{"id":3575,"date":"2025-08-19T16:49:22","date_gmt":"2025-08-19T07:49:22","guid":{"rendered":"https:\/\/junpukai.or.jp\/center\/?page_id=3575"},"modified":"2026-02-02T15:31:08","modified_gmt":"2026-02-02T06:31:08","slug":"secondary-form","status":"publish","type":"page","link":"https:\/\/junpukai.or.jp\/center\/follow\/workers\/secondary-form\/","title":{"rendered":"\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a \u7533\u3057\u8fbc\u307f\u30d5\u30a9\u30fc\u30e0"},"content":{"rendered":"<div class=\"inner mb-65\">\r\n  <h2>\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a <br class=\"br-559\">\u7533\u3057\u8fbc\u307f\u30d5\u30a9\u30fc\u30e0<\/h2>\r\n  <div class=\"mb-50\">\r\n    <div class=\"please-note\">\r\n      <p class=\"bold mark-txt no-mb\"><span class=\"look-red\">\u203b\u5f8c\u65e5\u3001\u6df3\u98a8\u4f1a\u306e\u62c5\u5f53\u8005\u3088\u308a\u3054\u9023\u7d61\u3055\u305b\u3066\u3044\u305f\u3060\u304d\u307e\u3059\u3002\u6298\u308a\u8fd4\u3057\u9023\u7d61(\u30e1\u30fc\u30eb\u307e\u305f\u306f\u96fb\u8a71)\u3092\u3082\u3063\u3066\u4e88\u7d04\u78ba\u5b9a\u3068\u306a\u308a\u307e\u3059\u3002<br>\u65e5\u795d\u3092\u9664\u304f3\u65e5\u9593\u7d4c\u904e\u3057\u3066\u3082\u8fd4\u4e8b\u304c\u306a\u3044\u5834\u5408\u306f\u3001\u8ff7\u60d1\u30e1\u30fc\u30eb\u8a2d\u5b9a\u306e\u3054\u78ba\u8a8d\u3092\u304a\u9858\u3044\u3057\u307e\u3059\u3002<\/span><\/p>\r\n    <\/div>\r\n    <div class=\"secondary-check\">\r\n      <div class=\"check-area\">\r\n        <p class=\"look-red bold\">\u4e0b\u8a185\u9805\u76ee\u306e\u5185\u30011\u3064\u3067\u3082\u3010\u3044\u3044\u3048\u3011\u306b\u30c1\u30a7\u30c3\u30af\u304c\u3042\u308b\u5834\u5408\u306f\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a\u306e\u7d66\u4ed8\u5bfe\u8c61\u8005\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u306e\u3067\u3001\u3054\u53d7\u8a3a\u3044\u305f\u3060\u3051\u307e\u305b\u3093\u3002<br>\u3054\u4e0d\u660e\u70b9\u306e\u3042\u308b\u5834\u5408\u306f\u3001<a href=\"tel:0120-226-248\">0120-226-248<\/a>\u307e\u3067\u304a\u554f\u3044\u5408\u308f\u305b\u304f\u3060\u3055\u3044\u3002<\/p>\r\n        <div class=\"check-item\">\r\n          <p>\u2460\u52b4\u707d\u4fdd\u967a\u306b\u52a0\u5165\u3057\u3066\u3044\u308b\uff08\u52a0\u5165\u72b6\u6cc1\u304c\u308f\u304b\u3089\u306a\u3044\u5834\u5408\u306f\u3001\u4f1a\u793e\u306e\u5065\u5eb7\u8a3a\u65ad\u3054\u62c5\u5f53\u8005\u69d8\u3078\u3054\u78ba\u8a8d\u304f\u3060\u3055\u3044\uff09<\/p>\r\n          <div class=\"check-btn\">\r\n            <label class=\"\"><input type=\"radio\" name=\"check01\" value=\"\u306f\u3044\" \/>\u306f\u3044<\/label>\r\n            <label class=\"wpcf7-list-item\"><input type=\"radio\" name=\"check01\" value=\"\u3044\u3044\u3048\" \/>\u3044\u3044\u3048<\/label>\r\n          <\/div>\r\n        <\/div>\r\n        <div class=\"check-item\">\r\n          <p>\u2461\u4eca\u5e74\u5ea6\uff084\/1\uff5e\u7fcc\u5e74 3\/31 \u306e\u9593\uff09\u306b\u3001\u52b4\u707d\u4e8c\u6b21\u5065\u5eb7\u8a3a\u65ad\u3092\u53d7\u8a3a\u3057\u3066\u3044\u306a\u3044<br><span class=\"look-red\">\u203b2026\u5e744\u6708\u4ee5\u964d\u306e\u53d7\u8a3a\u4e88\u7d04\u3092\u3055\u308c\u308b\u65b9\u306f\u300c\u306f\u3044\u300d\u3092\u30c1\u30a7\u30c3\u30af\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n          <div class=\"check-btn\">\r\n            <label><input type=\"radio\" name=\"check02\" value=\"\u306f\u3044\" \/>\u306f\u3044<\/label>\r\n            <label class=\"wpcf7-list-item\"><input type=\"radio\" name=\"check02\" value=\"\u3044\u3044\u3048\" \/>\u3044\u3044\u3048<\/label>\r\n          <\/div>\r\n        <\/div>\r\n        <div class=\"check-item\">\r\n          <p>\u2462\u8133\u8840\u7ba1\u75be\u60a3\uff08\u8133\u6897\u585e\u30fb\u8133\u51fa\u8840\u7b49\uff09\u3001\u5fc3\u75be\u60a3\uff08\u5fc3\u7b4b\u6897\u585e\u30fb\u72ed\u5fc3\u75c7\u7b49\uff09\u3067\u6cbb\u7642\u4e2d\u3067\u306f\u306a\u3044<\/p>\r\n          <div class=\"check-btn\">\r\n            <label><input type=\"radio\" name=\"check03\" value=\"\u306f\u3044\" \/>\u306f\u3044<\/label>\r\n            <label class=\"wpcf7-list-item\"><input type=\"radio\" name=\"check03\" value=\"\u3044\u3044\u3048\" \/>\u3044\u3044\u3048<\/label>\r\n          <\/div>\r\n        <\/div>\r\n        <div class=\"check-item\">\r\n          <p>\u2463\u52b4\u707d\u4fdd\u967a\u306b<span class=\"bold look-red\">\u7279\u5225\u52a0\u5165<\/span>\u3057\u3066\u3044\u306a\u3044 <span class=\"look-red\">\u203b<\/span><\/p>\r\n          <div class=\"check-btn mb_20\">\r\n            <label><input type=\"radio\" name=\"check04\" value=\"\u306f\u3044\" \/>\u306f\u3044<\/label>\r\n            <label class=\"wpcf7-list-item\"><input type=\"radio\" name=\"check04\" value=\"\u3044\u3044\u3048\" \/>\u3044\u3044\u3048<\/label>\r\n          <\/div>\r\n          <p class=\"txt_90\">\u203b\u300c\u52b4\u50cd\u8005\u3067\u306f\u306a\u3044\u304c\u3001\u52b4\u50cd\u8005\u306b\u6e96\u3058\u3066\u4fdd\u8b77\u3059\u308b\u306e\u304c\u9069\u5f53\u3067\u3042\u308b\u3068\u8a8d\u3081\u3089\u308c\u308b\u4e00\u5b9a\u306e\u65b9\u306f\u3001\u7279\u5225\u306b\u4efb\u610f\u52a0\u5165\u3067\u304d\u308b\u300d\u3053\u3068\u306b\u306a\u3063\u3066\u3044\u307e\u3059\u3002\r\n            \u3053\u308c\u304c\u300c\u7279\u5225\u52a0\u5165\u4fdd\u967a\u5236\u5ea6\u300d\u3067\u3059\u3002\r\n            \u30fb\u4ee3\u8868\u53d6\u7de0\u5f79 \u30fb\u6cd5\u4eba\u306e\u5f79\u54e1 \u30fb\u793e\u9577\u3001\u652f\u5e97\u9577\u3001\u6240\u9577\u3001\u5de5\u5834\u9577\u3001\u4e8b\u696d\u6240\u306e\u4ee3\u8868\u8005 \u30fb\u500b\u4eba\u4e8b\u696d\u4e3b\u30fb\u4e00\u4eba\u89aa\u65b9\u7b49<\/p>\r\n          <p class=\"txt_90\">\u52b4\u707d\u4fdd\u967a\u7279\u5225\u52a0\u5165\u304b\u3054\u4e0d\u660e\u306e\u5834\u5408\u306f\u3001\u5404\u4f1a\u793e\u62c5\u5f53\u8005\u306b\u3054\u78ba\u8a8d\u304f\u3060\u3055\u3044\u3002<\/p>\r\n        <\/div>\r\n        <div class=\"check-item\">\r\n          <p>\u2464\u5065\u5eb7\u8a3a\u65ad\u3092\u53d7\u3051\u305f\u65e5<br>\u203b\u304a\u624b\u5143\u306b\u5c4a\u3044\u305f\u5065\u8a3a\u7d50\u679c\u7968\u3092\u3054\u89a7\u3044\u305f\u3060\u304d\u3001\u3054\u5165\u529b\u304f\u3060\u3055\u3044\u3002<\/p>\r\n          <div class=\"flex start img-sample-box\">\r\n            <p class=\"no-mb\"><a href=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/secondary-health-notice.