Thisapplicationformmustbecompletedelectronically,printed,signedandthenscannedtothe Administrator(oranelectronicsignatureis acceptable).Allrelevantsupportingdocuments,as listed,are tobesubmittedwiththeapplication.Pleasescanandsubmitalldocumentselectronically.The applicationformmustbe fullycompleteforit tobe considered.

1. PersonalDetails

Surname / First Name(s) / Title(e.g. Mr,Ms) / Gender
(M/F)
Dateofbirth / Nationality / Contact address
Emailaddress / Telephonenumber (include internationalcodes)
Home: Work: / Home: Work: Mobile:
DateofApplication

2. Qualifications

Youmusthavetheminimumprofessionalrequirementsof anundergraduatedegree,pluseithera

TEFL/TESOL/EFL/ESOLcertificateoradegreewithaTESOLfocus.

Degree/Diploma/Certificate / Institution(name& location) / Datesofstudy
(From–To)

3. TeachingExperience

Youmusthaveaminimumof 3years’full-timeteachingexperiencetoadultstudents(16yearsandover), orequivalentpart-time.

Name and addressofemployer
(includetelephonenumber and email address) / Average teaching hoursper weekto adults(aged
16or over) / First languageof themajority of students / Focusof teaching (General English,Exam preparation, Business,EAP) / Datesof
employment
(From–To, including months)

Otherworkexperience

NameofEmployer / Duties / Dates
(From–To)

4. Experienceasanaccreditedassessor / Examinerfor recognisedexaminations

(national andinternational)

Examinationtitle(pleasedescribe theassessor role) / Examiningbody / Dates
(From–To)

5. Professionalattributesandinterpersonalskills

a) PleaserespondtothequestionsinAttachmentAofthisapplicationform.

b)Please sendtheReferenceTemplatetoyour refereetobe completed confidentiallyand emaileddirectlytothe recruitingcentre.

6. Englishlanguagecompetence HaveyoutakenanIELTStest? Yes/No If “Yes”,what wasyourtestdate?

DATE:

Whatwasyourtestscore?

Listening: / Reading: / Writing: / Speaking: / Overall BandScore:

PleaserespondtothequestionsinAttachmentBofthisapplicationform.Allapplicantsmustcomplete

AttachmentB.

7. PreviousIELTSExaminertraining

Haveyouever..? / YES/NO / Dateof application/
training / Centrewhereyouapplied
/trained
PreviouslyappliedtobeanIELTS Examiner?
ParticipatedinIELTS Examiner Training?

8. Applicationformchecklist

Please ensurethatyouhaveincludedwithyour application:

9. Declaration

Pleasereadand sign belowtoindicateyour agreement:

IdeclarethattheinformationIhaveprovidedinthisapplicationformisfullandaccurate,tothebest ofmy knowledge andbelief, correct andcomplete.
Warning:ifyouincludeanydetailsthatyou knowtobefalseorifyouwithholdrelevantinformation,you may renderyourselfliabletodisqualificationfromthe recruitmentexerciseor,ifinvitedto examine,tothe InvitationtoExaminebeingwithdrawn.In addition,IELTS AustraliaPtyLtd/BritishCouncil(whichever is appropriate) mayseektorecover fromyou all costsincurredbyusintherecruitment, certificationand trainingprocess andanyother costsrelatingtoyour work asanExaminer.
Nameof applicant / Signature

Database- Please signbelow:

IamawarethatifIbecomeanIELTSExaminer, allIELTSspecificinformationwillbepermanentlyheldona databasewhich maybeaccessedbyeither TestPartner,Examiner Support Coordinators(ESCs),Examiner Trainersor IELTS Centre Administrators atanytime.
Nameof applicant / Signature

Verificationofdocuments- Please signbelow:

I agreetopaythecost ofverificationofanydocumentsrequested aspart oftheIELTS Examiner recruitment process.
Nameof applicant / Signature

IELTSTest- Please signbelow:

