Examiner application form (languages)

Subject(s) applied for Level(s) For more information on Cambridge International Examinations qualifications please refer to www.cie.org.uk/qualifications

A) Personal Details
Title* Surname* Forename(s)*

Home Address* (Inc Postcode) !mail Address* $or% Telep"one (Inc Area #ode) *Mandatory Information Home Telep"one* (Inc Area #ode) &obile 'umber

() !mplo)ment Histor) Present Appointment

Appointment Sc"ool*!mplo)er Subject(s) + Level(s) Date Appointed

Previous Appointment(s)
Appointment Sc"ool*!mplo)er Subject(s) + Level(s) From To

Appointment Sc"ool*!mplo)er Subject(s) + Level(s)

From

To

!,aminer * &oderator Application Form

#) !,amination (oard !,perience (!,ternal !,aminin-* #ourse.or% &oderation)

(oard Level !,aminer 'umber Subject /ole* From To

(oard Level !,aminer 'umber

Subject /ole* From To

(oard Level !,aminer 'umber *

Subject /ole* From To

lease state w!et!er rincipal Examiner" #eam $eader" %ssistant Examiner" rincipal Moderator" etc.

D) 0niversit) De-ree or ot"er relevant 1ualifications

A.ardin- institution #lass * 3rade Subject 2ualification Date a.arded

A.ardin- institution #lass * 3rade Subject

2ualification Date a.arded

A.ardin- institution #lass * 3rade Subject

2ualification Date a.arded

!,aminer * &oderator Application Form

!) Availabilit)
Please indicate ."ic" e,amination periods )ou .ould be free to underta%e .or%4 Summer4 5verall mar%in- period4 &a) 6 7ul) $inter4 7anuar) 5verall mar%in- period4 5ctober 8 Yes/No* Yes/No* Yes/No* $ee%ends9 Yes/No*

#an )ou attend meetin-s4

$ee%da)s9

* Please delete as appropriate

Do )ou e,pect t"at )our time .ould be ta%en up b) ot"er e,ternal e,aminin- .or%9 If so: please -ive details4

Do )ou or t"e sc"ool ."ere )ou teac": prepare candidates for an) #ambrid-e Assessment (5#/: #ambrid-e International !,aminations or !S5L) suite of e,aminations9 If so: please -ive details9

Please use t"e space provide to add an) additional information* e,perience to support )our application4

Do )ou "ave a 0; (an% Account9 (<es*'o) lease do not pro&ide details of your account on t!is form

F) !lectronic Script &ana-ement

Cambridge International Examinations is committed to &arious forms of electronic script management 'E(M). In order to mark using t!ese systems you need to !a&e a C running *indows +" , or -ista and a broadband internet connection. If you are interested in taking part in t!e new de&elopments you will need to &isit t!e !ardware &alidation webpage at. !ttps.//www.ca.scoris.rm.com/e!&/index.aspx lease make a note of your -alidation /eference 0umber and enter it below. -alidation /eference 0umber.

If you !a&e not entered a -alidation 0umber please gi&e t!e reason below 'e.g. 1o not own a C" Failed &alidation test)
!,aminer * &oderator Application Form

3) Supplementar) Form for !,aminin- $or% in Lan-ua-es ot"er t"an !n-lis"

In addition to your application for examining work" would you be interested in setting examination questions2 Yes/No*

For eac! of t!e following skills" please indicate your le&el in t!e target language Spea%in$ritinNative speaker/ Fluent/ Moderately fluent* Native speaker/ Fluent/ Moderately fluent*
* Please delete as appropriate

Have )ou ever tau-"t literature9

Yes/No*

$ould )ou feel confident to e,amine literature9

Yes/No*

$ould )ou be interested in bein- a visitin- 5ral !,aminer for t"e #ambrid-e Pre80 ()ou .ould need to be available for visits to sc"ools bet.een &arc" and 7une)9

Yes/No*

Ho. do )ou maintain )our contact*connection .it" t"e tar-et lan-ua-e9

!,aminer * &oderator Application Form

Tell us .") )ou t"in% )our e,perience ma%es )ou suitable to be an e,aminer*moderator in t"e tar-et lan-ua-e4

H) /eferences
lease pro&ide details of one referee for t!e Cambridge examiner recruitment team to contact independently 'please note references will not normally be accepted from spouses" partners and close family members). /eferees will be contacted by email in t!e first instance. lease note t!at personal email addresses s!ould be pro&ided w!ere possible to pre&ent delays during sc!ool !olidays.

<ou must provide a second reference .it" t"is application form *e ask t!at you contact your
second referee and recei&e t!e document back before submitting your application 't!e application s!ould be submitted wit! t!e completed reference form attac!ed). #!e reference documents can be found under t!e following link. !ttp.//www.cie.org.uk/aboutcie/3obs/aboutcie/3obs/examiners Personal * Professional reference to be provided b) Applicant 'ame* !mail Address* Postal Address (inc Postcode) 5fficial Position* /elations"ip *

Professional reference to be ta%en up b) #ambrid-e International !,aminations 'ame* !mail Address* Postal Address (inc Postcode) *Mandatory Information 5fficial Position* /elations"ip *

!,aminer * &oderator Application Form

I) Declaration
4y completing and returning t!is application you consent to 5C$E( seeking and recei&ing rele&ant information !eld by ot!er exam boards regarding your performance as well as gi&ing consent to 5C$E( to disclose suc! information s!ould any ot!er exam board make a request for a rele&ant reason. I certify t!at t!e information I !a&e gi&en in t!is application is true and complete to t!e best of my knowledge and t!at I include a personal reference to support my application.

Si-ned

Please type name here

Date

lease email your completed application form and reference to. recruitment.c6cie.org.uk 7r post to. Examiner /ecruitment" Cambridge Examiner Management" 8 9ills /oad" Cambridge" C48 :E5

!,aminer * &oderator Application Form