新の有無"]
[null,null,null,null,null,null,null,null,null,null,null,"雇用予定期間",null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
["本人の就労実績に関する項目　※実績（就労予定等で実績がない場合は、今後の就労見込み）を記載してください。"]
[11,"直近の\n就労実績",null,null,null,null,"年･月",null,null,null,"ⅰ",null,null,null,"年",null,"月","ⅱ",null,null,null,"年",null,"月","ⅲ",null,null,null,"年",null,"月"]
[null,null,null,null,null,null,"就労日数\n※有給休暇含む",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"労働時間\n※休憩・残業時間含む",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"残業実施日数",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"残業時間",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額（税・社会保険等の控除前金額）",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"年・月",null,null,null,"ⅳ",null,null,null,"年",null,"月","ⅴ",null,null,null,"年",null,"月","ⅵ",null,null,null,"年",null,"月"]
[null,null,null,null,null,null,"就労日数\n※有給休暇含む",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"労働時間\n※休憩・残業時間含む",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"残業実施日数",null,null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,"日",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,"残業時間",null,null,null,null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"給与支給実績\n※賞与一時金、通勤手当を除いた給与額（税・社会保険等の控除前金額）",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
["育児に関する休業・短時間勤務制度に関する項目"]
[12,"産前･産後休業の\n取得(予定)期間",null,null,null,null,null,null,null,2021,null,"年",11,null,"月",1,null,"日",null,"～",2022,null,"年",1,null,"月",31,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[13,"育児休業の\n取得(予定)期間",null,null,null,null,"根拠"]
[null,null,null,null,null,null,null,null,null,2022,null,"年",2,null,"月",1,null,"日",null,"～",2022,null,"年",11,null,"月",30,null,"日"]
[null,null,null,null,null,null,"延長",null,null,null,"任意",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"延長",null,null,null,"任意",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"入所が内定した場合の育児休業の短縮可否"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"～",null,null,"年",null,null,"月",null,null,"日"]
[14,"復職（予定）日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,"※証明書発行事業所で育児休業等を取得中等の場合に限る"]
[15,"育児のための短時間勤務制度の利用をはじめとした勤務体制の変更\n（変更中・変更予定）",null,null,null,null,"勤務体制の変更（予定）",null,null,null,null,null,null,null,"体制変更要因"]
[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,null,null,null,"変更後の就労日"]
[null,null,null,null,null,null,"勤務体制の変更（予定）期間",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"変更後の就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","就労日数",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分"]
[null,null,null,null,null,null,"変更後の\n就労時間帯",null,null,"時間帯①",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"時間帯②",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"時間帯③",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
["保育士等（保育士、幼稚園教諭又は保育教諭）としての勤務実態の有無"]
[16,"保育士等としての\n勤務実態の有無",null,null,null,null,null,null,null,"勤務先施設等種別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")"]
[]
[null,"資格･免許取得状況"]
["備考"]
["備考"]
["鹿島市追加項目"]
["その他基本的事項"]
[17,"基本事項",null,null,null,null,"法人番号"]
[null,null,null,null,null,null,"記載内容問合せ先メールアドレス"]
[null,null,null,null,null,null,"社員番号等(任意)"]
[null,null,null,null,null,null,"業種"]
[]
[]
[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,"）"]
["本人の就労状況、就労先（就労予定先の場合も含む）に関する項目"]
[18,"就労状況・予定②",null,null,null,null,"単身赴任",null,null,null,null,null,null,"期間",null,"赴任開始日（赴任予定日）",null,null,null,null,null,null,"～","赴任終了日※未定の場合は記載不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,null,null,null,null,"赴任（予定）地"]
[null,null,null,null,null,null,"配偶者控除"]
[null,null,null,null,null,null,"扶養親族"]
[null,null,null,null,null,null,"社会保険加入状況"]
[null,null,null,null,null,null,"雇用保険加入状況"]
[null,null,null,null,null,null,"健康保険加入状況"]
[null,null,null,null,null,null,"源泉徴収税"]
[null,null,null,null,null,null,"主な就労場所"]
[null,null,null,null,null,null,"業務内容"]
[null,null,null,null,null,null,"通勤距離",null,null,null,null,null,null,null,null,"約",null,null,"㎞"]
["本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目\n※実際に働いた時間や支給された給与の額ではなく、雇用契約・就業規則の内容に関する事項を記載してください。"]
[19,"就労形態②",null,null,null,null,"給与形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額",null,null,null,null,null,"円"]
[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,"雇用主との親族関係",null,null,null,null,null,null,null,null,"続柄"]
[null,null,null,null,null,null,"内職者\n関係",null,null,"委託元事業者の業務内容"]
[null,null,null,null,null,null,null,null,null,"作業日数",null,"月",null,null,"日","作業時間帯",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分"]
[null,null,null,null,null,null,"月２回以上の夜間勤務の有無",null,null,null,null,null,null,null,null,null,null,"※宿直や宿泊を伴う出張を含み、残業は含まない\n※夜間勤務とは、夜24時を含む勤務"]
[null,null,null,null,null,null,"週２回以上の夜間勤務の有無",null,null,null,null,null,null,null,null,null,null,"※宿直や宿泊を伴う出張を含み、残業は含まない\n※夜間勤務とは、夜24時を含む勤務"]
[null,null,null,null,null,null,"（新規雇用・復帰等の場合）\n時間外勤務予定",null,null,null,null,null,null,null," １日当たり",null,null,null,null,"時間程度（見込み）"]
[null,null,null,null,null,null,"土日祝の就労予定数",null,null,null,null,null,"月",null,null,"日",null,"休業日"]
["本人の就労実績に関する項目　※実績（就労予定等で実績がない場合は、今後の就労見込み）を記載してください。 "]
[20,"直近の就労実績②",null,null,null,null,"締日",null,null,null,null,"日","支払日",null,null,null,null,"日","給与支給実績",null,null,null,"平均\n(直近３か月)",null,null,"月",null,null,null,null,"円"]
[21,"産休・育休以外の\n休業の取得期間",null,null,null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"期間",null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
["育児・短時間勤務制度に関する項目"]
[22,"出産(予定)日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[23,"職場内託児所",null,null,null,null,"託児所",null,null,null,null,"利用有無",null,null,null,null,null,"利用料"]
[null,null,null,null,null,null,"施設名"]
[24,"育児休業の短縮・\n延長への同意",null,null,null,null,"育児休業の取得(予定)期間終了前であっても、保育所等入所の内定があった場合に育児休業を短縮し、保育所等入所月内に職場復帰すること"]
[null,null,null,null,null,null,"育児休業の取得(予定)期間終了後については、育児休業(に準ずる措置）を延長し、保育所等入所の内定があった時点で保育所等入所月内に職場復帰すること"]
[25,"育児休業給付金\n受給資格の有無"]
[26,"育児のための短時間勤務制度の利用をはじめとした勤務体制の変更実績",null,null,null,null,"体制変更要因"]
[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,null,null,"勤務体制の変更期間（実績）",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"変更後の就労時間\n※休憩時間含む",null,null,null,null,"月",null,null,"時間",null,null,null,"分","就労日数",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,"日",null,null,"時間",null,null,null,"分",null,"（うち休憩時間",null,null,null,null,"分）"]
