Interlocutor/Assessor Application Form

English Language Competence
What English language qualification do you have?*
What is your spoken English level?*
Please enter details*
Qualifications in Teaching English as a Second language
Qualification *
Date attained

DayMonthYear
Other teaching qualifications
Please list any other teaching qualifications and the date at which the qualification was achieved
Experience in teaching English as a Second Language
Job title*
Institution / centre*
Full time / part time*

Full timePart time
Are you currently working in this position?*

YesNo
Date position held from*

DayMonthYear
Date position held to*

DayMonthYear
English language levels taught*
English language levels taught*
Please detail any previous teaching history

Declaration
By selecting the boxes below I confirm that:*

I will not be acting as an assessor or interlocutor for any test takers that I might currently be teachingIf the need arises for me to act as an assessor or interlocutor for test takers I am currently teaching, I will contact Language Testing, Pearson immediately for special dispensationI will present copies of my qualifications to a local Language Testing, Pearson representative or, if requested, to Language Testing, Pearson in London, UKAll information provided by me on this form is true and correct
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