Cambridge International Checkpoint Marker Application Form
Please return to - recruitment.c@cie.org.uk
Personal Details
Title
Forename (s)
Surname
Address
Post code
Country
Email Address
Home Telephone
Mobile Telephone
Gender
Date of Birth
Cambridge Assessment may contact me regarding other positions in the future?
Yes/No
Do you have any unspent criminal convictions? If yes please give details below.
Yes/No
National Insurance
Number
Student Loans
Do you have a Student Loan which is not fully repaid and all of the following apply?
- You left a course of UK higher education before last 6 April.
- You received your first Student Loan instalment on or after 1 September 1998.
Yes/No
Read all the following statements carefully and select which applies to you:
Please delete as appropriate - A/B/C
Present
Circumstances
A – This would be my first job since last 6 April and I have not been receiving taxable
Jobseeker's Allowance, Employment or Support Allowance or taxable Incapacity
Benefit or a state or occupational pension.
B – This would be my only job, but since last 6 April I have had another job, or have
received taxable Jobseeker's Allowance, Employment and Support Allowance or
taxable Incapacity Benefit. I do not receive a state or occupational pension.
C – I have another job or receive a state or occupational pension.
Subjects Applied for (Maths or Science)
Subject
Subject
Checkpoint Application Form
Employment History
Job Title
From
To
From
To
School/Employer
Subject(s) & Level(s)
Job Title
School/Employer
Subject(s) & Level(s)
Subject specific qualifications that meet Checkpoint criteria
Awarding institution
Class / Grade
Qualification
Subject
Awarding institution
Class / Grade
Date awarded
Qualification
Subject
Date awarded
Where did you hear about examining opportunities with Cambridge
International examinations?
Do you know anyone that is a candidate for any Cambridge Checkpoint examinations?
Checkpoint Application Form
Please use the space provide to add any additional information/ experience to support your application:
Can you attend the 2 day meeting in
Cambridge in April?
Yes
No
References
Name
Relationship
Company/School Name
Official Position
Email Address
Postal Address
Declaration
By completing and returning this application you consent to UCLES seeking and receiving relevant information
held by other exam boards regarding your performance as well as giving consent to UCLES to disclose such
information should any other exam board make a request for a relevant reason.
I certify that the information I have given in this application is true and complete to the best of my
knowledge and that I include a personal reference to support my application.
Signed
Date
Checkpoint Application Form