Examiner Application Form - Appendix 3

This application form must be completed electronically, printed, signed and then scanned to the
Administrator (or an electronic signature is acceptable). All relevant supporting documents, as listed, are to
be submitted with the application. Please scan and submit all documents electronically. The application
form must be fully complete for it to be considered.

1. Personal Details

Surname First Name(s) Title (e.g. Mr, Ms)

Contact address

Email address Telephone number (include international codes)

Home: Home:

Work: Work:

Mobile:
Date of Application

2. Qualifications

You must have the minimum professional requirements of an undergraduate degree, plus either a
TEFL/TESOL/EFL/ESOL certificate or a degree with a TESOL focuses.

Degree / Diploma / Certificate Institution (name & location) Dates of study

(From – To)
 Examiner Application Form - Appendix 3

3. Teaching Experience

You must have a minimum of 3 years’ full-time TESOL teaching experience to adult students (16 years’ and
over), or equivalent part-time.

Name and address of employer Average First Focus of Dates of

(include telephone number and email teaching language of teaching employment
address) (From – To,
hours per the majority (General including
week to of students English, Exam months)
adults (aged preparation,
16 or over) Business, EAP)

Other work experience

Name of Employer Duties Dates

(From – To)
 Examiner Application Form - Appendix 3

4. Experience as an accredited assessor / Examiner for recognised examinations (national

and international)

Examination title (please describe Examining body Dates

the assessor role) (From – To)

5. Professional attributes and interpersonal skills

a) Please respond to the questions in Attachment A of this application form.

b) Please send the Reference Template to your referee to be completed confidentially and emailed directly to
the recruiting centre.

6. English language competence

Have you taken an IELTS test? Yes / No

If “Yes”, what was your test date?

DATE:

What was your test score?

Listening: Reading: Writing: Speaking: Overall Band Score:

Please respond to the questions in Attachment B of this application form. All applicants must complete
 Examiner Application Form - Appendix 3
Attachment B.

7. Previous IELTS Examiner training

Have you ever..? YES/NO Date of application / Centre where you applied /
training trained

Previously applied to be an IELTS

Examiner?

Participated in IELTS Examiner Training?

8. Application form checklist

 Examiner Application Form - Appendix 3
Please ensure that you have included with your application: tick to
confirm
Fully completed each question of the application, providing all requested information
9. Declaration
Please readdocuments,
and sign below
suchtoas
indicate your or
agreement:
Supporting certificates diplomas, as listed in section 2
I declare that the information I have provided in this application form is full and accurate, to the best of my
Attachment
knowledge andA belief, correct and complete.

Attachment B include any details that you know to be false or if you withhold relevant information, you may
Warning: if you
render yourself liable to disqualification from the recruitment exercise or, if invited to examine, to the Invitation to
Examine being
A signature for withdrawn.
each part ofInthe
addition, IELTS
declaration inAustralia
section 9Pty Ltdpage)
(next / British Council (whichever is appropriate) may
seek to recover from you all costs incurred by us in the recruitment, certification and training process and any
other costs relating to your work as an Examiner.

Name of Signature
applicant

Database - Please sign below:

I am aware that if I become an IELTS Examiner, all IELTS specific information will be permanently held on a
database which may be accessed by either Test Partner, Examiner Support Coordinators (ESCs), Examiner
Trainers or IELTS Centre Administrators at any time.

Name of Signature
applicant

Verification of documents - Please sign below:

I agree to pay the cost of verification of any documents requested as part of the IELTS Examiner recruitment
process.

Name of Signature
applicant

IELTS Test - Please sign below:

I agree to pay the IELTS test fee if I am required to take it as part of the IELTS Examiner recruitment
process. All applicants must sign here, even if an IELTS test has already been taken or they have English as
their first language. NB The IELTS test fee is the same as that charged to IELTS candidates at the centre
where you are applying.

Name of Signature
applicant

Recording of interview - Please sign below:

I agree to allow IELTS to record my recruitment interview for quality assurance purposes.

Name of Signature
applicant

Signature and date of application:

Applicant name

Applicant signature

Date of application
 Examiner Application Form - Appendix 3
Please scan/email this page with your signatures on. This document is kept for 2 years after you stop
working as an Examiner.

Attachment A – Professional Attributes and Interpersonal Skills

In this section you are required to present evidence that you have the required professional attributes and
interpersonal skills to become an IELTS Examiner (see number 4 on the application form).

Give details of a situation you were in, the action you took and the outcome for each of the questions below. If you
answer on a separate sheet to submit with your application you must include your name on each page– write no more
than 100 words for each situation.

1. Describe a situation in your professional life in which effective communication is important – how have
you ensured that your own communication is effective?

2. Describe a situation in your professional life where you have had to maintain confidentiality or
follow procedures to ensure security.

3. Describe a task that you have to complete accurately and in detail – how do you ensure that you
complete the task to the required standard?

4. Describe an occasion when you received and built on guidance and advice from others.

5. What advice would you give to a new teacher on what is expected in terms of punctuality, dress code,
ways of addressing others and any other important aspects of the cultural context in which you work?
 Examiner Application Form - Appendix 3
Please ensure that all attachments are correctly labelled with your name and contact details.

Attachment B – English Language Competence

All Applicants must complete this attachment, regardless of nationality and first language.

PART A

Read the following statements and circle the one answer that most accurately reflects your English language skills.

A1: When watching a television programme or video in English, I can understand

Everything Most of the time Often Rarely Never

A2: When writing a report in English, I can convey my thoughts to express my meaning precisely. I can do this

Easily Most of the time Often Rarely Never

A3: I am able to understand a variety of Standard English accents

Easily Most of the time Often Rarely Never

A4: After reading a paragraph on language teaching, I can summarise its contents
Easily Most of the time Often Rarely Never

PART B

Answer each of the questions below in the space provided.

B1: What was the main language spoken in your home when you were a small child?

B2: Were any other languages spoken in your home when you were a child? Yes / No

If “Yes”, list the additional languages.

B3: At approximately what age did you start to speak English regularly?

B4: What was the main language of instruction when you first started school?

B5: Were any other languages used in your primary school? Yes / No

If “Yes”, list the languages.

B6: What was the main language of instruction at your secondary school(s)?
 Examiner Application Form - Appendix 3
B7: Was any other language used for instruction at your secondary school? Yes / No

If “Yes”, name the language(s).

B8: Were you required to study another language at either primary or secondary school? Yes / No

If “Yes”, name the language(s).

B9: What was the main language of instruction at tertiary level?

B10: What language(s) do you use when relaxing with friends?

B11: What is the official language of the country in which you currently live?

B12: How long have you lived in that country?

B13 Have you delivered a conference paper in English? Yes / No

If “Yes”, what was the topic?