2010 epik application form

8/14/2019 2010 EPIK Application Form

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EPIK APPLICATION FORMFOR MARCH 2010 1/16

PLEASE NOTE:PLEASE NOTE: In order to be eligible for an interview, all fields in this formIn order to be eligible for an interview, all fields in this formmust be completed fully.must be completed fully.

Please enter N/A for questions that do not apply to you to show that you have read them. Please type your

answers. Do not write.

-1 LEGAL NAME-1 LEGAL NAME

Enter your name exactly as it appears on your passport

-1 DATE OF BIRTH-1 DATE OF BIRTH -2 AGE-2 AGE

YEAR MONTH DAY

-1 GENDER-1 GENDER -2-2 MARRIAGEMARRIAGE -3 PLACE OF BIRTH-3 PLACE OF BIRTH

-1 PRIMARY CITIZENSHIP-1 PRIMARY CITIZENSHIP -2 SECONDARY CITIZENSHIP**-2 SECONDARY CITIZENSHIP**

CITIZENSHIP YOU WOULD USE TO TEACH IN KOREA LIST ANY OTHER CITIZENSHIP(S) YOU HOLD

** NOTE FOR KOREAN CITIZENS: Overseas Koreans with permanent residence in one of the seven (7) designated

English-speaking countries and a minimum total of 10 years of education (from grade 7 up) in that country

may also apply

-1 CRIMINAL RECORDHave you ever been charged (whether convicted or dismissed) with anything moreserious than a minor traffic offense?

NOTE: ALCOHOL OR SUBSTANCE-RELATED TRAFFIC OFFENCES ARE NOT

YES NO

-2 MINIMUM EDUCATIONAL REQUIREMENTSHave you studied in one of the seven (7) designated English-speaking countriesbeginning from the first year of middle school through high school anduniversity for a minimum total of 10 years AND do you now or will you soon hold aBachelors degree or its equivalent?

-3 WILLINGNESS TO WORK ANYWHERE IN KOREAAre you willing to work at a public school anywhere in Korea?

-4 WILLINGNESS TO WORK AT ANY EDUCATIONAL INSTITUTIONAre you willing to work at any public educational institute (primary, secondary ortrainin center ?-5 SUCCESSFUL CONTRACT COMPLETIONHave you ever resigned from, or broken, any teaching contract, whether at home or

Pleaseattached yourmost recenthead photo

here

FIRST NAME MIDDLE INITIAL

LAST NAME

MALE FEMALE MARRIED UNMARRIED CITY (STATE/PROVINCE) COUNTRY


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If yes, please explain briefly:

-6 CURRENT CONTRACT STATUSDo you currently hold a contract position in Korea? If yes, please give the exact finish

** THE MANDATORY ORIENATION WILL BEGIN IN MID-FEBRUARY 2010 M M D D Y Y Y Y


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INTERVIEW CONTACT INFORMATION

Please many contact info as possible. Please include country code and area code with phone numbers.

Available Interview Days &

Primary Phone City & Country

Secondary Phone City & CountrySkype ID Primary email

Live (MSN) Messenger ID Secondary

** Interviews are scheduled in Korean Standard Time (KST). Interviews are for about 30-45 minutes, and

are HELD ONLY DURING OFFICE HOURS FROM 09:30-11:00 in the morning and 13:30-16:30 KST in the

afternoon. Please list a rangeof available interview dates & times(e.g., M-F, 13:30-16:30 KST).-1 CURRENT ADDRESSPlease enter your contact information at the time of application

HOUSE NUMBER & STREET NAME CITY STATE/PROVINCE ZIP CODE COUNTRY

PRIMARY TELEPHONE (INCL. COUNTRY CODE & AREA CODE) EMAIL

-2 CURRENT AND PREVIOUS RESIDENCE(S)

Please list the dates and names of your current address and the three most recent locations where you have lived for 6

months or more in the past 10 years (you can omit addresses where you resided for a single school term). Please list

from most recent to least recent.

STATE/PROVINCE COUNTRY FROM (MM/YY) TO (MM/YY) YEAR(S) MONTH(S)

Residence listed in section -1 MM/YY MM/YY

MM/YY MM/YYMM/YY MM/YY

MM/YY MM/YY

-3 MAILING ADDRESS FOR SUCCESSFUL APPLICANTSEPIK normally couriers contracts to

successful applicants from December to February. Please be sure to notify your application agent or the EPIK office

immediatelyof any address changes.

YES NO

If you are invited to become an EPIK teacher, do you expect that EPIK can mail thecontract to you at the address listed in -1?**

** IF NO, PLEASE LIST YOUR EXPECTED FUTURE MAILING ADDRESS IN SECTION -5.

-4 CHANGE OF ADDRESSPlease be sure to notify your application agent or the EPIK officeimmediatelyof any changes

to your address.

When do you expect to change your current address?**

M M D D Y Y Y Y

** IF YOU WILL CHANGE ADDRESSES, LIST YOUR EXPECTED FUTURE ADDRESS OR PERMANENT ADDRESS INFO IN -5.


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IF YOU DO NOT EXPECT TO CHANGE ADDRESSES IN THE NEXT 6 MONTHS, PLEASE ENTER N/A.

-5 FUTURE/PERMANENT MAILING ADDRESS FOR SUCCESSFUL APPLICANTS

Please list as much detail as possible about your expected future address or permanent address.

HOUSE NUMBER & STREET NAME CITY STATE/PROVINCE ZIP CODE COUNTRY

TELEPHONE (INCL. COUNTRY CODE & AREA CODE) EMAIL


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-1 EDUCATIONAL BACKGROUND-1 EDUCATIONAL BACKGROUND

Please fill outall of the requested fields below. For elementary, middle, and high school, list only the final institution

you attended for each level. For post-secondary education, please list all of the institutions where you have obtained

credits toward your degree(s).

