Examiner Application Form - Appendix 3

This appli ation !o"# #ust $e completed electronically, p"inted% si&ned and then s anned to the Ad#inist"ato" 'o" an ele t"oni si&natu"e is a epta$le() All "ele*ant suppo"tin& do u#ents% as listed% a"e to $e su$#itted +ith the appli ation) Please s an and su$#it all do u#ents ele t"oni all,) The application form must be fully complete for it to be considered.

1. Personal Details
urname First !ame"s# Title "e.$. %r, %s# &ender "%'F#

Date of birth

!ationality

(ontact address

Email address

Telephone number "include international codes# )ome* +or,* %obile*

)ome* +or,*

Date of Application

-. .ualifications
-ou #ust ha*e the #ini#u# p"o!essional "e.ui"e#ents o! an unde"&"aduate de&"ee% plus eithe" a TEFL/TESOL/EFL/ESOL e"ti!i ate o" a de&"ee +ith a TESOL !o us)
De$ree ' Diploma ' (ertificate /nstitution "name 0 location# Dates of study "From 1 To#

IELTS PSN Manual 2013 edition CONFIDENTIAL

Examiner Application Form - Appendix 3

3. Teachin$ Experience
-ou #ust ha*e a #ini#u# o! 3 ,ea"s0 !ull1ti#e tea hin& e2pe"ien e to adult students '13 ,ea"s and o*e"(% o" e.ui*alent pa"t1ti#e)
!ame and address of employer "include telephone number and email address# A2era$e teachin$ hours per 3ee, to adults "a$ed 14 or o2er# First lan$ua$e of the ma5ority of students Focus of teachin$ "&eneral En$lish, Exam preparation, 6usiness, EAP# Dates of employment "From 1 To, includin$ months#

7ther 3or, experience

!ame of Employer Duties Dates "From 1 To#

IELTS PSN Manual 2013 edition CONFIDENTIAL

Examiner Application Form - Appendix 3

8. Experience as an accredited assessor ' Examiner for reco$nised examinations "national and international#
Examination title "please describe the assessor role# Examinin$ body Dates "From 1 To#

9. Professional attributes and interpersonal s,ills

a# b#

Please "espond to the .uestions in Atta h#ent A o! this appli ation !o"#) Please send the 4e!e"en e Te#plate to ,ou" "e!e"ee to $e o#pleted on!identiall, and emailed directly to the recruitin$ centre.

4. En$lish lan$ua$e competence

5a*e ,ou ta6en an IELTS test7 I! 8-es9% +hat +as ,ou" test date7
DATE*

:es ' !o

:hat +as ,ou" test s o"e7

;istenin$* <eadin$* +ritin$* pea,in$* 72erall 6and core*

Please "espond to the .uestions in Atta h#ent ; o! this appli ation !o"#) All appli ants #ust o#plete Atta h#ent ;)

IELTS PSN Manual 2013 edition CONFIDENTIAL

Examiner Application Form - Appendix 3

?. Pre2ious /E;T Examiner trainin$

)a2e you e2er..@ :E '!7 Date of application ' trainin$ (entre 3here you applied ' trained

Pre2iously applied to be an /E;T Examiner@ Participated in /E;T Examiner Trainin$@

A. Application form chec,list

Please ensure that you ha2e included 3ith your application* Fully completed each =uestion of the application, pro2idin$ all re=uested information upportin$ documents, such as certificates or diplomas, as listed in section Attachment A Attachment 6 A si$nature for each part of the declaration in section > "next pa$e# tic, to confirm

IELTS PSN Manual 2013 edition CONFIDENTIAL

Examiner Application Form - Appendix 3 >. Declaration

Please read and si$n belo3 to indicate your a$reement* / declare that the information / ha2e pro2ided in this application form is full and accurate, to the best of my ,no3led$e and belief, correct and complete. +arnin$* if you include any details that you ,no3 to be false or if you 3ithhold rele2ant information, you may render yourself liable to dis=ualification from the recruitment exercise or, if in2ited to examine, to the /n2itation to Examine bein$ 3ithdra3n. /n addition, /E;T Australia Pty ;td ' 6ritish (ouncil "3hiche2er is appropriate# may see, to reco2er from you all costs incurred by us in the recruitment, certification and trainin$ process and any other costs relatin$ to your 3or, as an Examiner. !ame of applicant i$nature

Database - Please si$n belo3*

/ am a3are that if / become an /E;T Examiner, all /E;T specific information 3ill be permanently held on a database 3hich may be accessed by either Test Partner, Examiner upport (oordinators "E (s#, Examiner Trainers or /E;T (entre Administrators at any time. !ame of applicant i$nature

Berification of documents - Please si$n belo3*

/ a$ree to pay the cost of 2erification of any documents re=uested as part of the /E;T Examiner recruitment process. !ame of applicant i$nature

/E;T Test - Please si$n belo3*

/ a$ree to pay the /E;T test fee if / am re=uired to ta,e it as part of the /E;T Examiner recruitment process. All applicants must si$n here, e2en if an /E;T test has already been ta,e n or they ha2e En$lish as their first lan$ua$e. NB The IELTS test fee is the same as that charged to IELTS candidates at the centre where you are applying. !ame of applicant i$nature

<ecordin$ of inter2ie3 - Please si$n belo3*

/ a$ree to allo3 /E;T to record my recruitment inter2ie3 for =uality assurance purposes. !ame of applicant i$nature

i$nature and date of application*

Applicant name Applicant si$nature Date of application

Please scan'email this pa$e 3ith your si$natures on. This document is ,ept for - years after you stop 3or,in$ as an Examiner.

