Application Form.pdf

Application for Aptitude Diagnosis
Chiba Prefecture Truck Association
President
Note: Please make a reservation by phone before sending the application by FAX.
We do not accept applications by FAX only.
Date:
Month, Day
Month, Day
Month, Day
(Weekday)
(Weekday)
(Weekday)
1, 2, 3
1, 2, 3
Less than 5 years, 5-10 years,
Less than 5 years, 5-10 years,
Less than 5 years, 5-10 years,
of experience after obtaining a regular license
10-20 years, 20-30 years, over 30 years
10-20 years, 20-30 years, over 30 years
10-20 years, 20-30 years, over 30 years
Start time: Please mark one of the following: 1) 9:30 AM, 2) 1:00 PM, 3) 3:00 PM.
Diagnosis type, sex, industry, license type, and years after obtaining a regular license: Please mark the applicable items.
Diagnosis fee: 4,800 yen
* Members of the Chiba Prefecture Truck Association will receive a subsidy from the association.
Industry:
Regular, initial, or aptitude diagnosis
Bus, taxi
Truck, private use
Male, female
Start time: 1, 2, 3
Date of birth (age)
Sex
Company name (required)
Branch name
Department name
Postal code (required)
Address (required)
Phone number (required)
FAX number (required)
Second-class, large, medium
2,400 yen
Regular diagnosis
1, 2, 3
FAX: 043-301-3526
Phone: 043-301-3525
Date
Aptitude diagnosis
Medium (8t limited), regular
Second-class, large, medium
Medium (8t limited), regular