["医師・看護師等としての勤務実態の有無"]
[27,"医師・看護師等としての勤務実態の有無",null,null,null,null,null,null,null,null,null,null,"資格･免許取得状況"]
[null,"介護士等としての\n勤務実態の有無",null,null,null,null,null,null,null,null,null,null,"資格･免許取得状況"]
[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,"）"]
[28,"施設等種別",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,"）"]
["個人事業に関する項目"]
[29,"個人事業形態",null,null,null,null,"経営者との関係",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄\n※「専従者」、「家族従業者」、「その他」にチェックを入れた場合に記載"]
[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,"就労日"]
[null,null,null,null,null,null,"仕事関連の資格の有無",null,null,null,null,null,null,null,null,"資格名"]
[null,null,null,null,null,null,"給与形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")","平均月収",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"前年分年間\n総収入額",null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,"営業(開業･\n就労)時間",null,null,"平日",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"土曜",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,null,null,null,"日曜",null,null,null,null,"時",null,null,"分","～",null,null,"時",null,null,"分","（うち休憩時間",null,null,null,null,"分）"]
[null,null,null,null,null,null,"店舗の\n有無",null,null,null,"純利益",null,null,null,null,"円","開業\n期間",null,null,"年",null,"月",null,"日","～",null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,"取引開始(予定)日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[30,"個人農業者",null,null,null,null,"耕作面積",null,null,null,null,null,null,null,"a","作付内容"]
[null,null,null,null,null,null,"農閑期",null,null,null,"月","～",null,null,"月","農閑期の仕事内容"]
[31,"区長又は民生・児童委員\n※第一次産業及び自営業の方は区長又は民生・児童委員の確認が必要です",null,null,null,null,"　　上記のとおり確認いたしました。"]
[null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"　　住所"]
[null,null,null,null,null,null,"　　氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,null,null,"―",null,null,"―"]
["（※事業者証明欄はここまで）"]
[]
[]
["保護者\n記載欄",null,"児童との続柄"]
[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,"児童名",null,null,null,null,null,"生年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"児童№",null,null,null,null,null,"希望保育\n時間"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　","施設名"]
[null,null,"児童名",null,null,null,null,null,"生年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"児童№",null,null,null,null,null,"希望保育\n時間"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,"就労先への通勤時間",null,null,null,null,null,"時間",null,null,"分（往復）"]
[null,null,"その他の状況",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,"ひとり親世帯",null,null,null,"事由",null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"）","養育費等経済援助"]
[null,null,null,null,null,null,"事由発生年月日",null,null,null,null,null,"年",null,null,"月",null,null,"日",null,null,null,"援助金額",null,null,"月額",null,null,null,null,"円"]
["※就労証明書様式の記載要領は当BOOKの「記載要領」シートを参照してください。"]
["保護者記入欄"]
["入所児童氏名",null,null,null,null,null,null,"生年月日",null,null,null,null,null,null,"利用（希望）保育所等名",null,null,null,null,null,null,"利用（希望）クラブ名"]
