Speaking Examiner Application form

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Name:This will be printed on your Cambrdige letter.
First Name
Last Name
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Sex
Male
Female
Transgender
3
Your NationalityName of country whose Passport you hold.
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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E-mail
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Phone NumberYour personal cell#
7
Your Skype Address if any This will be used for Video Interview you if required
8
Which Cambridge Exam you are applying to become Speaking Examiner?Tick all exams you want to be examiner for. Note that for each exam you may need to attend a 2 days training. do online assignments and attend a training once a year.
KET Key English Test
Business English Certificate Preliminary
Business English Certificate Vantage
Business English Certificate Higher
FCE First Certificate in English
CAE Cambridge English Advance
YLE Young Learner Exam
PET Preliminary English Test
Trainer for CELT p/s teaching qualifications
TKT Teaching Knowledge Test
Trainer for Certificate in EMI - English as medium of instruction
CELTA Tutor training / Observation
Any other qualification / course not stated here. Kindly do mention in your remarks name of training
9
ENGLISH LANGUAGE PROFICIENCYIs English your first language
Yes
No
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ENGLISH LANGUAGE PROFICIENCYIf English is not your first language, please name your first language- Eg. Urdu etc.
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What is your English Language Level? (Please state the CEFR, if possible)For details about CEFR see http://www.cambridgeenglish.org/exams-and-tests/cefr/
Type your level of English like C1 or B2 . You have to provide a valid proof for your English level
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What proof can you give for your English language level? For example, English Language exam taken, include level, exam board etc.
IELTS score.
Any other exam score yoiu have like TOEFL, CAE, PTE etc.
Your grades in English language in highest qualification
Any other proof. You have to supply documents related to that.
13
HIGHER EDUCATION AND TEACHING QUALIFICATIONS Mention your highest qualification / teaching qualifications only.
Do you have a degree. If yes, please mention its name, institution name and month / year it was awarded.
Please Select
Please Select
Yes
No
Do you have a teaching qualification
If you have a teaching qualification, title of degree, subject of degree, name of institution and year awarded
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When did you start teaching?Enter Month / Year
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Are there any gaps in your teaching?From(Month/Year) , To(Month/Year)
For example - from Dec 2015 to March 2017
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EnglishLanguage Teaching Experience Please give your most recent relevantexperience, up to a maximum of three roles
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Total Number of Hours Experience as an EFL/ESOL Teacher
Less than 1800 hours
Between 1800 and 3000 hours
More than 3000 hours
Other
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Please confirm that you agree and confirm that you fulfill criteria of Speaking Examiner * This field is required.
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