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"link-bnr\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/secondary-health-notice.jpg\" width=\"152\" height=\"212\" alt=\"\u3042\u306a\u305f\u306e\u5065\u5eb7\u30b0\u30e9\u30d5\u306e\u7528\u7d19\"><\/a><\/p>\r\n            <p class=\"no-mb end\"><a href=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/secondary-health-graph.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"link-bnr\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/secondary-health-graph.jpg\" width=\"152\" height=\"212\" alt=\"\u5065\u5eb7\u8a3a\u65ad\u500b\u4eba\u901a\u77e5\u66f8\u306e\u7528\u7d19\"><\/a><\/p>\r\n          <\/div>\r\n          <p class=\"mb-10\">\r\n            <span class=\"date-label\">\u5065\u5eb7\u8a3a\u65ad\u3092\u53d7\u3051\u305f\u65e5<\/span>\r\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-date-1\">\r\n              <input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required preferred-date-picker preferred-date-1\" id=\"preferred-date-1\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u9078\u629e\u3067\u30ab\u30ec\u30f3\u30c0\u30fc\u5165\u529b\" value=\"\" type=\"text\" name=\"preferred-date-1\" \/>\r\n            <\/span>\r\n          <\/p>\r\n\r\n          <p id=\"showDate\"><\/p>\r\n          <div class=\"check-btn-list\" id=\"showCheckList\">\r\n            <label><input type=\"radio\" name=\"check05\" value=\"\u306f\u3044\" \/>\u306f\u3044<\/label>\r\n            <label class=\"wpcf7-list-item\"><input type=\"radio\" name=\"check05\" value=\"\u3044\u3044\u3048\" \/>\u3044\u3044\u3048<\/label>\r\n          <\/div>\r\n        <\/div>\r\n        <div class=\"check-item\">\r\n          <p class=\"look-red bold\">\u4e0a\u8a185\u9805\u76ee\u306e\u3046\u3061\u30011\u3064\u3067\u3082\u300c\u3044\u3044\u3048\u300d\u306b\u30c1\u30a7\u30c3\u30af\u304c\u3042\u308b\u5834\u5408\u306f\u3001\u3054\u53d7\u8a3a\u3044\u305f\u3060\u3051\u307e\u305b\u3093\u3002<\/p>\r\n          <div class=\"check-btn\">\r\n            <label class=\"\"><input type=\"checkbox\" name=\"check06\" value=\"\u78ba\u8a8d\u3057\u307e\u3057\u305f\" \/>\u78ba\u8a8d\u3057\u307e\u3057\u305f<\/label>\r\n          <\/div>\r\n        <\/div>\r\n      <\/div>\r\n    <\/div>\r\n\r\n    <div class=\"flex start link-boxs\">\r\n      <a href=\"https:\/\/reservation.junpukai.com\/252-2\/\" class=\"txt-3box facility-link-box okayama\" target=\"_blank\" rel=\"noopener\">\r\n        <div class=\"facility-img\"><img decoding=\"async\" src=\"\/center\/wp-content\/themes\/child\/image\/contents\/follow\/workers\/facility-okayama.png\" alt=\"\u5065\u5eb7\u7ba1\u7406\u30bb\u30f3\u30bf\u30fc\u5ca1\u5c71\"><\/div>\r\n        <span class=\"facility-link okayama\">\u5065\u5eb7\u7ba1\u7406\u30bb\u30f3\u30bf\u30fc\u5ca1\u5c71\u306e\u3054\u4e88\u7d04<\/span>\r\n      <\/a>\r\n      <a href=\"https:\/\/kurashiki-reservation.junpukai.com\/169-2\/\" class=\"txt-3box facility-link-box kurashiki\" target=\"_blank\">\r\n        <div class=\"facility-img\"><img decoding=\"async\" src=\"\/center\/wp-content\/themes\/child\/image\/contents\/follow\/workers\/facility-kurashiki.png\" alt=\"\u5065\u5eb7\u7ba1\u7406\u30bb\u30f3\u30bf\u30fc\u5009\u6577\"><\/div>\r\n        <span class=\"facility-link kurashiki\">\u5065\u5eb7\u7ba1\u7406\u30bb\u30f3\u30bf\u30fc\u5009\u6577\u306e\u3054\u4e88\u7d04<\/span>\r\n      <\/a>\r\n      <a href=\"\" class=\"txt-3box facility-link-box longlife end\">\r\n        <div class=\"facility-img\"><img decoding=\"async\" src=\"\/center\/wp-content\/themes\/child\/image\/contents\/follow\/workers\/facility-longlife.png\" alt=\"\u6df3\u98a8\u4f1a\u30ed\u30f3\u30b0\u30e9\u30a4\u30d5\u30db\u30b9\u30d4\u30bf\u30eb\"><\/div>\r\n        <span class=\"facility-link longlife\">\u6df3\u98a8\u4f1a\u30ed\u30f3\u30b0\u30e9\u30a4\u30d5\u30db\u30b9\u30d4\u30bf\u30eb\u306e\u3054\u4e88\u7d04<\/span>\r\n        <p class=\"look-red txt-left\">\u7533\u3057\u8a33\u3054\u3056\u3044\u307e\u305b\u3093\u304c\u3001\u305f\u3060\u4eca\u30011\u6708\u4ee5\u964d\u306e\u3054\u4e88\u7d04\u3092\u304a\u53d7\u3051\u3059\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u305b\u3093\u30021\u6708\u4ee5\u964d\u306b\u3054\u53d7\u8a3a\u306e\u65b9\u306f\u3001\u5ca1\u5c71\u30fb\u5009\u6577\u3067\u306e\u3054\u4e88\u7d04\u3092\u304a\u9858\u3044\u81f4\u3057\u307e\u3059\u3002<\/p>\r\n      <\/a>\r\n    <\/div>\r\n  <\/div>\r\n  \n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3577-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"3577\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/center\/wp-json\/wp\/v2\/pages\/3575#wpcf7-f3577-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"3577\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3577-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:3577,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false}}\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"kurashiki-table\">\n<h3>\u5065\u5eb7\u7ba1\u7406\u30bb\u30f3\u30bf\u30fc\u5009\u6577 \u3054\u4e88\u7d04\u30d5\u30a9\u30fc\u30e0<\/h3>\n<table class=\"table-01 mb-30 shudan-tbl shudan02-tbl\">\n  <tbody>\n    <tr>\n      <th class=\"no-need w-180\" scope=\"row\">\u4e8b\u696d\u6240\u540d<\/th>\n      <td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-organization\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-organization\" \/><\/span><\/td>\n    <\/tr>\n    <tr>\n      <th class=\"no-need w-180\" scope=\"row\"><div class=\"txt_id\">\u500b\u4ebaID<\/div><\/th>\n      <td>\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"personal-id\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"personal-id\" \/><\/span>\n        <p class=\"look-red no-mb txt-95 mt-10\">\u203b\u500b\u4ebaID \u306f\u304a\u624b\u5143\u306b\u5c4a\u3044\u305f\u5065\u8a3a\u7d50\u679c\u7968\u3092\u3054\u89a7\u3044\u305f\u3060\u304d\u300110\u6841\u6570\u5b57\u3092\u5165\u529b\u304f\u3060\u3055\u3044\u3002<br>\u8868\u793a\u4f4d\u7f6e\u306b\u3064\u3044\u3066\u306f\u4e0b\u8a18\u306e\u30b5\u30f3\u30d7\u30eb\u3092\u30af\u30ea\u30c3\u30af\u3057\u3066\u3054\u78ba\u8a8d\u304f\u3060\u3055\u3044\u3002<\/p>\n        <div class=\"flex start img-sample-box\">\n          <p class=\"no-mb\"><a href=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/health-notice.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"link-bnr\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/re-examination_id_sample01.jpg\" width=\"152\" height=\"212\" alt=\"\u3042\u306a\u305f\u306e\u5065\u5eb7\u30b0\u30e9\u30d5\u306e\u7528\u7d19\"><\/a><\/p>\n          <p class=\"no-mb end\"><a href=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/health-graph.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"link-bnr\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/re-examination_id_sample02.jpg\" width=\"152\" height=\"212\" alt=\"\u5065\u5eb7\u8a3a\u65ad\u500b\u4eba\u901a\u77e5\u66f8\u306e\u7528\u7d19\"><\/a><\/p>\n        <\/div>\n      <\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need w-180\" scope=\"row\">\u53d7\u8a3a\u8005(\u6c0f\u540d)<\/th>\n      <td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need w-180\" scope=\"row\">\u53d7\u8a3a\u8005(\u30ab\u30ca)<\/th>\n      <td><span class=\"wpcf7-form-control-wrap\" data-name=\"furigana\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"furigana\" \/><\/span><\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need w-180\" scope=\"row\">\u53d7\u8a3a\u8005(\u751f\u5e74\u6708\u65e5)<\/th>\n      <td class=\"birth\"> <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-year\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input-short\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth-year\"><option value=\"1920\">1920<\/option><option value=\"1921\">1921<\/option><option value=\"1922\">1922<\/option><option value=\"1923\">1923<\/option><option value=\"1924\">1924<\/option><option value=\"1925\">1925<\/option><option value=\"1926\">1926<\/option><option value=\"1927\">1927<\/option><option value=\"1928\">1928<\/option><option value=\"1929\">1929<\/option><option value=\"1930\">1930<\/option><option value=\"1931\">1931<\/option><option value=\"1932\">1932<\/option><option value=\"1933\">1933<\/option><option value=\"1934\">1934<\/option><option value=\"1935\">1935<\/option><option value=\"1936\">1936<\/option><option value=\"1937\">1937<\/option><option value=\"1938\">1938<\/option><option value=\"1939\">1939<\/option><option value=\"1940\">1940<\/option><option value=\"1941\">1941<\/option><option value=\"1942\">1942<\/option><option value=\"1943\">1943<\/option><option value=\"1944\">1944<\/option><option value=\"1945\">1945<\/option><option value=\"1946\">1946<\/option><option value=\"1947\">1947<\/option><option value=\"1948\">1948<\/option><option value=\"1949\">1949<\/option><option value=\"1950\">1950<\/option><option value=\"1951\">1951<\/option><option value=\"1952\">1952<\/option><option value=\"1953\">1953<\/option><option value=\"1954\">1954<\/option><option value=\"1955\">1955<\/option><option value=\"1956\">1956<\/option><option value=\"1957\">1957<\/option><option value=\"1958\">1958<\/option><option value=\"1959\">1959<\/option><option value=\"1960\">1960<\/option><option value=\"1961\">1961<\/option><option value=\"1962\">1962<\/option><option value=\"1963\">1963<\/option><option value=\"1964\">1964<\/option><option value=\"1965\">1965<\/option><option value=\"1966\">1966<\/option><option value=\"1967\">1967<\/option><option value=\"1968\">1968<\/option><option value=\"1969\">1969<\/option><option value=\"1970\">1970<\/option><option value=\"1971\">1971<\/option><option value=\"1972\">1972<\/option><option value=\"1973\">1973<\/option><option value=\"1974\">1974<\/option><option value=\"1975\">1975<\/option><option value=\"1976\">1976<\/option><option value=\"1977\">1977<\/option><option value=\"1978\">1978<\/option><option value=\"1979\">1979<\/option><option value=\"1980\" selected=\"selected\">1980<\/option><option value=\"1981\">1981<\/option><option value=\"1982\">1982<\/option><option value=\"1983\">1983<\/option><option value=\"1984\">1984<\/option><option value=\"1985\">1985<\/option><option value=\"1986\">1986<\/option><option value=\"1987\">1987<\/option><option value=\"1988\">1988<\/option><option value=\"1989\">1989<\/option><option value=\"1990\">1990<\/option><option value=\"1991\">1991<\/option><option value=\"1992\">1992<\/option><option value=\"1993\">1993<\/option><option value=\"1994\">1994<\/option><option value=\"1995\">1995<\/option><option value=\"1996\">1996<\/option><option