["藤津　一郎",null,null,null,null,null,null,"H30",null,"年",5,"月",6,"日","☆☆☆保育園",null,null,null,null,null,null,null,null,null,null,"クラブ"]
["藤津　一美",null,null,null,null,null,null,"H26",null,"年",11,"月",17,"日",null,null,null,null,null,null,null,"◇◇◇◇",null,null,null,"クラブ"]
[null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,null,null,null,null,null,null,null,null,"クラブ"]
["※この就労証明書の内容は、放課後児童クラブ・保育所入所事務及び入所申込書の添付書類として福祉課・申込施設でのみ使用し、それ以外の目的では使用いたしません。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"鹿島市役所　　福祉課",null,null,null,"0954-63-2119（直通）"]

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["戻","【就労証明書（詳細版）】記載要領"]
["■証明書を発行する事業者に関する項目（①～⑥）"]
[]
[null,"①","証明書発行事業所名",null,"○証明書を発行する事業者の名称（法人名）を記載してください。\n　※就労証明書の発行に責任を持つ企業・組織・団体名等を記載してください。\n　※個人事業主の場合は事業者の名称を記載してください。"]
[null,"②","証明書発行事業所住所",null,"○証明書発行事業所の住所を記載してください。\n　※証明書の証明対象となる者（以下「本人」という。）の就労先住所ではない点に注意してください。"]
[null,"③","証明書発行責任者氏名",null,"○証明書の内容に責任を持つ者の氏名を記載してください。"]
[null,"④","証明書発行責任者役職",null,"○証明書の内容に責任を持つ者の役職名を記載してください。"]
[null,"⑤","証明日",null,"○証明日（証明書発行日）を記載してください。\n　※年の欄は西暦で記載してください。"]
[null,"⑥","記載内容の問合せ先",null,"○証明書の内容について、自治体からの事務的な連絡を受ける担当部署、担当者名、電話番号を記載してください。\n　※個人事業主等「部署」が存在しない場合は、「担当部署」欄は空欄で構いません。\n　※本証明書の作成は、業務内容について事業者として証明できる担当部署、担当者が作成するよう、ご留意ください。"]
[]
["■氏名等に関する項目"]
[]
[null,"№1","フリガナ/本人氏名",null,"○本人の氏名、フリガナを記載してください。"]
[null,null,"本人住所",null,"○本人の住所を記載してください。"]
[]
["■本人の就労状況、就労先（就労予定先の場合含む）に関する項目"]
[]
[null,"№2","就労状況・予定",null,"○現在の就労状況について該当する項目をチェック（レ点記入）してください。\n　※「□就労中」には証明書発行事業所から出向し就労している場合も含みます。\n　※「□産休・育休中」には、法令上の産前・産後休業及び育児休業に限らず法人独自の休業等も含みます。\n　※「□就労予定（転職内定含む）」には、以下の両方を含みます。\n　　・新規就労（現在無職だが、証明書発行事業所での就労が内定している場合）\n　　・転職（現在別事業所で働いているが、証明書発行事業所での就労が内定している場合）\n　※いずれにも該当しない場合は「□その他」をチェック（レ点記入）し、カッコ内に具体的に記載してください。"]
[null,"№3","主な就労先事業所名\n",null,"○①証明書発行事業所名と異なる場合は本人が働いている事業所の名称を記載してください。"]
[null,"№4","主な就労先住所",null,"○②証明書発行事業所住所と異なる場合は本人が実際に働いている事業所の住所を記載してください。　\n　※実際に働いている就労場所が複数存在する場合は、主たる就労先の住所を記載するようにしてください。\n　※就労場所が存在しない場合には、自宅等就労時に本人が主として存在している場所を記載するようにしてください。"]
[]
["■本人との契約（雇用契約等、就労に関する契約）・就業規則の内容に関する項目"]
[]
[null,"№5","就労形態/働き方","就労形態","○就労形態について該当する項目にチェック（レ点記入）してください。"]
[null,null,null,null,"「□役員（会社の取締役・監査役、法人の理事等）」\n　会社、団体、公社等の役員（法人格を有する商店等の経営者を含む。）"]
[null,null,null,null,"「□自営業主（個人事業主）」\n　個人経営の事業を営んでいる者"]
[null,null,null,null,"「□正規の職員・従業員」\n　派遣労働者ではなく、期間の定めのない労働契約を締結する者"]
[null,null,null,null,"「□パート・アルバイト」\n　正社員より1日の所定労働時間が短い、または１週間の所定労働日数が少ない者 "]
[null,null,null,null,"「□派遣社員」（労働者派遣事業所の派遣社員）\n　働いている企業等と直接雇用関係がなく、期間の定めがある労働契約を締結する者"]
[null,null,null,null,"「□契約・嘱託社員」\n　働いている企業等と直接雇用の関係があり、期間の定めがある労働契約を締結する者"]
[null,null,null,null,"「□会計年度任用職員」\n　地方公務員法第22条の２に基づき任用される非常勤職員"]
[null,null,null,null,"「□自営業専従者」\n　自営業主（個人事業主）と親族関係にある者で専従者控除の対象となる者。いわゆる専従者や自営業協力者のこと。"]
[null,null,null,null,"「□内職者」\n　自宅で内職（賃仕事）をしている者"]
[null,null,null,null,"「□家族従業者」\n　自営業主の家族（生計を一にする親族）で、その自営業主の営む事業に無給で従事している者"]
[null,null,null,null,"「□業務委託」\n　業務委託契約を締結する者"]
[null,null,null,null,"「□その他」\n　上記のいずれにも該当しない場合にチェック（レ点記入）し、カッコ内に具体的に記載してください。\n\n　※「契約・嘱託社員」等の場合で「会計年度任用職員」にも該当する場合は、「会計年度任用職員」にチェック（レ点記入）してください。"]
