Contact and Consultation Reservation Form

How would you like to be contacted?Required
Consultation on the phone E-mail Consultation at the office Consultation on Zoom * For online participation via Zoom, we will coordinate the schedule after your application and provide the Zoom ID and password. ● Consultation on the phone ○ Mail ○ Consultation at the office ○ Consultation on Zoom
Preferred consultation date *Please select up to the third preference.
* For those who prefer to consult by phone, in-person, or online (Zoom), please fill out the necessary fields. First preference: First preference date you provided is incorrect. First preference date you provided is not open hours. First preference time you provided is incorrect. Second preference: Second preference date you provided is incorrect. Second preference date you provided is not open hours. Second preference time you provided is incorrect. Third preference: Third preference date you provided is incorrect. Third preference date you provided is not open hours. FThird preference time you provided is incorrect. First preference: Second preference: Third preference:
NameRequired
* If you prefer to remain anonymous in your consultation, please write 'Anonymous'. First name： Last name： This field is required. *Please complete the following fields: First Name, Last Name.
E-mail AddressRequired
The email address you provided is incorrect.
Phone Number
* For those who prefer to consult by phone, please fill out the required fields. This field is required.
Company NameRequired
* If you prefer to remain anonymous in your consultation, please write 'Anonymous'. * For those who have retired, please enter the company name where you were employed. This field is required.
The location of the company (or workplace)Required
* For those who have retired, please select the location of the company (or workplace) where you were employed. This field is required.
Is this your first time using our center?
Yes, this is my first time. No, I am a returning user. ● Yes, this is my first time. ○ No, I am a returning user.
Details of Inquiry / ConsultationRequired
Please note that depending on the content, the office may contact you to confirm further details. Also, inquiries are limited to employment and labor-related consultations. (Up to 1024 full-width characters) This field is required.
How did you hear about HiLECC?Required
This field is required.
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