For English medium examiners only.

09/OL/2017
* Incomplete applications will be rejected.
*Please read instructions on page 04 and in
O/L Marks
ldr®hFOR
d, m%OFFICE USEi`oyd
%fhdackh
Code No.

2017
Circular No.03 (01)/ 2009 before completing.

* If a family member or a resident of an applicant is To be filled by the examiner.

sitting this examination, he/she can apply for an Last Served
Year Town
Assistant Examiner post only. The closing date of
Applications is Code No.
05 th July 2017.
G.C.E. (O/L) Examination - 2017
Application for Selection of Marking Examiners
01. Subject No. & subject applied for marking :

02. Town No. and town you wish to do marking : (Town closest to place of work or permanent residence. Please see the list
of towns on page 04.)
(a) First choice : (b) Second choice :
03. (a) Name with initials : Rev./Mr./Ms. .................................................................................................................
(b) Names denoted by initials : .......................................................................................................................................
(c) Postal address : .......................................................................................................................................
(d) E-mail address : .......................................................................................................................................
(e) Gender : ........................ (f) National identity card No. :

04. Present working (a) District : (b) Education zone :

(c) Permanent residential district and address : ...........................................................................
...........................................................................
05. (a) Official address : ................................................................................................................................................................

(b) Telephone Nos. : Official Home Mobile

06. (a) Date of birth: D D M M Y Y Y Y

(b) Age as at 31.12.2017:
Y Y M M D D
07. Date of appointment as a teacher: D D M M Y Y Y Y
08. (a) Present post : ....................................................... (b) Service & grade/ class : .............................................

(c) Date of appointment to above post : D D M M Y Y Y Y

09. (a) Date of appointment as a trained/ NCOE/ graduate teacher: D D M M Y Y Y Y

(Strike off words inapplicable.)
(b) Period of service after the above appointment : Years Y Y
10. Period of service as a holder of Diploma/ Post Graduate Diploma in Education or similar qualification: Years Y Y
11. (a) Academic and professional qualifications: (If this section is incomplete, application will be rejected.)
Academic/ Professional/ Course Year Subjects Passed Class Name of University/ Training
Other Qualifications Followed Completed (Compulsory to Received College/ Institution
State Subjects) (If any)
Training relevant to subject
applied
Degree relevant to subject
applied

Any other qualifications

(b) If you have participated in national level activities related to the subject, state in brief. (Contribution to prepare
textbooks, teacher's guides, prototype question papers, evaluation reports or publication of subject-related books.)
Please attach copies of relevant letters. ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
 02
12. Fill in 12(a), (b), (c) according to your duties :
(a) For teachers and lecturers :
(i)
Complete personal time table approved for year 2017 (with Subjects & Grades)
Monday Tuesday Wednesday Thursday Friday
Time Subject Grade Subject Grade Subject Grade Subject Grade Subject Grade

(ii) No. of periods you teach the subject applied (iii) Results of school at G.C.E. (O/L) - 2016 of the subject
in G.C.E. (O/L) classes per week: applied for marking :

Grade No.of periods Subject No. : Subject :
Grade 10
Grade 11 (First shy) Overall result of Result of students you
school taught
Grade 11 (Second shy)
No. sat
Total No. of periods
No. passed
Pass percentage
(iv) No. of Assessments conducted by you for Grade 10 and 11 under the SBA program for the relevant subject in the year
2017:
In Term I of 2017 In Term II of 2017
Conducted Planned
Assessment types you have chosen for above:
........................................................ ...................................................... .......................................................
........................................................ ...................................................... .......................................................
........................................................ ...................................................... .......................................................

I hereby certify that the personal time table, statistics about results and information regarding SBA furnished above
are correct according to the relevant documents.

................................................. (Official frank ) .......................................................

Name of Deputy Principal Signature & Date

You are thoroughly advised not to submit incorrect time tables. Disciplinary action will be taken against the teachers
and heads of institutions who submit false time tables.
(b) For In-service advisers :
(i) Date of appointment to ISA service: D D M M Y Y Y Y
(ii) Subject/ subject field : ................................................................................................................................................
(iii) Zone : ............................................ Division : .........................................
(iv) Your duties related to this subject : (If there are any special projects conducted by you in the year 2017,
please mention them.) ..............................................................................................................................................
(c) For other officers working in education field :
(i) Relevant subject field : Date of appointment : D D M M Y Y Y Y

(ii) Work you are engaged in relation to the subject applied for marking and to the G.C.E. (O/L) syllabus : ..................
..................................................................................................................................................................................
I hereby certify that the above information is true.

.............................................................................
Date : .................................. Signature of Zonal/ Divisional Director of Education/ Head of Institution

(Official frank is compulsory.)
 03
13. Experience regarding evaluation:
(a) G.C.E. (O/L) Examination
(i) Experience as an Assistant Examiner : Years

(ii) Experience as an Assistant Examiner of the subject applied : Years

(iii) Experience as a Chief Examiner of the subject applied : Years

(iv) Year you last attended marking of the subject applied : Code No. :

(b) G.C.E. (A/L) Examination

(i) Experience as an Assistant Examiner : Years

(ii) Experience as a Chief/ Additional Chief Examiner : Years

(iii) Year of last attended marking : Code No. :

(c) (i) If you were appointed as an Assistant/Chief Examiner in 2016 and could not attend duties, indicate the reasons.
....................................................................................................................................................................................
(ii) If you have participated in marking earlier and did not participate in recent years, indicate the reasons.
...................................................................................................................................................................................
(iii) Would you like to accept a Chief Examiner post this year, if given? Yes No
(Tick (√ ) the relevant box.)
(d) (i) Experience as an EMF : Years
(ii) If you served as an EMF in 2016, your code No. :
G.C.E. (A/L) G.C.E. (O/L) Grade 5 Scholarship
14. Are you, a family member or a resident of your house expected to sit this examination this year ? Yes No
If yes, from which district is it ? ............................................................ (See Paragraph 1.5 on page 04.)