[null,"№7","就労時間\n※休憩時間含む",null,"○一月当たり、一週当たり、一日当たりの就労時間について記載してください。\n　※雇用契約に基づく就労時間であり、実際に就労した時間（実績）ではありません。育児短時間勤務制度等を利用している場合でも、制度利用前の就労時間数を記載してください。\n　※雇用契約上、週当たりの就労時間が定められている場合、月当たりの就労時間欄には、４（週）を乗じた時間を記載してください。\n　※雇用契約上、年当たりの就労時間が定められている場合、月当たりの就労時間欄には12（月）で除した時間を、週当たりの就労時間欄には48（週）で除した時間を記載してください。\n　※雇用契約上の就労時間であるため、残業時間は除いてください。\n　※シフト勤務等変則就労の場合は、一日当たりの就労時間については、平均的な就労時間を記載してください。なお、市区町村における保育の必要性認定に必要となる場合は、シフト表の追加提出を求める場合があります。\n　※休憩時間（就業規則等で定められている休憩に限る。）は含めてください。また、就業規則等で定められている休憩時間数についても記載してください。"]
[null,"№8","就労時間帯",null,"○就労時間帯（何時から何時まで働くこととされているか）を記載してください。\n　※時間帯は、「24時間表記」で記載してください。夜間勤務など日をまたぐ場合には、０時～29時の幅（例えば22時から翌朝５時まで就労する場合は「22時00分～29時00分」）で記載してください。\n　※短時間勤務制度を利用している場合は、制度利用前の雇用契約・就業規則上の就労時間帯を記載してください。\n　※フレックスタイム制、裁量労働制の場合は、標準的な就労時間帯を記載してください。\n　※曜日等により標準的な時間帯が異なるなど、定期的に異なる就業時間帯を組み合わせている場合は、３パターンまで、各パターンごとに標準的な就労時間帯を記載してください。\n　※複数パターンの就労時間帯を記載する場合、主たる労働時間帯が決まっている場合は当該時間帯を①に、決まっていない場合は一月当たりの勤務回数の多い時間帯を①としてください。"]
[null,"№9","就労日",null,"○雇用契約・就業規則上の就労日（曜日又は祝日）について該当する項目にチェック（レ点記入）してください。\n　※定休日ではないので注意してください。\n　※時間帯①～③について、No.8で回答した時間帯に対応する就労日を選択してください。No.8において記載していない時間帯については、記載不要です。\n\n○休日が不規則で、事業所の年間カレンダーで休日が決まっている場合には、その旨を備考欄に記載の上、別途カレンダーを提出してください。\n\n○土日祝日の就労が常態的（平均して月１回以上）である場合には、その旨備考欄に記載してください。"]
[null,"№10","雇用（予定）期間等",null,"○雇用期間について「□無期」か「□有期」にチェック（レ点記入）してください。\n\n○雇用期間について「□無期」の場合は就労開始（予定）日のみを、「□有期」の場合はその期間を記載してください。\n　※年の欄は西暦で記載してください。\n　※就労開始（予定）日については、確定していなくても予定日での記載をするようにしてください。就労開始予定日を保育所等の利用開始日としている場合は、「□保育所等入所次第」にチェック（レ点記入）してください。\n\n○雇用期間について「□有期」をチェックした場合は契約満了後の更新の有無について「□有」「□有（見込み）」「□無」「□未定」のいずれかにチェック（レ点記入）してください。\n\n○［様式上項目設定した場合］契約満了後の更新の有無について「□有」又は「□有（見込み）」を選択した場合、更新後の雇用予定期間について可能な範囲で記載してください。\n　※原則として年度更新が予定されているものの確定していない等のケースであっても、予定で記載するようにしてください。"]
[]
["■育児に関する休業・短時間勤務制度に関する項目"]
[]
[null,"№12","産前･産後休業の\n取得(予定)期間",null,"○産前・産後休業の取得（予定）期間を記載してください。\n　※年の欄は西暦で記載してください。\n　※法令上の産前・産後休業に限らず法人独自の就業規則等に基づいた休業も含みます。\n　※取得済みの場合は実績を記入してください。\n　※現在取得中の場合もしくは今後取得予定の場合はその期間（発行者が⑥証明日時点で把握している年月日）を記載してください。終了日が確定していない場合でも終了予定日を記載するようにしてください。"]
[null,"№13","育児休業の取得\n(予定)期間","期間","○育児休業の取得（予定）の根拠について「□法定」か「□企業独自」かにチェック（レ点記入）してください。\n　※育児・介護休業法に基づく育児休業の場合は「□法定」とし、同法に基づかない法人独自の就業規則等に基づく育児のための休業の場合は「□企業独自」としてください。\n○育児休業の取得（予定）期間を記載してください。\n　※年の欄は西暦で記載してください。\n　※法令上の育児休業に限らず法人独自の就業規則等に基づいた休業も含みます。\n　※取得済みの場合は実績を記載してください。\n　※現在取得中の場合若しくは今後取得予定の場合はその期間（発行者が⑥証明日時点で把握している年月日）を記載してください。\n　※終期が確定していない場合でも終了予定日を記載するようにしてください。取得期間が未定で、終了予定日についての記載も困難な場合は空欄で構いません。"]
[null,"№14","復職（予定）日",null,"○証明書発行事業所において取得中（又は取得予定）の育児休業等に係る復職（予定）日について証明書発行事業所が⑤証明日時点で把握している年月日を記載してください。\n　※年の欄は西暦で記載してください。\n　※証明書発行事業所において取得した育児休業等から復職済みの場合は、復職した日を記載してください。"]
["■備考"]
[]
[null,null,"備考",null,"○No.11における給与支給実績につき、当該月分の労働時間数と必ずしも一致しない場合はその旨を記載してください。\n○No.16における資格が「資格取得予定」の場合はその旨を記載してください。\n○特記事項があれば、この欄に記載してください。\n\n　　＊１点目は、No.11において給与支給実績を記載するよう求めている市区町村のみに該当する内容であるため、不要な市区町村においては文言削除を可能とする。"]
[null,"№31","区長又は民生・児童委員",null,"○自営業の方は、民生・児童委員による確認が必要です。証明書の内容が事実であることを確認する民生・児童委員が、氏名、住所及び電話番号を記載してください。また、その確認日を記載してください。\n　※年の欄は西暦で記載してください。\n　　※本項目について市区町村が設定する場合は、市区町村は必要に応じて事前に市区町村民児協等と調整をしていただく等の対応をお願いいたします。"]