value=\"1997\">1997<\/option><option value=\"1998\">1998<\/option><option value=\"1999\">1999<\/option><option value=\"2000\">2000<\/option><option value=\"2001\">2001<\/option><option value=\"2002\">2002<\/option><option value=\"2003\">2003<\/option><option value=\"2004\">2004<\/option><option value=\"2005\">2005<\/option><option value=\"2006\">2006<\/option><option value=\"2007\">2007<\/option><option value=\"2008\">2008<\/option><option value=\"2009\">2009<\/option><\/select><\/span> \u5e74 <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-month\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input-short\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth-month\"><option value=\"\">&#8212;\u4ee5\u4e0b\u304b\u3089\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><\/select><\/span> \u6708 <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-day\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input-short\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth-day\"><option value=\"\">&#8212;\u4ee5\u4e0b\u304b\u3089\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><option value=\"13\">13<\/option><option value=\"14\">14<\/option><option value=\"15\">15<\/option><option value=\"16\">16<\/option><option value=\"17\">17<\/option><option value=\"18\">18<\/option><option value=\"19\">19<\/option><option value=\"20\">20<\/option><option value=\"21\">21<\/option><option value=\"22\">22<\/option><option value=\"23\">23<\/option><option value=\"24\">24<\/option><option value=\"25\">25<\/option><option value=\"26\">26<\/option><option value=\"27\">27<\/option><option value=\"28\">28<\/option><option value=\"29\">29<\/option><option value=\"30\">30<\/option><option value=\"31\">31<\/option><\/select><\/span> \u65e5<\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need\" scope=\"row\">\u65e5\u4e2d\u306e\u3054\u9023\u7d61\u5148<\/th>\n      <td class=\"tel\"><p class=\"mb-10\"><span class=\"wpcf7-form-control-wrap\" data-name=\"tel1\"><input size=\"40\" maxlength=\"3\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input-short\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel1\" \/><\/span>-<span class=\"wpcf7-form-control-wrap\" data-name=\"tel2\"><input size=\"40\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input-short ml_1_par\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel2\" \/><\/span>-<span class=\"wpcf7-form-control-wrap\" data-name=\"tel3\"><input size=\"40\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input-short ml_1_par\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel3\" \/><\/span><\/p>\n          <p class=\"flex start\">\u3054\u9023\u7d61\u5148\u306e\u7a2e\u5225:<span class=\"wpcf7-form-control-wrap\" data-name=\"career\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"career\" value=\"\u81ea\u5b85\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u5b85<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"career\" value=\"\u4f1a\u793e\" \/><span class=\"wpcf7-list-item-label\">\u4f1a\u793e<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"career\" value=\"\u643a\u5e2f\" \/><span class=\"wpcf7-list-item-label\">\u643a\u5e2f<\/span><\/label><\/span><\/span><\/span><\/p>\n      <\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need\" scope=\"row\">\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<\/th>\n      <td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u30a2\u30c9\u30ec\u30b9\u3092\u304a\u6301\u3061\u306e\u65b9\u306f\u3053\u3061\u3089\u306b\u3054\u5165\u529b\u304f\u3060\u3055\u3044\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><br>\u203b\u3053\u3061\u3089\u306e\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9\u306b\u78ba\u5b9a\u53d7\u8a3a\u65e5\u3092\u3054\u9023\u7d61\u3044\u305f\u3057\u307e\u3059\u3002<br>\u203b\u304a\u7533\u8fbc\u307f\u306e\u691c\u67fb\u5185\u5bb9\u306b\u3064\u3044\u3066\u3001\u304a\u96fb\u8a71\u3055\u305b\u3066\u3044\u305f\u3060\u304f\u3053\u3068\u304c\u3042\u308a\u307e\u3059\u3002<br><br>\u9001\u4fe1\u524d\u306b\u30c9\u30e1\u30a4\u30f3\u6307\u5b9a\u53d7\u4fe1\u7b49\u306e\u8a2d\u5b9a\u3092\u78ba\u8a8d\u3057\u3066\u304f\u3060\u3055\u3044\u3002<br>\u30c9\u30e1\u30a4\u30f3\u6307\u5b9a\u53d7\u4fe1\u3092\u3057\u3066\u3044\u308b\u5834\u5408\u3001 @junpukai.or.jp \u306e\u8ffd\u52a0\u3092\u304a\u9858\u3044\u3057\u307e\u3059\u3002<br>\u8ff7\u60d1\u30e1\u30fc\u30eb\u5bfe\u7b56\u7b49\u3067\u3001\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u30e1\u30fc\u30eb\u306e\u62d2\u5426\u8a2d\u5b9a\u3092\u884c\u3063\u3066\u3044\u308b\u3068\u53d7\u4fe1\u3067\u304d\u307e\u305b\u3093\u3002<br><span class=\"look-red\">\u65e5\u795d\u3092\u9664\u304f3\u65e5\u9593\u7d4c\u904e\u3057\u3066\u3082\u8fd4\u4e8b\u304c\u306a\u3044\u5834\u5408\u306f\u3001\u8ff7\u60d1\u30e1\u30fc\u30eb\u8a2d\u5b9a\u306e\u3054\u78ba\u8a8d\u3092\u304a\u9858\u3044\u3057\u307e\u3059\u3002<\/span>\n      <\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need\" scope=\"row\">\u5e0c\u671b\u65e5<br><span class=\"bold look-red\">\u203b1\u9031\u9593\u4ee5\u5185\u306e\u53d7\u8a3a\u3092\u3054\u5e0c\u671b\u306e\u5834\u5408\u306f\u304a\u96fb\u8a71\u306b\u3066\u3054\u9023\u7d61\u304f\u3060\u3055\u3044\u3002<\/span >\n<\/th>\n<td>\n    <span class=\"works-date-flex\"><span class=\"date-list\">\n    <p class=\"mb-10\"><span class=\"date-label\">\u7b2c1\u5e0c\u671b<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-date-kurashiki1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required want-date01 use-datepicker02\" id=\"preferred-date-kurashiki1\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u9078\u629e\u3067\u30ab\u30ec\u30f3\u30c0\u30fc\u5165\u529b\" value=\"\" type=\"text\" name=\"preferred-date-kurashiki1\" \/><\/span><\/p>\n    <p class=\"mb-10\"><span class=\"date-label\">\u7b2c2\u5e0c\u671b<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-date-kurashiki2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required want-date02 use-datepicker02\" id=\"preferred-date-kurashiki2\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u9078\u629e\u3067\u30ab\u30ec\u30f3\u30c0\u30fc\u5165\u529b\" value=\"\" type=\"text\" name=\"preferred-date-kurashiki2\" \/><\/span><\/p>\n    <p class=\"mb-10\"><span class=\"date-label\">\u7b2c3\u5e0c\u671b<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-date-kurashiki3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required want-date03 use-datepicker02\" id=\"preferred-date-kurashiki3\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u9078\u629e\u3067\u30ab\u30ec\u30f3\u30c0\u30fc\u5165\u529b\" value=\"\" type=\"text\" name=\"preferred-date-kurashiki3\" \/><\/span><\/p>\n    <p class=\"mt-10 no-mb\">\n      <span class=\"look-red\">\u203b\u5065\u5eb7\u8a3a\u65ad\u53d7\u8a3a\u65e5\u304b\u30893\u30f6\u6708\u4ee5\u5185\u306b\u53d7\u8a3a\u3057\u3066\u304f\u3060\u3055\u3044\u3002<br>\u571f\u66dc\u5348\u5f8c\u30fb\u65e5\u66dc\u30fb\u795d\u65e5\u306f\u4f11\u8a3a\u3067\u3059\u3002<br>2025\u5e7412\u670830\u65e5\uff5e2026\u5e741\u67085\u65e5\u306f\u4f11\u8a3a\u3067\u3059\u3002<br>\u65e5\u7a0b\u306e\u78ba\u5b9a\u306f\u30e1\u30fc\u30eb\u3067\u3054\u9023\u7d61\u3044\u305f\u3057\u307e\u3059\u3002<\/span>\n    <\/p>\n<\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need\" scope=\"row\">\u53d7\u8a3a\u9805\u76ee\u306b\u3064\u3044\u3066<\/th>\n      <td class=\"secondary-med\">\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"facility_type\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first last\"><label><input type=\"radio\" name=\"facility_type\" value=\"\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a(\u7121\u6599)+\u8981\u7cbe\u5bc6\u691c\u67fb\u30fb\u518d\u691c\u67fb\u306e\u9805\u76ee(\u6709\u6599)\u3082\u53d7\u8a3a\u5e0c\u671b\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a(\u7121\u6599)+\u8981\u7cbe\u5bc6\u691c\u67fb\u30fb\u518d\u691c\u67fb\u306e\u9805\u76ee(\u6709\u6599)\u3082\u53d7\u8a3a\u5e0c\u671b<\/span><\/label><\/span><\/span><\/span><span class=\"look-red secondary-sub\">\u203b\u4fdd\u967a\u8a3a\u7642\u306b\u3088\u308a\u4e00\u90e8\u672c\u4eba\u8ca0\u62c5\u3068\u306a\u308a\u307e\u3059<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"facility_type\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first last\"><label><input type=\"radio\" name=\"facility_type\" value=\"\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a(\u7121\u6599)\u306e\u307f\u5e0c\u671b\" \/><span class=\"wpcf7-list-item-label\">\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a(\u7121\u6599)\u306e\u307f\u5e0c\u671b<\/span><\/label><\/span><\/span><\/span>\n      <\/td>\n    <\/tr>\n    <tr>\n      <th class=\"no-need\" scope=\"row\">\u305d\u306e\u4ed6\u8cea\u554f\u4e8b\u9805\u7b49<\/th>\n      <td>\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"other\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other\"><\/textarea><\/span><br>\n      <\/td>\n    <\/tr>\n  <\/tbody>\n<\/table>\n<div class=\"please-note\">\n  <p class=\"bold mark-txt no-mb\"><span class=\"look-red\">\u203b\u5f8c\u65e5\u3001\u6df3\u98a8\u4f1a\u306e\u62c5\u5f53\u8005\u3088\u308a\u3054\u9023\u7d61\u3055\u305b\u3066\u3044\u305f\u3060\u304d\u307e\u3059\u3002\u6298\u308a\u8fd4\u3057\u9023\u7d61(\u30e1\u30fc\u30eb\u307e\u305f\u306f\u96fb\u8a71)\u3092\u3082\u3063\u3066\u4e88\u7d04\u78ba\u5b9a\u3068\u306a\u308a\u307e\u3059\u3002<br>\u65e5\u795d\u3092\u9664\u304f3\u65e5\u9593\u7d4c\u904e\u3057\u3066\u3082\u8fd4\u4e8b\u304c\u306a\u3044\u5834\u5408\u306f\u3001\u8ff7\u60d1\u30e1\u30fc\u30eb\u8a2d\u5b9a\u306e\u3054\u78ba\u8a8d\u3092\u304a\u9858\u3044\u3057\u307e\u3059\u3002<\/span><\/p>\n<\/div>\n<p class=\"shudan-btn\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner btn_send_02\" type=\"submit\" value=\"\u30d7\u30e9\u30a4\u30d0\u30b7\u2015\u30dd\u30ea\u30b7\u30fc\u306b\u540c\u610f\u3057\u3066\u9001\u4fe1\" \/><\/p>\n<p class=\"privacy-link txt-center\"><a href=\"https:\/\/junpukai.or.jp\/center\/privacy\/\">\u30d7\u30e9\u30a4\u30d0\u30b7\u30fc\u30dd\u30ea\u30b7\u30fc\u306f\u3053\u3061\u3089<\/a><\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\r\n  \n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3581-o2\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"3581\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/center\/wp-json\/wp\/v2\/pages\/3575#wpcf7-f3581-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"3581\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3581-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:3581,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false}}\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"longlife-table\">\n<h3>\u6df3\u98a8\u4f1a\u30ed\u30f3\u30b0\u30e9\u30a4\u30d5\u30db\u30b9\u30d4\u30bf\u30eb \u3054\u4e88\u7d04\u30d5\u30a9\u30fc\u30e0<\/h3>\n<table class=\"table-01 mb-30 shudan-tbl shudan02-tbl\">\n  <tbody>\n    <tr>\n      <th class=\"no-need w-180\" scope=\"row\">\u4e8b\u696d\u6240\u540d<\/th>\n      <td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-organization\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-organization\" \/><\/span><\/td>\n    <\/tr>\n    <tr>\n      <th class=\"no-need w-180\" scope=\"row\"><div class=\"txt_id\">\u500b\u4ebaID<\/div><\/th>\n      <td>\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"personal-id\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"personal-id\" \/><\/span>\n        <p class=\"look-red no-mb txt-95 mt-10\">\u203b\u500b\u4ebaID \u306f\u304a\u624b\u5143\u306b\u5c4a\u3044\u305f\u5065\u8a3a\u7d50\u679c\u7968\u3092\u3054\u89a7\u3044\u305f\u3060\u304d\u300110\u6841\u6570\u5b57\u3092\u5165\u529b\u304f\u3060\u3055\u3044\u3002<br>\u8868\u793a\u4f4d\u7f6e\u306b\u3064\u3044\u3066\u306f\u4e0b\u8a18\u306e\u30b5\u30f3\u30d7\u30eb\u3092\u30af\u30ea\u30c3\u30af\u3057\u3066\u3054\u78ba\u8a8d\u304f\u3060\u3055\u3044\u3002<\/p>\n        <div class=\"flex start img-sample-box\">\n          <p class=\"no-mb\"><a href=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/health-notice.