First name Last name Sex male female Nationality Date of Birth VISA status proper visa essential Expiry date How long have you been in Japan? Adress in Japan Closest train line Closest station Distance from station on foot Lesson place at home at cafe Phone number Fax number Mobile number e-mail adress e-mail adress (imput again for confirmation) Native language you can teach Japanese level none beginner intermediater advanced expert University／Degree Teaching license Teaching experience English teaching qualification TEFL TESL ESL CELTA other Name of your current working place Your position in the working place Family member Do you have any pet? yes no If yes,what kind and how many? Size of your room Hobby Your speciality Your teaching style Name of a text you are using Other lesson you can teach Ex. cooking/singing/dancing/flower arrangement Type(s) of student you would accept? (you can choose more than one type) female male children Any more comment to your potential student and us

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