15. (a) Is any disciplinary inquiry against you in progress? Yes No

(b) (i) Are you debarred from examination duties ? Yes No

(√ ) the relevant box.
Tick
(If these boxes are not filled application will be rejected.)

(ii) If yes, give details ......................................................................................................................................................

16. Declaration of applicant :
I hereby declare that the information given above is true and accurate and that I am not debarred from marking at
present and I am aware that I will be subjected to disciplinary action if found to have submitted false information and
mislead the department. If I am selected as a marking examiner, I agree to safeguard the dignity of the institution
where the marking center is established and abide by its rules and regulations, and follow the provisions of the Public
Examinations Act as well as the instructions given by the Commissioner General of Examinations and abide by the code
of ethics for evaluation staff.
Date : ........................................... ...........................................
Signature of Applicant
17. Recommendation of the certifying officer :
(a) State your recommendation clearly regarding the selection of this applicant for marking of the above examination.
..................................................................................................................................................................................
(b) I hereby certify that the information contained in Sections 01 to 12 and in Section 15 is correct and that this
applicant is suitable to serve as a marking examiner, and I agree to release him/ her if selected.

.......................................
Signature of Principal/ Head of Institution Name : ..................................................................................
Address : ..............................................................................
(Official frank is compulsory.)
Date : ..........................................

To be certified by the Principal for a teacher, by the Zonal/ Divisional Director of Education for an ISA and by the Head of
Institution for any other officer.
 04
01. Instructions to complete the application:
1.1 Instructions of Circular No. 03 (01)/ 2009 dated 01.03.2011 should be followed.
1.2 Teachers and officers working under the Ministry of Education and fulfill the following requirements can apply.
(a) Having studied the subject applied for the teacher training (ordinary or special)/ NCOE training/ Degree
and have received a proper and permanent appointment.
(b) Teaching the subject in G.C.E. (O/L) (Grade 10, 11) classes if a teacher or engaged in duties related to G.C.E.
(O/L) syllabus, if any other officer. (If you are a Principal, please do not apply.)
1.3 When filling Section 11, it is compulsory to note down qualifications relevant to the subject. Failure to state
subjects will result in rejection of the application.
1.4 When filling Section No.14 & 15, clearly indicate 'Yes' or 'No' with a ' √ ' in the relevant box. If this section is
not completed properly your application will be rejected.
* If there's a disciplinary inquiry in progress against you or you are debarred from marking, you cannot submit
an application form.
1.5 A family member means your spouse, children, grand children or your or spouse's siblings and their children.
1.6 A separate application should be submitted, if you are applying for an additional subject.
If the subject applied is different from subjects offered for training or degree, indicate qualifications for
proficiency of the subjects applied. ex : G.C.E. (A/L), Daham School Examination, Bauddha Dharmacharaya.

1.7 It is expected to establish Evaluation Centers in the following towns:
01. Colombo 13. Gampaha 25. Galle 37. Trincomalee 49. Akkareipattu
02. Maharahama 14. Nittambuwa 26. Akuressa 38. Kegalle 50. Batticaloa
03. Homagama 15. Ratnapura 27. Matara 39. Peradeniya 51. Vavuniya
04. Piliyandala 16. Pelmadulla 28. Tangalle 40. Gampola 52. Mannar
05. Moratuwa 17. Embilipitiya 29. Hambantota 41. Kandy 53. Jaffna
06. Hanwella 18. Balangoda 30. Kurunegala 42. Matale 54. Nelliadi
07. Avissawella 19. Bandarawela 31. Nikaweratiya 43. Theldeniya 55. Kilinochchi
08. Horana 20. Badulla 32. Kuliyapitiya 44. Nuwara Eliya 56. Puttalam
09. Panadura 21. Welimada 33. Chilaw 45. Hatton 57. Dambulla
10. Kalutara 22. Mahiyangana 34. Kekirawa 46. Monaragala 58. Wellawaya
11. Mathugama 23. Ambalangoda 35. Anuradhapura 47. Ampara
12. Negombo 24. Elpitiya 36. Polonnaruwa 48. Kalmunai
N.B. Evaluation Centers will not be established in towns where sufficient number of applications is not
received. Therefore your second choice also should be mentioned.
1.8 Appointment will be given to the town closest to the private or official address. If there are no evaluation
panels of the subject applied in the closest center or if there are no vacancies, you will be directed to another
closer evaluation center.
1.9 Fill this form (except Section 17) and handover to the Principal / Head of your institution.

02. Certifying officer:

Certification should be done by the Principal for a teacher, by the Zonal / Divisional Director of Education for an
In-service Advisor and Head of Institution for any other officer.

03. Instructions to certifying officer:

3.1 Examine whether the information provided by the applicant is correct.
3.2 Certifying that the information is correct at the relevant place on page 03 is compulsory.
3.3 It is the responsibility of certifying officer to indicate recommendation on Section 17 and authenticate with
signature and official frank.
3.3 This is a confidential report. Keep copies of applications after certification and send along with a schedule to
reach the following address on or before July 05, 2017. Indicate "Application for Marking Examiners - OL 2017"
on top left corner of the envelope.

Commissioner General of Examinations

Evaluation (School Exams) Branch
Department of Examinations, Sri Lanka
P. O. Box. 1503
Colombo

This application form is published in the Department's website too. (www.doenets.lk)