(All data you submit remains confidential. Check our Confidentiality Policy.)

     Surname:►    Given names:►
 Nationality:►     Visa:   –type:► length (years):►

              E-mail:►                                                  Phone:►
Alternate e-mail:                         Alternate phone:
      Postal code:►                               Prefecture (if applicable):► 
                  City:►                              Ward (if applicable):►
 Further address details:►

Main University:►   Campus:►
                  Since:►          Full-/Part-time [F/P]:►                                  Tenured? [Y/N]►
  Contract length:► year(s)                                                                                    Written contract? [Y/N]►

Other universities (if applicable):
University:►   Campus:►   Since:►
University:►   Campus:►   Since:►
University:►   Campus:►   Since:►
University:►   Campus:►   Since:►
University:►   Campus:►   Since:►

Please list any other union(s) of which you are currently a member:►

If you have any previous union experience, please describe it:

Please list any professional organizations (JALT, TESOL, JACET, etc) to which you currently belong:

Please list any human rights or NGO group you belong to that might prove helpful to UTU:

Japanese - Spoken: Good Fair Poor                 Japanese - Written: Good Fair Poor

If you have any special skills or abilities that might prove useful to the union, please describe them:

UTU needs your support. Can you devote some time to union activities during the year?
      Definitely       Probably       Hopefully       Unlikely

Your Reasons for Joining UTU - Please select all that apply:►
     I am currently involved in a labour dispute.
     Deteriorating conditions make the possibility of dispute seem imminent.
     Working conditions on campus need to be improved.
     I believe in labour solidarity and would like to help.
     Other (Please explain below):

   ► I have read and accept the UTU Privacy and Confidentiality Policy (link at top of page).
This box must be checked in order to complete your application.