IELTS PSN Manual 2013 edition CONFIDENTIAL

Examiner Application Form - Appendix 3

Attachment A 1 Professional Attributes and /nterpersonal ,ills
In this se tion ,ou a"e "e.ui"ed to p"esent e*iden e that ,ou ha*e the "e.ui"ed p"o!essional att"i$utes and inte"pe"sonal s6ills to $e o#e an IELTS E2a#ine" 'see nu#$e" < on the appli ation !o"#() =i*e details o! a situation ,ou +e"e in% the a tion ,ou too6 and the out o#e !o" ea h o! the .ues tions $elo+) I! ,ou ans+e" on a sepa"ate sheet to su$#it +ith ,ou" appli ation ,ou #ust in lude ,ou" na#e on ea h pa&e +"ite no #o"e than 1CC +o"ds !o" ea h situation)

1.

Describe a situation in your professional life in 3hich effecti2e communication is im portant 1 ho3 ha2e you ensured that your o3n communication is effecti2e@

-.

Describe a situation in your professional life 3here you ha2e had to maintain confidentiality or follo3 procedures to ensure security.

3.

Describe a tas, that you ha2e to complete accurately and in detail 1 ho3 do you ensure that you complete the tas, to the re=uired standard@

8.

Describe an occasion 3hen you recei2ed and built on $uidance and ad2ice from others.

9.

+hat ad2ice 3ould you $i2e to a ne3 teacher on 3hat is expected in terms of punctuality, dress code, 3ays of addressin$ others and any other important aspects of the cultural context in 3hich you 3or,@

Please ensure that all attachments are correctly labelled with your name and contact details.

IELTS PSN Manual 2013 edition CONFIDENTIAL

Examiner Application Form - Appendix 3

Attachment 6 1 En$lish ;an$ua$e (ompetence
All Applicants must complete this attachment, re$ardless of nationality and first lan$ua$e. PA<T A 4ead the !ollo+in& state#ents and i" le the one ans+e" that #ost a u"atel, "e!le ts ,ou" En&lish lan&ua&e s6ills)

A1> : hen +at hin& a tele*ision p"o&"a##e o" *ideo in En&lish% I an unde"stand E2erythin$ %ost of the time 7ften <arely !e2er

A2> : hen +"itin& a "epo"t in En&lish% I an on*e, #, thou&hts to e2p"ess #, #eanin& p"e isel,) I an do this Easily %ost of the time 7ften <arely !e2er

A3> I a# a$le to unde"stand a *a"iet, o! Standa"d En&lish a ents Easily %ost of the time 7ften <arely !e2er

A<> A!te" "eadin& a pa"a&"aph on lan&ua&e tea hin&% I an su##a"ise its ontents Easily %ost of the time 7ften <arely !e2er

PA<T 6 Ans+e" ea h o! the .uestions $elo+ in the spa e p"o*ided) ;1> : hat +as the #ain lan&ua&e spo6en in ,ou" ho#e +hen ,ou +e"e a s#all hild7

;2> : e"e an, othe" lan&ua&es spo6en in ,ou" ho#e +hen ,ou +e"e a hild7 I! 8-es9% list the additional lan&ua&es)

:es ' !o

;3> At app"o2i#atel, +hat a&e did ,ou sta"t to spea6 En&lish "e&ula"l,7

;<> : hat +as the #ain lan&ua&e o! inst"u tion +hen ,ou !i"st sta"ted s hool7

;?> : e"e an, othe" lan&ua&es used in ,ou" p"i#a", s hool7 I! 8-es9% list the lan&ua&es)

:es ' !o

;3> : hat +as the #ain lan&ua&e o! inst"u tion at ,ou" se onda", s hool's(7

IELTS PSN Manual 2013 edition CONFIDENTIAL

Examiner Application Form - Appendix 3

;@> : as an, othe" lan&ua&e used !o" inst"u tion at ,ou" se onda", s hool7 I! 8-es9% na#e the lan&ua&e's()

:es ' !o

;A> : e"e ,ou "e.ui"ed to stud, anothe" lan&ua&e at eithe" p"i#a", o" se onda", s hool7 I! 8-es9% na#e the lan&ua&e's()

:es ' !o

;B> : hat +as the #ain lan&ua&e o! inst"u tion at te"tia", le*el7

;10> : hat lan&ua&e's( do ,ou use +hen "ela2in& +ith !"iends7

;11> : hat is the o!!i ial lan&ua&e o! the ount", in +hi h ,ou u""entl, li*e7

;12> 5o+ lon& ha*e ,ou li*ed in that ount",7

;13 5a*e ,ou deli*e"ed a on!e"en e pape" in En&lish7 I! 8-es9% +hat +as the topi 7

:es ' !o

IELTS PSN Manual 2013 edition CONFIDENTIAL