Formulario de Aplicación de JICA - 2014

7/21/2019 Formulario de Aplicacin de JICA - 2014

1/14

CONFIDENTIAL

Guidelines of Application Form for

the JICA Training and Dialogue Program

The attached form is to be used to apply for the training and dialogue programs of the

Japan International Cooperation Agency (JICA), which are implemented as part of the

Official Deelopment Assistance !rogram of the "oernment of Japan# !lease complete

the application form while referring to the following and consult with the respectie country$s

JICA Office % or the &mbassy of Japan if the former is not aailable % in your country for

further information#

! Parts of Application Form to "e completed# $hich part of the form should "e su"mitted%

It depends on the type of training and dialogue program you are applying for#

&Application for Group and 'egion Focused Training Program

Official application and !arts A and ' including edical istory and &*amination must be

submitted#

&&Application for Countr( Focused Training Program including Counterpart Training

Program and Training related to ODA Loan

!art ' including edical istory and &*amination will be submitted# !art A needs not to be

submitted

)# *o+ man( parts does the Application Form consist of%

The Application +orm consists of three parts as follows

Official Application

This part is to be confirmed and signed by the head of the releant department-diision of

the organi.ation which is applying#

Part A! Information on the Appl(ing Organi,ation

This part is to be confirmed by the head of the releant department-diision of the

organi.ation which is applying#

Part -! Information A"out the Nominee including .edical *istor( and E/amination

This part is to be completed by the person who is nominated by the organi.ation applying#

The applicants for "roup and /egion +ocused Training !rogram are re0uired to fill in e0er(

item# As for the applications for Country +ocused Training !rogram including Counterpart

Training !rogram and some specified International Dialogue !rograms, it is re0uired to fill

in the designated1re2uired3 items as is shown on the +orm#

!lease refer to the "eneral Information to find out which type the training and dialogue

program that your organi.ation applies for belongs to#

)! *o+ to complete the Application Form

In completing the application form, please be adised to1


2/14

CONFIDENTIAL

(a) carefully read the "eneral Information ("I) for which you intend to apply, and confirm if

the ob2ecties and contents are releant to yours,

(b) be sure to write in the title name of the course-seminar-wor3shop-pro2ect accurately

according to the "I, which you intend to apply,

(c) use a typewriter-personal computer in completing the form or write in"loc4 letters,

(d) fill in the form in English,

(e) use or 4*5 to fill in the ( ) chec3 bo*es,

(f) attach a picture of the 6ominee,

(g) attach additional page(s) if there is insufficient space on the form,

(h) prepare the necessary document(s) described in the "eneral Information ("I), and

attach it (them) to the form,

(i) confirm the application procedure stipulated by your goernment, and

(2) submit the original application form with the necessary document(s) to the responsible

organi.ation of your goernment according to the application procedure#

Any information that is ac0uired through the actiities of the Japan International

Cooperation Agency (JICA), such as the nominee$s name, educational record, and medical

history, shall be properly handled in iew of the importance of safeguarding personal

information#

5! Pri0ac( Polic(

# 6cope of 7se

Any information used for identifying indiiduals that is ac0uired by JICA will be stored, used,

or analy.ed only within the scope of JICA actiities# JICA reseres the right to use such

identifying information and other materials in accordance with the proisions of this priacy

policy#

)# Limitations on 7se and Pro0ision

JICA shall neer intentionally proide information that can be used to identify indiiduals to

any third party, with the following three e*ceptions1

(a) In cases of legally mandated disclosure re0uests

(b) In cases in which the proider of information grants permission for its disclosure to a

third party

(c) In cases in which JICA commissions a party to process the information collected the

information proided will be within the scope of the commissioned tas3s#

5# 6ecurit( Notice

JICA ta3es measures re0uired to preent lea3age, loss, or destruction of ac0uired

information, and to otherwise properly manage such information#

8! Cop(right polic(

!articipants of the JICA Training and Dialogue program are re0uested to comply with the

following copyright policy


3/14

CONFIDENTIAL

Article 7# Compliance matters with participants$ drafting of documents (arious reports,

action plans, etc#) and presentations (report meetings, lectures, speeches, etc#)

7# Any contents of the documents and presentations shall be created by themseles in

principle#

8# Comply with the following matters, if you, oer the limit of 0uotation, hae to use a third

person$s wor3 (reproduction, photograph, illustration, map, figure, etc#) that is protected

under laws or regulations in your country or copyright%related multinational agreements or

the li3e1

(7) Obtain license to use the wor3 on your own responsibility# In this case, the scope of the

license shall meet the proisions of Article 8#

(8) 9ecure eidential material that proes the grants of the license and specifies the scope

of the license#

(:) Consult with the third party and perform the payment procedure on your ownresponsibility regarding negotiations with a third person about the consideration for granting

the license and the procedure for paying the consideration,#

Article 8# Details of use of wor3s used for training

(7) The copyright on a wor3 that a participant prepares for a training course shall belong to

the trainee# The copyright on the parts where a third party$s wor3 is used shall belong to the

third party#

(8) ;hen using te*ts, supplementary educational materials and other materials distributed

for the JICA training courses, participants shall comply with the purposes and scopes

approed by each copyright holder#


4/14

CONFIDENTIAL

Training !rograms under Technical Cooperation with the "oernment of Japan

Application Form for the JICA Training and Dialogue Program

OFFICIAL APPLICATION

(to be confirmed and signed by the head of the releant department - diision of the applying organi.ation)

