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["就労状況申告書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"令和",null,"年",null,"月",null,"日"]
[]
["文京区長　文京区教育委員会　宛"]
[]
[]
["私の１週間の就労状況は下記の通りです。"]
["住　　所　"]
["保護者氏名\n（申告者）",null,null,null,null,null,null,null,null,null,"生年月日",null,null,"年",null,"月",null,"日"]
[]
["〈１週間の就労状況〉"]
["・複数勤務の方や就労時間の定めが無い方（役職がある方・自営業者等）は平均的な1週間の状況をご自身でご記入ください。"]
["・勤務時間は記入しやすい時間で書き直していただいても結構です。"]
[null,"例",null,"月曜日",null,"火曜日",null,"水曜日",null,"木曜日",null,"金曜日",null,"土曜日",null,"日曜日"]
[]
["06:00:00"]
[null,null,null,null,null,null,null,null,"　"]
[]
["08:00:00","○○出社"]
[]
[]
["10:00:00","勤務"]
[]
[]
["12:00:00"]
[null,"休憩時間"]
[]
["14:00:00","勤務"]
[]
[null,"移動"]
["16:00:00","△△出社"]
[]
[]
["18:00:00","勤務"]
[]
[]
[null,"退社"]
[]
[]
["〈注意事項〉"]
["・申告者本人が記入してください。"]
["・本書類は就労証明書の補足資料です。「複数勤務の方」や「就労時間の定めが無い方（役職（取締役等）がある方・自営業者等"]
["　のうち、就労証明書に就労時間の記載が困難な方）」は、就労証明書と併せてご提出ください。"]
["・記載事項に虚偽があった場合、入園（継続）申請および認定は無効となります。また、在園者は退園となる場合があります。"]
["　　　　　 "]
[]
["文京区　幼児保育課　入園相談係　電話 03－5803－1190"]