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Name (in full)
Address:
Tel/Fax. No.
Date of Birth
Nationality
Passport No.
Current Place of Employment:
Tel/Fax.
E-mail:
Current Position/Duties
Secondary Education
Higher Education
Other Qualifications
Where did you find out about this course?
Preferred course dates:
Native Language:
Other Languages (specify skill and proficiency e.g. reading - weak)
IELTS score (if applicable)
Previous working experience (place, brief description, no. of years)
Have you ever had a criminal record?
Yes
Do you have any health problems which may affect your ability to complete the course?
Yes
Do you have a disability which requires any special facilities?
Yes
Name & address of two referees
Please Note:
Applications close 4 weeks prior to the commencement of the course.
(If faxed...)
Signature .................................................................
Date ........................................................................
IMPORTANT
Please send photocopies of degree/teacher's certificate, and for non-native speakers evidence of IELTS/TOEFL score, or equivalent.
Josie Gawron
Cert.TESOL Course Coordinator
IALF Bali
Jl. Raya Sesetan 190
Denpasar 80223
Bali Indonesia.
Tel: 62-361-225243; Fax: 62-361-263509
e-mail: tesol@ialf.edu
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