! Title9 (!lease write down as shown in the "eneral Information)

)! Num"er9 (!lease write down as shown in the "eneral Information)

J : ;

5! Countr( Name9

8! Name of Appl(ing Organi,ation9

7) :)

8)


5/14

CONFIDENTIAL

Department - Diision


6/14

CONFIDENTIAL

Part A9 Information on the Appl(ing Organi,ation

(to be confirmed by the head of the department - diision)

! Profile of Organi,ation

# Name of Organi,ation9

)# The mission of the Organi,ation and the Department > Di0ision9

)! Purpose of Application

# Current Issues9 Descri"e the reasons for (our organi,ation claiming the need to

participate in the training and dialogue program? +ith reference to issues or pro"lems to

"e addressed!

)# O"@ecti0e9 Descri"e +hat (our organi,ation intends to achie0e "( participating in the

training and dialogue program!


7/14

CONFIDENTIAL

5# Future Plan of Actions9 Descri"e ho+ (our organi,ation shall ma4e use of the

e/pected achie0ements? in addressing the said issues or pro"lems!

8# 6election of the Nominee9 Descri"e the reason=s# the nominee has "een selected for

the said purpose? referring to the follo+ing 0ie+ points # Course re2uirement? )#

Capacit( >Position? 5# Plans for the candidate after the training and dialogue program? 8#

Plan of organi,ation and


8/14

CONFIDENTIAL

Part -9 Information a"out the Nominee

(to be completed by the 6ominee)

6OT&===The applicants for "roup and /egion +ocused Training !rogram are re0uired to fill in 4&ery Item5# As for the

applications for Country +ocused Training !rogram including Counterpart Training !rogram and some specified

International Dialogue !rograms, it is re0uired to fill in the designated1re2uired3items as is shown below#

! Title9(!lease write down as shown in the "eneral Information) =re2uired#

)! Num"er9(!lease write down as shown in the "eneral Information) =re2uired#

J : ;

5! Information a"out the Nominee=nos! ;B are all re2uired#

# Name of Nominee =as in the passport#

Famil( Name

First Name

.iddle Name

)# Nationalit(

=as sho+n in the passport#


9/14

CONFIDENTIAL

information#!

H# Present Position and Current Duties

Organi.ation

Department - Diision

!resent !osition

Date of employment by

the present organi.ation

Date onth >ear Date of assignment to the

present position

Date onth >ear

# T(pe of Organi,ation

( ) 6ational "oernmental ( ) @ocal "oernmental ( ) !ublic &nterprise

( ) !riate (profit) ( ) 6"O-!riate (6on%profit) ( ) ?niersity

( ) Other ( )

B# Outline of duties9 Descri"e (our current duties

:# Contact Information

Office Address1

T&@1 obile (Cell !hone)1

+A1 &%mail1

ome Address1


+A1 &%mail1

Contact person

in emergency

6ame1

/elationship to you1

Address1


+A1 &%mail1

# Others =if necessar(#

8! Career 'ecord

# Jo" 'ecord =After graduation#

Organi.ation City-

Country

!eriod !osition or Title 'rief Job Description

+rom

onth->ear

To

onth->ear


10/14

CONFIDENTIAL

)# Educational 'ecord =*igher Education#=re2uired#

Institution City-

Country

!eriod Degree obtained a2or

+rom

onth->ear

To

onth->ear

5# Training or 6tud( in Foreign Countriesplease write your past visits to Japan specifically as

much as possible, if any.

Institution City-

Country

!eriod +ield of 9tudy - !rogram Title

+rom

onth->ear

To

onth->ear

7) @anguage to be used in the program (as in "I)

@istening ( ) &*cellent ( ) "ood ( ) +air ( ) !oor

9pea3ing ( ) &*cellent ( ) "ood ( ) +air ( ) !oor

/eading ( ) &*cellent ( ) "ood ( ) +air ( ) !oor

;riting ( ) &*cellent ( ) "ood ( ) +air ( ) !oor

Certificate (&*amples1 TO&+@, TO&IC)

8) other Tongue

:)Other languages ( ) ( ) &*cellent ( ) "ood ( ) +air ( ) !oor

&*cellent1 /efined fluency s3ills and topic%controlled discussions, debates B presentations# +ormulates strategies todeal with arious essay types, including narratie, comparison, cause%effect B argumentatie essays#"ood1 Conersational accuracy B fluency in a wide range of situations1 discussions, short presentations B interiews#Compound comple* sentences# &*tended essay formation#+air1 'roader range of language related to e*pressing opinions, giing adice, ma3ing suggestions# @imited compoundand comple* sentences B e*panded paragraph formation#!oor1 9imple conersation leel, such as self%introduction, brief 0uestion B answer using the present and past tenses#


11/14

CONFIDENTIAL


12/14

CONFIDENTIAL

! E/pectation on the applied training and dialogue program

# Personal Goal9 Descri"e +hat (ou intend to achie0e in the applied training and dialogue program

in relation to the organi,ational purpose descri"ed in Part A;)!

