Family Member Access Card Application Form

Before filling out this application form, make sure...

both the OIST employee/student and their family member read the Family Member Access Card regulations here
both the OIST employee/student and their family member sign the form
the image/scan of the signed form is uploaded to this application form
the family member take the safety orientation on this link
the image/scan of the completion certificate of the safety training is uploaded in this application form

1 スタート 2 完了

Your employee ID number *

Your first (and middle) name(s) *

Your last name(s) *

Your email address *

Family member's first (and middle) name(s) *

Family member's last name(s) *

Family member's email address *

Have you read the Family Access Card regulations and pledge to comply with them? *

Yes

If fail to comply with the regulations, you must surrender the Family Access Card when requested

Your telephone number

Until when do you anticipate needing an access? *

Year

月

日

Reasons for requesting an access card *

Please attach signed declaration form *

Files must be less than 100 MB.
Allowed file types: jpg jpeg png pdf.

Please attach the Safety Orientation completion certificate *

Files must be less than 60 MB.
Allowed file types: gif jpg jpeg png pdf.

What code is in the image? *

Enter the characters shown in the image.

Leave this field blank