Interlocutor/Assessor Application Form

Interlocutor/Assessor Application Form

Email Address*

Please provide an active email address. This will be the primary means of contact with you.

Interlocutor Number

If you already have an Interlocutor Number please enter it here. It should comprise of two letters and five numbers.

Title*

Select

First name*

Last name*

Country of test centre*

Select

English speaker*

Are you a native speaker of English?

Yes

International Certificate Interlocutor*

International Certificate Young Learners Assessor*

First Words - 4181

Springboard - 4182

Quickmarch - 4184

Breakthrough - 4184

Centre number*

Centre name*

Centre email address*

Teacher at this centre*

Are you currently teaching at this centre?

Yes

English language qualifications*

Please state what English Language qualifications you have.

Level of spoken English*

What is your spoken English level?

None

Other

Please enter details (Level of spoken English)*

If you have stated your level of spoken English as Other, please give details below:

Qualification*

Year attained

Other teaching qualifications and date achieved

Please list any other teaching qualifications and the date at which the qualifications were achieved.

Job title*

Institution / Centre*

Full time / part time*

Full time

Part time

Currently working in this position*

Yes

Date position held from*

Date position held to*

English language levels taught*

Previous teaching history*

Please detail any previous teaching history.

Declaration

By selecting the boxes below I confirm that:

1. I will not be acting as an assessor or interlocutor for any test takers that I might currently be teaching*

2. If 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 dispensation*

3. I will present copies of my qualifications to a local Language Testing, Pearson representative or, if requested, to Language Testing, Pearson in London, UK*

4. All information provided by me on this form is true and correct*

Keep me informed of Pearson products and services

Pearson would like to keep you updated with information on our range of products and services.

If you don’t want to receive this information, please uncheck this box

I give permission for my information to be stored for the duration of my work as an Interlocutor for Pearson.*

Send me a copy of my responses

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