CONFIDENTIAL
FORM
Invigilator Application Form
Personal details
Surname: Title (circle as appropriate): Nationality: Date of birth:
Miss Ms Mrs Mr Dr _ _ /_ _ /_ _
Other: Day / Month / Year
First name(s): Gender (circle as appropriate): First language: Date of application:
Male Female _ _ /_ _ /_ _
Day / Month / Year
Contact details: Phone number/s: Address: Email address:
Work:
Home:
Mobile:
Employment history
Date (From / To): Employer: Full time / Duties:
Part time:
Experience as an invigilator for recognised exams (national and international)
Date (From / To): Subject / Scheme: Examining / Validating body:
Reference: please attach an original reference from a current or former employer, including contact
details.
DECLARATION OF CONFIDENTIALITY
I hereby agree to observe strict security relating to IELTS test materials and related documents.
Date: Signature:
Centre name: Centre number:
Administrator’s signature:
For office use only:
Date of Appointment: