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["様式第９号(R4.12.2改正)"]
["対象労働者雇用状況等申立書"]
["労働移動支援助成金（早期雇入れ支援コース）"]
[]
[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,null,null,null,"(",null,null,"枚中",null,null,null,"枚目",null,")"]
["（１）支給対象者について"]
[1,"支給対象者氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2,"雇用保険\n被保険者番号"]
[]
[3,"所属部署",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4,"職種\n（※裏面のA～Lから選択）"]
[]
[5,"雇入れ日",null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日",null,6,"雇用形態\n（裏面の【※1】を参照）\nＡ～Dから選択）"]
[]
[7,"雇入れ経路\n（裏面の※２のＡ～Ｃから選択）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8,"年齢",null,null,null,null,null,null,null,null,null,null,null,null,"歳"]
[]
[9,"対象者の区分\n（該当するものに○をつけ、その右欄の日付を記入）",null,null,null,null,"イ　再就職援助計画対象者",null,null,null,null,null,null,null,null,null,null,null,null,"前職の離職日",null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"※労働局記載欄\n\n特例対象者\n【　該当　・　非該当】"]
[null,null,null,null,null,null,"ロ　求職活動支援書対象者",null,null,null,null,null,null,null,null,null,null,null,null,"前職の離職日",null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[10,null,null,null,null,null,"職業訓練計画認定番号",null,null,null,null,null,null,"第",null,null,null,null,null,null,null,null,null,"号","※10欄は職業訓練計画（様式第２号）を提出し、労働局から認定を受けた職業訓練を支給対象者が受講中、または受講が終了している場合に必ず記載してください。"]
[null,"職業訓練認定状況",null,null,null,null,"職業訓練認定日",null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,"訓練終了（予定）日",null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[11,"5の雇入れにおいて、支給対象者を期間の定めのない労働者として雇い入れた。",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,"（はい・いいえ）"]
[]
[12,"賃金締切日及び賃金支払日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（　　　　　　　　　　　・　　　　　　　　　　）"]
[]
[13,"雇入れ日以降、支払期日を超えて支払っていない賃金がある。",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,"（はい・いいえ）"]
[]
[14,"時間外手当・深夜手当・休日手当等を法定どおり支払っている。",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,"（はい・いいえ）"]
[]
[]
["（２）支給対象者を雇用していた事業主との関係"]
[1,"再就職援助計画対象被保険者又は支援書対象被保険者となった事業主名"]
[]
[2,"1の事業主と、支給対象者の雇入れの日から起算してその日以前１年間において、資本的・経済的・組織的関連性から見て密接な関係にある事業主に該当する。",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,"（はい・いいえ）"]
[]
[]
["（３）再就職支援の委託を受けた職業紹介事業者でないことの確認及び当該職業紹介事業者との関係"]
[1,"再就職援助計画対象被保険者又は支援書対象被保険者となった事業主から再就職支援の委託を受けた職業紹介事業者名"]
[]
[2,"申請事業主が1の職業紹介事業者である。",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,"（はい・いいえ）"]
[]
[3,"1の職業紹介事業者と支給対象者の雇入れの日から起算してその日以前１年間において、資本的・経済的・組織的関連性から見て密接な関係にある事業主に該当する。",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,"（はい・いいえ）"]
[]
[]
["（４）賃金上昇確認欄"]
["○再就職援助計画対象労働者証明書（写）又は求職活動支援書（写）に記載されている賃金額（Ａ）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
["○雇入れから最初に到来する賃金支払日以降６か月の毎月決まって支払われる賃金額（Ｂ）"]
[null,null,"月",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"月",null,null,null,null,null,null,null,null,null,null,null,"円",null,null,"月",null,null,null,null,null,null,null,null,null,null,"円"]
[]
[]
[null,null,"月",null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"月",null,null,null,null,null,null,null,null,null,null,null,"円",null,null,"月",null,null,null,null,null,null,null,null,null,null,"円"]
[]
[]
[]
[null,null,null,null,null,null,null,null,"（２）１の事業主の事業所への復帰の見込みがある。",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,"（はい・いいえ）"]
[null,null,"本人記載欄",null,null,null,null,null,"（２）１の事業主の事業所の離職後から現在の事業所に雇い入れされるまでのあいだに、\n　　別の事業所において雇用保険一般被保険者又は高齢被保険者として雇用されたことがある",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,"（はい・いいえ）"]
[null,null,null,null,null,null,null,null,"「（１）支給対象者について」欄及び上記の回答について、いずれも相違ありません。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
[]
[]
[null,null,"可能な範囲でご記載ください。",null,null,null,null,null,"（２）１の事業主の事業所における雇用形態（裏面の※３のＡ～Ｆより選択してください。）"]
[]
[null,null,null,null,null,null,null,null,"（２）１の事業主の事業所の産業分類（日本標準産業分類大分類）\n　　（裏面の※４のＡ～Ｔより選択してください）"]
[]
[]
[]
[null,"※記載にあたっては、裏面の記入上の注意を必ずご覧ください。"]
[null,"※事業主証明欄は裏面にあります。"]
[]
[]
[null,"以上の記載事項に誤りのないことを証明する。"]
[]
[null,null,null,null,null,"年",null,"月",null,null,"日"]
[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,null,null,null,null,null,"所在地"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,null,null,"代表者名"]