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[]
[null,"小型車両系建設機械(整地・運搬・積込み用及び掘削用)"]
[null,"の運転の業務に係る特別教育(3t未満)　受講申込書"]
[]
[]
[null,null,"令和",null,"年",null,"月",null,"日"]
[]
[null,"林業・木材製造業労働災害防止協会　香川県支部長　殿"]
[]
[null,null,null,null,null,null,null,null,"受講申込者氏名",null,null,null,null,null,null,null,null,null,"㊞"]
[]
[null,"フリガナ",null,null,null,null,null,null,null,null,"性別",null,"生　年\n\n月　日",null,"昭　和\n\n平　成"]
[null,"氏　　名",null,null,null,null,null,null,null,null,"男"]
[null,"　","旧姓を使用した氏名又は通称の併記の希望の有無　　有/無\n(いずれかを〇で囲む）",null,null,null,null,null,null,null,"女"]
[null,null,"併記を希望する氏名又は通称"]
[null,"現住所",null,null,null,"〒",null,null,"－"]
[]
[]
[null,null,null,null,null,"連絡先電話："]
[null,"所　　属","事業所名"]
[]
[null,null,"所 在 地",null,null,"〒",null,null,"－",null,null,"電話番号"]
[]
[]
[null,"受付番号",null,"　※",null,null,"受付年月日",null,null,"　※",null,null,"修了証番号",null,null,null,"　※"]
[null,"受講票送付年月日",null,null,null,null,"　※",null,null,null,null,null,"修了証交付年月日",null,null,null,"　※"]
[]
[null,"当支部発行の下記講習の修了証を所有している場合、交付年月日と修了証番号を記載してください。"]
[null,"講　　　習　　　名",null,null,null,null,null,null,null,null,"修了年月日",null,null,null,"修了証番号"]
[null,"刈払機取扱作業者に対する安全衛生教育"]
[null,"伐木等の業務に係る特別教育"]
[null,"伐木等機械の運転の業務に係る特別教育"]
[null,"走行集材機械の運転の業務に係る特別教育"]
[null,"簡易架線集材装置等の運転の業務に係る特別教育"]
[null,"機械集材装置の運転の業務に係る特別教育"]
[null,"荷役運搬機械等によるはい作業従事者に対する安全教育"]
[null,"林内作業車を使用する集材作業従事者に対する安全教育"]
[null,"※","写真（縦３．０ｃｍ×横２．４ｃｍは２枚必要です。（裏面に氏名を記入してください。）"]
[null,null,"１枚は受講申込書に貼付、もう１枚は修了証用ですので、裏返して（キズ防止の為）クリップ等で止めて提出してください。"]

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