Intern Ship Program
Pre-Application Form

Personal Information

ID-Card :

Name :     Last Name :    Nick Name :

ª×èÍ :    ¹ÒÁÊ¡ØÅ :    ª×èÍàÅè¹ :

Birth Date :

Country of Citizenship :

Country of Legal Residence :

Gender : Male      Female

Country of Birth :       City of Birth :

E-mail Address :

Phone Number :      Mobile Number :

Address :

City :      Province :

Country :      Postal Code :

Emergency Contact Information

First Name : Family Name :

Relationship : If contact is Other, please specify :

Phone Number : Mobile Number :

Educational History

University :

Field of Study :

Field of Study Description :

How many years of study has the applicant completed in this field ? :

What is the applicant's grade point average ? :

Is the applicant currently enrolled in university ? : Yes    No

If so, when will he or she graduate ? :

If graduated, graduation date : month/day/year

Please provide any other education or training that directly relates to the proposed training field :

Career History

Please list information on employment that directly relates to the applicant's chosen field for the Intrax Career Training Program

Job #1

Company :

Supervisor's First Name : Family Name :

Supervisor's Title :

Job Start Date : month/day/year

Job End Date : month/day/year

Applicant's Job Title :

Applicant's Job Description :

Job #2

Company :

Supervisor's First Name: Family Name :

Supervisor's Title :

Job Start Date : month/day/year

Job End Date : month/day/year

Applicant's Job Title :

Applicant's Job Description :

Job #3

Company :

Supervisor's First Name: Family Name :

Supervisor's Title :

Job Start Date : month/day/year

Job End Date : month/day/year

Applicant's Job Title :

Applicant's Job Description :

Job #4

Company :

Supervisor's First Name: Family Name :

Supervisor's Title :

Job Start Date : month/day/year

Job End Date : month/day/year

Applicant's Job Title :

Applicant's Job Description :

Additional Information

Has the applicant participated in a J-1 trainee program before ? : Yes    No

If so, how long was the program ? :

What is the applicant's goal for participating in this training ? :

How do you know American Learning Co.,Ltd. :

Please check the information provided in this application carefully before clicking on the "Submit" button below.