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["様式第１号（R7.4.1改正）"]
["対象労働者雇用状況等申立書"]
["早期再就職支援等助成金（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01～15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,null,null,null,null,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,"ハ　特定受給資格者（ハローワーク紹介）"]
[null,null,null,null,null,null,"ニ　特定受給資格者（ハ以外）"]
["10","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,"（　　　　　　　　　　　・　　　　　　　　　　）"]
[]
["11","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）"]
[]
["12","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若しくは支援書対象被保険者となった事業主名又は特定受給資格者として受給資格の決定に至ることとなる離職前の事業主名"]
[]
[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"]
[1,"　離職前に最後に支払われていた毎月決まって支払われる賃金額について、当てはまるものを☑をしてください。",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,null,"円"]
[null," □　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," □　離職前６か月のうち連続する２か月間の給与明細等に記載された賃金額（Ａ）"]
[]
[null," □　雇用保険受給資格者証の離職前賃金日額に30を乗じて得た額（Ａ）"]
[]
[2,"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"]
[]
[3,"毎月決まって支払われる賃金を上昇させた後、合理的な理由なく、引き下げるものではない。",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,"合理的な理由なく、毎月決まって支払われる賃金以外の諸手当等の額を引き下げ、毎月決まって支払われる賃金の額を引き上げるものではない。",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）"]
[]
[]
[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間に、\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,null,null,null,null,null,null,null,null,null,null,null,null,"（はい・いいえ）"]
[]
[]
[]
[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。"]

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["様式第11号（R46.124.21改正）"]
["労働移動支援早期再就職支援等助成金（早期雇入れ支援コース） 職業訓練支給申請額内訳"]
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["（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,2,"雇用保険\n被保険者番号"]
[]
[3,"雇入れ日",null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
["（２）職業訓練の実施について"]
[1,"訓練計画番号",null,null,null,null,null,null,null,null,null,null,null,null,null,2,"訓練の実施形態\n（該当するもの全てに○をつける）",null,null,null,null,null,"イ　事業主が自ら運営するOff-JT（事業内訓練）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ロ　教育訓練機関等へ委託して行うOff-JT（事業外訓練）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ハ　Off-JTとOJTを組み合わせた訓練"]
[3,"訓練の名称"]
[]
[4,"訓練計画の\n訓練の実施期間",null,null,null,null,null,null,"初  日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,5,"訓練計画の\n実施日数及び総訓練時間数",null,null,null,null,null,"日間",null,"総訓練時間",null,null,null,null,null,null,"時間",null,null,null,null,"分"]
[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,"時間換算【",null,null,null,{"$f":"IF(AK15=\"\",\"\",AK15+ROUND(AP15/60,2))","v":""},null,"時間】",null,"小数第3位四捨五入"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（うちOff-JT）",null,null,null,null,null,null,"時間",null,null,null,null,"分"]
[null,null,null,null,null,null,null,null,"最終日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,null,null,null,null,null,null,null,null,null,null,"時間換算【",null,null,null,{"$f":"IF(AK17=\"\",\"\",AK17+ROUND(AP17/60,2))","v":""},null,"時間】",null,"小数第3位四捨五入"]
[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,"（うちOJT）",null,null,null,null,null,null,"時間",null,null,null,null,"分"]
[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,"時間換算【",null,null,null,{"$f":"IF(AK19=\"\",\"\",AK19+ROUND(AP19/60,2))","v":""},null,"時間】",null,"小数第3位四捨五入"]
[6,"実際の\n訓練の実施期間",null,null,null,null,null,null,"初  日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,7,"受講した\n実施日数及び総訓練時間数",null,null,null,null,null,"日間",null,"総訓練時間",null,null,null,null,null,null,"時間",null,null,null,null,"分"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"時間換算【",null,null,null,{"$f":"IF(AK21=\"\",\"\",AK21+ROUND(AP21/60,2))","v":""},null,"時間】",null,"小数第3位四捨五入"]
[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,"（うちOff-JT）",null,null,null,null,null,null,"時間",null,null,null,null,"分"]