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"link-bnr\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/re-examination_id_sample01.jpg\" width=\"152\" height=\"212\" alt=\"\u3042\u306a\u305f\u306e\u5065\u5eb7\u30b0\u30e9\u30d5\u306e\u7528\u7d19\"><\/a><\/p>\n          <p class=\"no-mb end\"><a href=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/health-graph.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"link-bnr\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/junpukai.or.jp\/center\/wp-content\/themes\/child\/image\/contents\/follow\/info\/re-examination\/re-examination_id_sample02.jpg\" width=\"152\" height=\"212\" alt=\"\u5065\u5eb7\u8a3a\u65ad\u500b\u4eba\u901a\u77e5\u66f8\u306e\u7528\u7d19\"><\/a><\/p>\n        <\/div>\n      <\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need w-180\" scope=\"row\">\u53d7\u8a3a\u8005(\u6c0f\u540d)<\/th>\n      <td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need w-180\" scope=\"row\">\u53d7\u8a3a\u8005(\u30ab\u30ca)<\/th>\n      <td><span class=\"wpcf7-form-control-wrap\" data-name=\"furigana\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"furigana\" \/><\/span><\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need w-180\" scope=\"row\">\u53d7\u8a3a\u8005(\u751f\u5e74\u6708\u65e5)<\/th>\n      <td class=\"birth\"> <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-year\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input-short\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth-year\"><option value=\"1920\">1920<\/option><option value=\"1921\">1921<\/option><option value=\"1922\">1922<\/option><option value=\"1923\">1923<\/option><option value=\"1924\">1924<\/option><option value=\"1925\">1925<\/option><option value=\"1926\">1926<\/option><option value=\"1927\">1927<\/option><option value=\"1928\">1928<\/option><option value=\"1929\">1929<\/option><option value=\"1930\">1930<\/option><option value=\"1931\">1931<\/option><option value=\"1932\">1932<\/option><option value=\"1933\">1933<\/option><option value=\"1934\">1934<\/option><option value=\"1935\">1935<\/option><option value=\"1936\">1936<\/option><option value=\"1937\">1937<\/option><option value=\"1938\">1938<\/option><option value=\"1939\">1939<\/option><option value=\"1940\">1940<\/option><option value=\"1941\">1941<\/option><option value=\"1942\">1942<\/option><option value=\"1943\">1943<\/option><option value=\"1944\">1944<\/option><option value=\"1945\">1945<\/option><option value=\"1946\">1946<\/option><option value=\"1947\">1947<\/option><option value=\"1948\">1948<\/option><option value=\"1949\">1949<\/option><option value=\"1950\">1950<\/option><option value=\"1951\">1951<\/option><option value=\"1952\">1952<\/option><option value=\"1953\">1953<\/option><option value=\"1954\">1954<\/option><option value=\"1955\">1955<\/option><option value=\"1956\">1956<\/option><option value=\"1957\">1957<\/option><option value=\"1958\">1958<\/option><option value=\"1959\">1959<\/option><option value=\"1960\">1960<\/option><option value=\"1961\">1961<\/option><option value=\"1962\">1962<\/option><option value=\"1963\">1963<\/option><option value=\"1964\">1964<\/option><option value=\"1965\">1965<\/option><option value=\"1966\">1966<\/option><option value=\"1967\">1967<\/option><option value=\"1968\">1968<\/option><option value=\"1969\">1969<\/option><option value=\"1970\">1970<\/option><option value=\"1971\">1971<\/option><option value=\"1972\">1972<\/option><option value=\"1973\">1973<\/option><option value=\"1974\">1974<\/option><option value=\"1975\">1975<\/option><option value=\"1976\">1976<\/option><option value=\"1977\">1977<\/option><option value=\"1978\">1978<\/option><option value=\"1979\">1979<\/option><option value=\"1980\" selected=\"selected\">1980<\/option><option value=\"1981\">1981<\/option><option value=\"1982\">1982<\/option><option value=\"1983\">1983<\/option><option value=\"1984\">1984<\/option><option value=\"1985\">1985<\/option><option value=\"1986\">1986<\/option><option value=\"1987\">1987<\/option><option value=\"1988\">1988<\/option><option value=\"1989\">1989<\/option><option value=\"1990\">1990<\/option><option value=\"1991\">1991<\/option><option value=\"1992\">1992<\/option><option value=\"1993\">1993<\/option><option value=\"1994\">1994<\/option><option value=\"1995\">1995<\/option><option value=\"1996\">1996<\/option><option value=\"1997\">1997<\/option><option value=\"1998\">1998<\/option><option value=\"1999\">1999<\/option><option value=\"2000\">2000<\/option><option value=\"2001\">2001<\/option><option value=\"2002\">2002<\/option><option value=\"2003\">2003<\/option><option value=\"2004\">2004<\/option><option value=\"2005\">2005<\/option><option value=\"2006\">2006<\/option><option value=\"2007\">2007<\/option><option value=\"2008\">2008<\/option><option value=\"2009\">2009<\/option><\/select><\/span> \u5e74 <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-month\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input-short\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth-month\"><option value=\"\">&#8212;\u4ee5\u4e0b\u304b\u3089\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><\/select><\/span> \u6708 <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-day\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input-short\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth-day\"><option value=\"\">&#8212;\u4ee5\u4e0b\u304b\u3089\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><option value=\"13\">13<\/option><option value=\"14\">14<\/option><option value=\"15\">15<\/option><option value=\"16\">16<\/option><option value=\"17\">17<\/option><option value=\"18\">18<\/option><option value=\"19\">19<\/option><option value=\"20\">20<\/option><option value=\"21\">21<\/option><option value=\"22\">22<\/option><option value=\"23\">23<\/option><option value=\"24\">24<\/option><option value=\"25\">25<\/option><option value=\"26\">26<\/option><option value=\"27\">27<\/option><option value=\"28\">28<\/option><option value=\"29\">29<\/option><option value=\"30\">30<\/option><option value=\"31\">31<\/option><\/select><\/span> \u65e5<\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need\" scope=\"row\">\u65e5\u4e2d\u306e\u3054\u9023\u7d61\u5148<\/th>\n      <td class=\"tel\"><p class=\"mb-10\"><span class=\"wpcf7-form-control-wrap\" data-name=\"tel1\"><input size=\"40\" maxlength=\"3\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input-short\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel1\" \/><\/span>-<span class=\"wpcf7-form-control-wrap\" data-name=\"tel2\"><input size=\"40\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input-short ml_1_par\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel2\" \/><\/span>-<span class=\"wpcf7-form-control-wrap\" data-name=\"tel3\"><input size=\"40\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input-short ml_1_par\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel3\" \/><\/span><\/p>\n          <p class=\"flex start\">\u3054\u9023\u7d61\u5148\u306e\u7a2e\u5225:<span class=\"wpcf7-form-control-wrap\" data-name=\"career\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"career\" value=\"\u81ea\u5b85\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u5b85<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"career\" value=\"\u4f1a\u793e\" \/><span class=\"wpcf7-list-item-label\">\u4f1a\u793e<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"career\" value=\"\u643a\u5e2f\" \/><span class=\"wpcf7-list-item-label\">\u643a\u5e2f<\/span><\/label><\/span><\/span><\/span><\/p>\n      <\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need\" scope=\"row\">\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<\/th>\n      <td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u30a2\u30c9\u30ec\u30b9\u3092\u304a\u6301\u3061\u306e\u65b9\u306f\u3053\u3061\u3089\u306b\u3054\u5165\u529b\u304f\u3060\u3055\u3044\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><br>\u203b\u3053\u3061\u3089\u306e\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9\u306b\u78ba\u5b9a\u53d7\u8a3a\u65e5\u3092\u3054\u9023\u7d61\u3044\u305f\u3057\u307e\u3059\u3002<br>\u203b\u304a\u7533\u8fbc\u307f\u306e\u691c\u67fb\u5185\u5bb9\u306b\u3064\u3044\u3066\u3001\u304a\u96fb\u8a71\u3055\u305b\u3066\u3044\u305f\u3060\u304f\u3053\u3068\u304c\u3042\u308a\u307e\u3059\u3002<br><br>\u9001\u4fe1\u524d\u306b\u30c9\u30e1\u30a4\u30f3\u6307\u5b9a\u53d7\u4fe1\u7b49\u306e\u8a2d\u5b9a\u3092\u78ba\u8a8d\u3057\u3066\u304f\u3060\u3055\u3044\u3002<br>\u30c9\u30e1\u30a4\u30f3\u6307\u5b9a\u53d7\u4fe1\u3092\u3057\u3066\u3044\u308b\u5834\u5408\u3001 @junpukai.or.jp \u306e\u8ffd\u52a0\u3092\u304a\u9858\u3044\u3057\u307e\u3059\u3002<br>\u8ff7\u60d1\u30e1\u30fc\u30eb\u5bfe\u7b56\u7b49\u3067\u3001\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u30e1\u30fc\u30eb\u306e\u62d2\u5426\u8a2d\u5b9a\u3092\u884c\u3063\u3066\u3044\u308b\u3068\u53d7\u4fe1\u3067\u304d\u307e\u305b\u3093\u3002<br><span class=\"look-red\">\u65e5\u795d\u3092\u9664\u304f3\u65e5\u9593\u7d4c\u904e\u3057\u3066\u3082\u8fd4\u4e8b\u304c\u306a\u3044\u5834\u5408\u306f\u3001\u8ff7\u60d1\u30e1\u30fc\u30eb\u8a2d\u5b9a\u306e\u3054\u78ba\u8a8d\u3092\u304a\u9858\u3044\u3057\u307e\u3059\u3002<\/span>\n      <\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need\" scope=\"row\">\u5e0c\u671b\u65e5<br><span class=\"bold look-red\">\u203b1\u9031\u9593\u4ee5\u5185\u306e\u53d7\u8a3a\u3092\u3054\u5e0c\u671b\u306e\u5834\u5408\u306f\u304a\u96fb\u8a71\u306b\u3066\u3054\u9023\u7d61\u304f\u3060\u3055\u3044\u3002<\/span >\n<\/th>\n<td>\n    <span class=\"works-date-flex\"><span class=\"date-list\">\n    <p class=\"mb-10\"><span class=\"date-label\">\u7b2c1\u5e0c\u671b<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-date-long1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required want-date01 use-datepicker03\" id=\"preferred-date-long1\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u9078\u629e\u3067\u30ab\u30ec\u30f3\u30c0\u30fc\u5165\u529b\" value=\"\" type=\"text\" name=\"preferred-date-long1\" \/><\/span><\/p>\n    <p class=\"mb-10\"><span class=\"date-label\">\u7b2c2\u5e0c\u671b<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-date-long2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required want-date02 use-datepicker03\" id=\"preferred-date-long2\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u9078\u629e\u3067\u30ab\u30ec\u30f3\u30c0\u30fc\u5165\u529b\" value=\"\" type=\"text\" name=\"preferred-date-long2\" \/><\/span><\/p>\n    <p class=\"mb-10\"><span class=\"date-label\">\u7b2c3\u5e0c\u671b<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-date-long3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required want-date03 use-datepicker03\" id=\"preferred-date-long3\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u9078\u629e\u3067\u30ab\u30ec\u30f3\u30c0\u30fc\u5165\u529b\" value=\"\" type=\"text\" name=\"preferred-date-long3\" \/><\/span><\/p>\n    <p class=\"mt-10 no-mb\">\n      <span class=\"look-red\">\u203b\u5065\u5eb7\u8a3a\u65ad\u53d7\u8a3a\u65e5\u304b\u30893\u30f6\u6708\u4ee5\u5185\u306b\u53d7\u8a3a\u3057\u3066\u304f\u3060\u3055\u3044\u3002<br>\u571f\u66dc\u5348\u5f8c\u30fb\u65e5\u66dc\u30fb\u795d\u65e5\u306f\u4f11\u8a3a\u3067\u3059\u3002<br>\u65e5\u7a0b\u306e\u78ba\u5b9a\u306f\u30e1\u30fc\u30eb\u3067\u3054\u9023\u7d61\u3044\u305f\u3057\u307e\u3059\u3002<br>\u7533\u3057\u8a33\u3054\u3056\u3044\u307e\u305b\u3093\u304c\u3001\u305f\u3060\u4eca\u3001\u3054\u4e88\u7d04\u3092\u304a\u53d7\u3051\u3059\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u305b\u3093\u3002\u3054\u5e0c\u671b\u306e\u65b9\u306f\u3001\u5ca1\u5c71\u30fb\u5009\u6577\u3067\u306e\u3054\u4e88\u7d04\u3092\u304a\u9858\u3044\u81f4\u3057\u307e\u3059\u3002<\/span>\n    <\/p>\n<\/td>\n    <\/tr>\n    <tr>\n      <th class=\"need\" scope=\"row\">\u53d7\u8a3a\u9805\u76ee\u306b\u3064\u3044\u3066<\/th>\n      <td class=\"secondary-med\">\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"facility_type\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first last\"><label><input type=\"radio\" name=\"facility_type\" value=\"\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a(\u7121\u6599)+\u8981\u7cbe\u5bc6\u691c\u67fb\u30fb\u518d\u691c\u67fb\u306e\u9805\u76ee(\u6709\u6599)\u3082\u53d7\u8a3a\u5e0c\u671b\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a(\u7121\u6599)+\u8981\u7cbe\u5bc6\u691c\u67fb\u30fb\u518d\u691c\u67fb\u306e\u9805\u76ee(\u6709\u6599)\u3082\u53d7\u8a3a\u5e0c\u671b<\/span><\/label><\/span><\/span><\/span><span class=\"look-red secondary-sub\">\u203b\u4fdd\u967a\u8a3a\u7642\u306b\u3088\u308a\u4e00\u90e8\u672c\u4eba\u8ca0\u62c5\u3068\u306a\u308a\u307e\u3059<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"facility_type\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first last\"><label><input type=\"radio\" name=\"facility_type\" value=\"\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a(\u7121\u6599)\u306e\u307f\u5e0c\u671b\" \/><span class=\"wpcf7-list-item-label\">\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a(\u7121\u6599)\u306e\u307f\u5e0c\u671b<\/span><\/label><\/span><\/span><\/span>\n      <\/td>\n    <\/tr>\n    <tr>\n      <th class=\"no-need\" scope=\"row\">\u305d\u306e\u4ed6\u8cea\u554f\u4e8b\u9805\u7b49<\/th>\n      <td>\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"other\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other\"><\/textarea><\/span><br>\n      <\/td>\n    <\/tr>\n  <\/tbody>\n<\/table>\n<div class=\"please-note\">\n  <p class=\"bold mark-txt no-mb\"><span class=\"look-red\">\u203b\u5f8c\u65e5\u3001\u6df3\u98a8\u4f1a\u306e\u62c5\u5f53\u8005\u3088\u308a\u3054\u9023\u7d61\u3055\u305b\u3066\u3044\u305f\u3060\u304d\u307e\u3059\u3002\u6298\u308a\u8fd4\u3057\u9023\u7d61(\u30e1\u30fc\u30eb\u307e\u305f\u306f\u96fb\u8a71)\u3092\u3082\u3063\u3066\u4e88\u7d04\u78ba\u5b9a\u3068\u306a\u308a\u307e\u3059\u3002<br>\u65e5\u795d\u3092\u9664\u304f3\u65e5\u9593\u7d4c\u904e\u3057\u3066\u3082\u8fd4\u4e8b\u304c\u306a\u3044\u5834\u5408\u306f\u3001\u8ff7\u60d1\u30e1\u30fc\u30eb\u8a2d\u5b9a\u306e\u3054\u78ba\u8a8d\u3092\u304a\u9858\u3044\u3057\u307e\u3059\u3002<\/span><\/p>\n<\/div>\n<p class=\"shudan-btn\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner btn_send_02\" type=\"submit\" value=\"\u30d7\u30e9\u30a4\u30d0\u30b7\u2015\u30dd\u30ea\u30b7\u30fc\u306b\u540c\u610f\u3057\u3066\u9001\u4fe1\" \/><\/p>\n<p class=\"privacy-link txt-center\"><a href=\"https:\/\/junpukai.or.jp\/center\/privacy\/\">\u30d7\u30e9\u30a4\u30d0\u30b7\u30fc\u30dd\u30ea\u30b7\u30fc\u306f\u3053\u3061\u3089<\/a><\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\r\n<\/div>","protected":false},"excerpt":{"rendered":"\u52b4\u707d\u4e8c\u6b21\u5065\u8a3a \u7533\u3057\u8fbc\u307f\u30d5\u30a9\u30fc\u30e0 \u203b\u5f8c\u65e5\u3001\u6df3\u98a8\u4f1a\u306e\u62c5\u5f53\u8005\u3088\u308a\u3054\u9023\u7d61\u3055\u305b\u3066\u3044\u305f\u3060\u304d\u307e\u3059\u3002\u6298\u308a\u8fd4\u3057\u9023\u7d61(\u30e1\u30fc\u30eb\u307e\u305f\u306f\u96fb\u8a71)\u3092\u3082\u3063\u3066\u4e88\u7d04\u78ba\u5b9a\u3068\u306a\u308a\u307e\u3059\u3002\u65e5\u795d\u3092\u9664\u304f3\u65e5\u9593\u7d4c\u904e\u3057\u3066\u3082\u8fd4\u4e8b\u304c\u306a\u3044\u5834\u5408\u306f\u3001\u8ff7\u60d1\u30e1\u30fc\u30eb\u8a2d\u5b9a\u306e\u3054\u78ba\u8a8d\u3092\u304a\u9858\u3044\u3057 [&hellip;]","protected":false},"author":1,"featured_media":0,"parent":41,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3575","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/pages\/3575","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/comments?post=3575"}],"version-history":[{"count":27,"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/pages\/3575\/revisions"}],"predecessor-version":[{"id":3966,"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/pages\/3575\/revisions\/3966"}],"up":[{"embeddable":true,"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/pages\/41"}],"wp:attachment":[{"href":"https:\/\/junpukai.or.jp\/center\/wp-json\/wp\/v2\/media?parent=3575"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}