I agreetopaytheIELTS testfeeifIamrequiredtotakeitaspartoftheIELTS Examiner recruitment
process.All applicantsmustsignhere, evenifanIELTStest has alreadybeentakenor theyhaveEnglish as their firstlanguage.NBTheIELTS testfeeisthesameasthat chargedtoIELTScandidates at thecentre where you are applying.
Nameof applicant / Signature

Recordingofinterview- Please signbelow:

I agreetoallowIELTStorecordmyrecruitmentinterviewfor qualityassurancepurposes.
Nameof applicant / Signature

Signatureanddateofapplication:

Applicant name
Applicant signature
Dateof application

Pleasescan/emailthispagewithyoursignatureson.Thisdocumentiskeptfor2yearsafteryou stopworkingasanExaminer.

AttachmentA– ProfessionalAttributesandInterpersonalSkills

Inthissection you arerequiredto present evidencethatyou havetherequiredprofessional attributesand interpersonalskillsto becomeanIELTS Examiner (seenumber 4onthe applicationform).

Give detailsofa situationyouwere in,the actionyoutookandthe outcomeforeach ofthequestionsbelow.Ifyou answer ona separate sheettosubmitwithyourapplicationyou mustincludeyournameoneach page–writeno more than100wordsfor eachsituation.

1. Describea situationinyour professionallifeinwhich effective communicationisimportant–howhave you ensuredthatyour owncommunicationiseffective?

2. Describea situationinyour professionallifewhereyouhavehadtomaintainconfidentialityor follow proceduresto ensuresecurity.

3. Describeataskthatyouhaveto complete accuratelyandindetail–howdoyouensurethatyou completethetasktotherequired standard?

4. Describeanoccasionwhenyoureceived andbuiltonguidance andadvicefromothers.

5. What advicewouldyougivetoanewteacheronwhatis expectedintermsofpunctuality,dress code, waysof addressingothersand anyother importantaspectsofthe cultural contextinwhichyouwork?

Please ensurethatall attachmentsare correctlylabelled with your nameandcontactdetails.

AttachmentB – English LanguageCompetence

AllApplicantsmust completethis attachment,regardlessof nationalityandfirst language.

PARTA

Readthefollowing statementsand circletheoneanswer thatmostaccuratelyreflectsyourEnglish languageskills.

A1:Whenwatchingatelevisionprogramme orvideoinEnglish,Ican understand

Everything / Most ofthetime / Often / Rarely / Never

A2:WhenwritingareportinEnglish,I canconveymy thoughtstoexpressmymeaning precisely.Icandothis

Easily / Most ofthetime / Often / Rarely / Never

A3:Iamableto understandavarietyofStandardEnglishaccents

Easily / Most ofthetime / Often / Rarely / Never

A4:Afterreadinga paragraphon languageteaching,Ican summarise itscontents

Easily / Most ofthetime / Often / Rarely / Never

PARTB

Answer each ofthequestionsbelowinthe space provided.

B1:Whatwasthe mainlanguage spoken inyourhomewhenyouwerea smallchild?
B2:Wereanyother languagesspokeninyourhomewhenyouwerea child? Yes/No
If“Yes”, listtheadditional languages.
B3:At approximatelywhat agedidyou starttospeakEnglishregularly?
B4:Whatwasthe mainlanguage ofinstructionwhenyoufirststarted school?
B5:Wereanyother languagesused inyour primaryschool? Yes/No
If“Yes”, listthe languages.
B6:Whatwasthe mainlanguage ofinstruction atyoursecondaryschool(s)?
B7:Wasanyother languageusedfor instructionatyoursecondaryschool? Yes/No
If“Yes”, namethe language(s).
B8:Were yourequiredtostudyanotherlanguage ateither primaryorsecondary school? Yes/No
If“Yes”, namethe language(s).
B9:Whatwasthe mainlanguage ofinstruction attertiarylevel?
B10:What language(s)doyouusewhenrelaxingwithfriends?
B11:Whatisthe official language ofthe country inwhichyou currentlylive?
B12:Howlong haveyou lived inthat country?
B13Haveyoudelivereda conference paper inEnglish? Yes/No
If“Yes”,whatwasthetopic?

IELTS PSNManual 2013edition–CONFIDENTIAL