[null,null,null,null,null,null,null,null,"最終日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日",null,null,null,null,null,null,null,null,null,null,null,"時間換算【",null,null,null,{"$f":"IF(AK23=\"\",\"\",AK23+ROUND(AP23/60,2))","v":""},null,"時間】",null,"小数第3位四捨五入"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（うちOJT）",null,null,null,null,null,null,"時間",null,null,null,null,"分"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"時間換算【",null,null,null,{"$f":"IF(AK25=\"\",\"\",AK25+ROUND(AP25/60,2))","v":""},null,"時間】",null,"小数第3位四捨五入"]
[]
[8,"①","賃金助成　※支給金額が支給限度上限を超える時は、実施時間に応じて支給限度上限の金額を支給する。"]
["Off―JT",null,"1人当たりの時間単価",null,null,null,null,null,null,null,null,null,null,null,null,null,"Off―JTの訓練時間数",null,null,null,null,null,null,null,null,null,null,null,"支給申請額"]
[]
[null,null,null,null,null,null,null,null,null,null,"円",null,null,"×",null,null,null,null,null,null,null,null,null,"時間",null,null,"＝",null,null,null,null,null,null,null,null,null,null,"円",null,"…①"]
[null,null,null,"通常助成：900960円、優遇助成：1,0001,060円",null,null,null,null,null,null,null,null,null,null,null,null,null,"※限度時間数600時間",null,null,null,null,null,null,null,null,null,null,"〔円未満切捨て〕"]
[null,null,null,"優遇助成（賃金上昇加算）：1,100円"]
[]
[null,"②","経費助成（事業内訓練（2欄のイに該当する場合）の支給見込額）"]
[null,null,"a","外部講師の謝金",null,null,null,null,null,null,null,null,"実施時間数",null,null,null,null,null,null,null,null,null,"b","施設・設備の借上げ費",null,null,null,null,null,null,null,null,null,null,null,"ｃ","教材費・教科書代"]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,"時間",null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,"※1時間当たり3万円上限"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訓練の総受講者数",null,null,null,null,null,null,null,null,"支給申請額"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（ａ＋ｂ＋ｃ）",null,null,null,null,null,null,"÷",null,null,null,null,null,null,"人",null,"＝",null,null,null,null,null,null,null,null,null,"円",null,"…②"]
[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,"〔円未満切捨て〕"]
[null,"③ ","経費助成（事業外訓練（2欄のロに該当する場合）の支給見込額）"]
[null,null,null,null,null,null,null,null,null,"１人あたりの入学料、受講料及び教科書代等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"支給申請額"]
[null,null,null,null,null,null,null,null,null,null,null,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,null,"円",null,"…③"]
[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,"〔円未満切捨て〕"]
[null,"②及び③の支給申請額の合計と、次の④の額（支給限度額）を比較し、少額であるほうが経費助成の支給申請額になります。"]
[null,"④","経費助成の支給限度額"]
[null,null,null,null,null,"②＋③の額",null,null,null,null,null,null,null,null,null,null,null,null,null,"1人当たりの支給限度額",null,null,null,null,null,null,null,null,null,null,null,null,"支給限度額"]
[null,null,null,null,null,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,null,null,null,null,null,null,null,"円",null,"…④"]
[]
["　OJT","⑤","OJTの実施助成（2欄のハに該当する場合）"]
[null,null,"1人当たりの時間単価",null,null,null,null,null,null,null,null,null,null,null,null,null,"訓練時間数",null,null,null,null,null,null,null,null,null,null,null,"支給申請額"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"円",null,null,"×",null,null,null,null,null,null,null,null,"時間",null,null,"＝",null,null,null,null,null,null,null,null,null,null,"円",null,"…⑤"]
[null,null,null,null,"通常助成：800円、優遇助成：900円",null,null,null,null,null,null,null,null,null,null,null,null,"※限度時間数340時間",null,null,null,null,null,null,null,null,null,null,"〔円未満切捨て〕"]
[null,null,null,null,"優遇助成（賃金上昇加算）：1,000円"]
[]
[]
[9,"支給申請額\n　（合計）",null,null,null,null,null,null,"賃金助成分\n①の額",null,null,null,null,null,null,"経費助成分\n②＋③の額又は④の額",null,null,null,null,null,null,null,null,"OJT実施助成分\n⑤の額",null,null,null,null,null,null,null,null,null,"支給申請額"]
[null,null,null,null,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,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,null,null,null,null,null,null,null,"〔百円未満切捨て〕"]
[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。"]