)# 'ele0ant E/perience9 Descri"e (our pre0ious 0ocational e/periences +hich are highl( rele0ant

in the themes of the applied training and dialogue program! =re2uired#

5# Area of Interest9 Descri"e (our su"@ect of particular interest +ith reference to the contents of the

applied training and dialogue program! =re2uired#

H! Declaration =to "e signed "( the Nominee# =re2uired#

I certify that the statements I made in this form are true and correct to the best of my 3nowledge#

If accepted for the program, I agree1

(a) not to bring or inite any member of my family (e*cept for the program whose period is one year or

more),

(b) to carry out such instructions and abide by such conditions as may be stipulated by both the

nominating goernment and the Japanese "oernment regarding the program,

(c) to follow the program, and abide by the rules of the institution or establishment that implements the

program,

(d) to refrain from engaging in political actiity or any form of employment for profit or gain,

(e) to return to my home country at the end of the actiities in Japan on the designated flight schedule

arranged by JICA,

(f) to discontinue the program if JICA and the applying organi.ation agree on any reason for such

discontinuation and not to claim any cost or damage due to the said discontinuation#(g) to consent to waie e*ercise of my copyright holder$s rights for documents or products that are

produced during the course of the pro2ect, against duplication and-or translation by JICA, as long as

they are used for the purposes of the program#


13/14

CONFIDENTIAL

(h) to approe the priacy policy and the copyright policy mentioned in the "uidelines of Application#

JICA$s Information 9ecurity !olicy in relation to !ersonal Information !rotection

JICA will properly and safely manage personal information collected through this application form in

accordance with JICA$s priacy policy and the releant laws of Japan concerning protection of

personal information and ta3e protection measures to preent diulgation, loss or damages of such

personal information#

?nless otherwise obtained approal from an applicant itself or there are alid reasons such as

disclosure under laws and ordinances, etc#, and e*cept for the following 7#%:#, JICA will neither

proide nor disclose personal information to any third party# JICA will use personal information

proided only for the purposes in the following 7#%: and will not use for any purpose other than the

following 7#%: without prior approal of an applicant itself#

7# To proide technical training to technical training participants from deeloping countries#

8# To proide technical training to technical training trainees from deeloping countries under the

Citi.ens$ Cooperation Actiities##

:# In addition to 7# and 8# aboe, if the goernment of Japan or JICA determines necessary in the

course of technical cooperation#

(i) to obsere Japanese laws and ordinances during my stay, if I iolate Japanese laws and ordinances,

I will return the total amount or a part of the e*penditure re0uired for the training depending on the e*tent

of the iolation#

(2) to understand that JICA does not assure issuance of Japan entry isa een after JICA decide to accept

me# I understand the &mbassy of Japan will decide it according to necessary formalities upon the

submission of isa application from each participant#

Date1 9ignature1

!rint 6ame1


14/14

CONFIDENTIAL

.EDICAL *I6TO'

7# !resent edical 9tatus

(a) Do you currently use any medicine or hae regular medical chec3up by a physician for

your illness

E F 6o E F >es1 6ame of illness ( ), 6ame of medicine ( )

If yes, please attach your doctor's letter (preferably, written in English) that

describes current status of your illness and agreement to join the program.

(b) Are you pregnant

E F 6o E F >es1 onths of pregnancy ( months)

(c) Are you allergic to any medication or food

E F 6o E F >es1 ;hat are you allergic to ( )

(d) !lease indicate any needs arising from disabilities that might necessitate additional

support or facilities#

( )

Note: isability does not lead to e!clusion of persons with disability from the program. "owe#er, upon the

situation, you may be directly in$uired by the %I& official in charge for a more detailed account of your

condition.

8# !ast edical istory

(a) ae you had any significant or serious illness

E F 6o E F >es1 !lease specify ( )

(b) ae you eer been a patient in a mental clinic or been treated by a psychiatrist

E F 6o E F >es1 !lease specify ( )

:# Other edical !roblems

If you have any medical problems that are not described above, please indicate

below.

I certify that I hae read the aboe instructions and answered all 0uestions truthfully and

completely to the best of my 3nowledge#

I understand and accept that medical conditions resulting from an undisclosed pre%e*isting

condition may not be financially compensated by JICA and may result in termination of the

program#

Date1 9ignature1

!rint 6ame1

Formulario de Aplicación de JICA - 2014

Documents

Transcript of Formulario de Aplicación de JICA - 2014