産婦人科・不妊治療（IVF）／大津市　竹林ウィメンズクリニック <link rel="stylesheet" href="./css/body.css" type="text/css"> <SCRIPT TYPE="text/javascript" SRC="./js/default_css.js"></SCRIPT> <META HTTP-EQUIV="Content-Style-Type" CONTENT="text/css"> <META HTTP-EQUIV="Content-Script-Type" CONTENT="text/javascript"> <link href="in-common.css" rel="stylesheet" type="text/css" /> <link href="staff/staff2.css" rel="stylesheet" type="text/css" /> </head> <body> <div id="wrapper">  <div id="head"> <h1><img src="common_img/in-head_01.jpg" width="501" height="81" /><a href="index.html"><img src="common_img/in-head_02.jpg" alt="産婦人科・不妊治療（IVF）／大津市　竹林ウィメンズクリニック " border="0" /></a></h1>  <div id="menu"> <ul> <li><a href="greet/greet.html" class="off">ごあいさつ</a></li> <li><a href="treat/treat.html" class="off">診療案内</a></li> <li><a href="faci/faci.html" class="off">施設案内</a></li> <li><a href="hospi/hospi.html" class="off">入院案内</a></li> <li><a href="reserve/reserve.html" class="off">診療予約</a></li> <li><a href="time/time.html" 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width="433" align="left" style="padding:5px 0px;"><input style="width:50%" maxlength="200" name="name" type="text" /> <span class="gray">（例）竹林浩一</span> </td> </tr> <tr> <td colspan="2" align="left" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr class="t1h16"> <td align="left" style="padding:8px 15px;"><strong><span class="cream">フリガナ</span> <span class="red">*</span></strong></td> <td align="left" style="padding:5px 0px;"><input style="width:50%" maxlength="200" name="name_kana" type="text" /> <span class="gray">（例）タケバヤシコウイチ</span> </td> </tr> <tr> <td colspan="2" align="left" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr class="t1h16"> <td align="left" style="padding:8px 15px;"><strong><span class="cream">ご住所</span> <span class="red">*</span></strong></td> <td align="left" style="padding:5px 0px;"><input style="width:50%" maxlength="200" name="address" type="text" /> <span class="gray">（例）滋賀県大津市大萱1-1-1</span> </td> </tr> <tr> <td colspan="2" align="left" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr class="t1h16"> <td align="left" style="padding:8px 15px;"><strong><span class="cream">年齢</span> <span class="red">*</span></strong></td> <td align="left" style="padding:5px 0px;"><input size="3" maxlength="3" style="ime-mode:disabled;" name="age" type="text" /> <span class="gray">歳</span> </td> </tr> <tr> <td colspan="2" align="left" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr class="t1h16"> <td align="left" style="padding:8px 15px;"><strong><span class="cream">電話番号</span> <span class="red">*</span></strong></td> <td align="left" style="padding:5px 0px;"><input size="6" maxlength="6" name="telephone[0]" type="text" />-<input size="6" maxlength="4" name="telephone[1]" type="text" />-<input size="6" maxlength="4" name="telephone[2]" type="text" /> <span class="gray">（例）077-547-3557</span> </td> </tr> <tr> <td colspan="2" align="left" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr class="t1h16"> <td align="left" style="padding:8px 15px;"><strong><span class="cream">メールアドレス</span> <span class="red">*</span></strong></td> <td align="left" style="padding:5px 0px;"><input style="ime-mode:disabled;" maxlength="200" name="mailaddress" type="text" /> <span class="gray">（例）info@takebayashi-clinic.com</span> </td> </tr> <tr> <td colspan="2" align="left" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr class="t1h16"> <td align="left" style="padding:8px 15px;"><strong><span class="cream">希望職種</span> <span class="red">*</span></strong></td> <td align="left" style="padding:5px 0px;"><table border="0" cellspacing="0" cellpadding="0"> <tr class="t1"> <td style="padding-right: 20px;"><span class="gray"><input name="job[1]" type="checkbox" value="1" id="qf_63e9db" /><label for="qf_63e9db">助産師</label></span></td> <td style="padding-right: 20px;"><span class="gray"><input name="job[2]" type="checkbox" value="1" id="qf_eadbfc" /><label for="qf_eadbfc">看護師</label></span></td> <td style="padding-right: 20px;"><span class="gray"><input name="job[3]" type="checkbox" value="1" id="qf_ad7e95" /><label for="qf_ad7e95">准看護師</label></span></td> </tr> <tr class="t1"> <td style="padding-right: 20px;"><span class="gray"><input name="job[4]" type="checkbox" value="1" id="qf_2bb5e0" /><label for="qf_2bb5e0">看護助手</label></span></td> <td style="padding-right: 20px;"><span class="gray"><input name="job[5]" type="checkbox" value="1" id="qf_fb351d" /><label for="qf_fb351d">胚培養士</label></span></td> <td style="padding-right: 20px;"><span class="gray"><input name="job[6]" type="checkbox" value="1" id="qf_7ab469" /><label for="qf_7ab469">受付医療事務</label></span></td> </tr> </table> </td> </tr> <tr> <td colspan="2" align="left" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr class="t1h16"> <td align="left" style="padding:8px 15px;"><strong><span class="cream">自己PR</span> <span class="red">*</span></strong></td> <td align="left" style="padding:5px 0px;"><textarea style="width:98%" rows="5" name="body"></textarea> </td> </tr> <tr> <td colspan="2" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr> <td colspan="2"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> <tr> <td colspan="2" background="staff/img/common/dotted.gif"><img src="staff/img/spacer.gif" alt="" width="1" height="1"></td> </tr> </table> <table width="100" border="0" cellspacing="0" cellpadding="0"> <tr> <td><img src="staff/img/spacer.gif" alt="" width="1" height="30"></td> </tr> </table> <table width="573" border="0" cellspacing="0" cellpadding="0"> <tr> <td align="center"><input type="image" name="confirm" value="" id="btn_01" src="staff/img/staff/btn_01.gif" alt="確認する" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('btn_01','','staff/img/staff/btn_01_.gif',1)"> </a></td> </form> </tr> </table> </td> </tr> <tr valign="top"> <td align="right"> </td> </tr> </table> </div>   <div id="foot"> <hr class="hr-foot" /> <div class="left"> <h1>〒520-2144 滋賀県大津市大萱1-1-1 TEL：077-547-3557　産婦人科･IVF 竹林ウィメンズクリニック</h1> </div> <div class="right"> <p><A href="policy/policy.html" class="con">≫プライバシーポリシー</A></p> </div> <br clear="all" /> <div class="left"> <p>Copyright (C) 2006 Takebayashi Women's Clinic. 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