Shane Corporation Teacher Training

LTCL Diploma TESOL application form

Personal Details
Surname (Mr. /Ms/Miss/Mrs): First Name(s): ROHUN Date and Place of Birth: 1986-07-24LONDON, UK GUPTA

PHOTO

Nationality: BRITISH CITIZEN First Language: ENGLISH (British)

Permanent Address: 21 Cambrian Close, York Hill, London, SE27 0BS, UK Tel: 0044 208 761 4996, 0044 7903 061 898 Contact email address: (please print clearly)
rohun.gupta.efl@gmail.com I agree to allow my email address to be communicated to fellow Diploma students.

Yes

Temporary Address (If applicable) / Present Address: JAPAN, 253-0021, Kanagawa-ken, Chigasaki-shi, Hamatake 4-1-75, Leo Palace Avangarude 202 Tel.No: 080-4357-2124 Present Occupation: TEACHER How many hours do you currently teach per week?

Education
Secondary School Qualifications (and year obtained): A-Levels (2004): Spanish (A), Chemistry (B), Biology (B) AS Levels (2003): German (A), General Studies (A) GCSEs (2002): Spanish (A*), German (A*), English (A*), French (A*), Geography (A), Mathematics (A), Chemistry (A), Physics (A), English Literature (A), Biology (B) [French was taken a year early in 2001] Further Education (and year obtained): University College London (2011): Bachelor of Arts in Language and Culture. Upper Second Class Honours (2:i). Distinction in spoken Spanish.

Teaching Experience
Please give details of your teaching experience, indicating the levels taught and age range of the students.

DATES

EMPLOYER

POSITION / RESPONSIBILITIES

Reasons for doing the course

Please state briefly your reasons for doing the course and your future plans.

With reference to your own teaching experience, what do you consider to be the most important factors which aid language learning in a classroom?

Give brief details of any learning difficulty you have such as dyslexia, dyspraxia. ADS, etc:

Give any details of any mental or physical health condition you have that might affect you or others on the course.

Have you ever been convicted of a criminal offence in the United Kingdom or any other country? Yes How did you hear about this course? No

Signed: Referees:

Date:

Please give the names and addresses of two referees to whom we can apply for confidential references. Referees will be contacted in the first instance by email so please be sure to contact your referees in advance to speed up the process of your application. It is sensible to select people who know you well, can advise us about your work and/or study experience and have been in contact with you recently. Please do not use members of your family.

1st referee
Name: Address: Name: Address:

2nd referee

Fax:

Telephone:

Fax:

Telephone:

E-mail: (please print clearly)

E-mail: (please print clearly)

Position held:

Position held:

Please return this application form with a completed pre-interview task to Sophia McMillan at: Kenkyushafujimi Bldg 4F, 2-11-3 Fujimi Chiyoda-Ku, Tokyo, 102-0071 Japan.