For institutions where you did not obtain a degree, please enter N/A in the fields for degree and graduation date.

NOTE:EPIK DOESNOTRECOGNIZEDEGREESOBTAINEDFROMPOST-SECONDARYINSTITUTIONSOUTSIDEONEOFTHESEVEN (7) DESIGNATED

ENGLISH-SPEAKINGCOUNTRIES. FAILURETOFILLOUTTHISPART ACCORDINGLYWILL NULLIFYYOUR

APPLICATION

MUST INCLUDE YOUR GPA OR CUMULATIVE MARK/GRADE/CLASS FOR TERTIARY DEGREESMUST INCLUDE YOUR GPA OR CUMULATIVE MARK/GRADE/CLASS FOR TERTIARY DEGREES

EARNEDEARNED

LEVEL NAME OF INSTITUTION STATE &

COUNTRY

ENROLLMENT GRADUATION

DATE (MM/YY)

Total No.

of yearsat each

level/

school

FROM

(MM/YY)

TO

(MM/YY)

ELEMENTARY

SCHOOLMM/YY MM/YY N/A

MIDDLE

SCHOOL

MM/YY MM/YY N/A

HIGH

SCHOOL

MM/YY MM/YY MM/YY

POST

SECONDARY

EDUCATION (1)

MM/YY MM/YY MM/YY

DEGREE: GPA: /DEGREE: GPA: / MAJOR:MAJOR:

POST

SECONDARY

EDUCATION (2)

(IF APPLICABLE) MM/YY MM/YY MM/YY


POST

SECONDARY

EDUCATION (3)

(IF APPLICABLE) MM/YY MM/YY MM/YY


-2 TEFL//TESOL /CELTA or TEACHERS CERTIFICATION/LICENSE-2 TEFL//TESOL /CELTA or TEACHERS CERTIFICATION/LICENSE

TITLE OF CERTIFICATION ACCREDITINGINSTITUTION

ISSUE DATE(MM/YY)

EXP. DATE(MM/YY)

HoursComplete

d

TEFL/TESOL orCELTA

MM/YY MM/YY

TEACHERS

CERTIFICATION/

MM/YY MM/YY N/A


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LICENSE

**Successful applicants must provide documented proof of the number of completed hours for a TEFL or

TESOL certificate.

If the number of hours is not stated on the certificate, additional official documentations are required. A

minimum of 100 course hours is required to be potentially eligible for a higher pay level. Initially copy of

certificate copies suffice, original certificate must be shown upon arrival in Korea.

-1 NON-TEACHING WORK EXPERIENCE List from the most recent employment - add more rows if

necessary.

JOB TITLE EMPLOYER COUNTRY FROM

(MM/YY)

TO

(MM/YY)

NUMBER OF

MONTHS

MM/YY MM/YY

MM/YY MM/YYMM/YY MM/YY


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-1 FULL-TIME TEACHING EXPERIENCE-1 FULL-TIME TEACHING EXPERIENCE

Please list only PAID full-time teaching experience at an accredited educational institution. List

from the most recent paid full-time teaching experience and add more rows if necessary. IMPORTANT

NOTE: For GET Qualification Level & Pay, EPIK ONLY accepts paid full-time teaching experience coming

from one educational institution for a minimum of one full academic year. In order to be eligible for a

higher GET level & salary, successful applicants MUST provide Official Proof of Teaching Experience/PTE

issued by the institution in question. The PTE should be written in an official letterhead with full contact

information of the issuing institution including official signature where applicable, as well as employment

period (start and finish dates) with the month and year employed. PTE/s should clearly state paid full-

time teaching; PTE/s indicating less than 12 months of employment must clearly state that the teacher

was employed for one full academic year. PTE/s that do not subscribe to these specifications will

automatically be null and void which will result to lower GET level and pay.

NAME OF INSTITUTION COUNTRY AGE RANGEOF STUDENTS

FROM

(MM/YY)

TO

(MM/YY)

NUMBER OF

MONTHS

MM/YY MM/YY

IF YOU NOW HOLD A CONTRACT POSITION, WHEN IS THE EXACT FINISH DATE OF THE CONTRACT? M M D D Y Y Y Y

MM/YY MM/YY

MM/YY MM/YY

-2 REFERENCES FOR FULL-TIME TEACHING EXPERIENCE IN KOREA-2 REFERENCES FOR FULL-TIME TEACHING EXPERIENCE IN KOREA If you have taught in Korea, please list the contact information for your institution(s). Contact information

must be for the main administration office, your director or supervisor. Contacts of colleagues/co-

workers are not acceptable. If you have done more than two contracts, please list the two most recent

contracts.

NAME OF INSTITUTION NAME OFDIRECTOR/SUPER

OFFICE PHONE MOBILE PHONE

-3 PART-TIME , STUDENT TEACHING, or TUTORING EXPERIENCE-3 PART-TIME , STUDENT TEACHING, or TUTORING EXPERIENCE

List from the most recent experience and add more rows if necessary. You may also include education-related volunteer

experience in this section.

NAME OF INSTITUTION COUNTRY AGE RANGEOF STUDENTS

FROM

(MM/YY)

TO

(MM/YY)

NUMBER OF

MONTHS

MM/YY MM/YY

MM/YY MM/YY

MM/YY MM/YY


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-1 SALARY LEVEL-1 SALARY LEVEL

EPIK salary is standardized (non-negotiable) based on qualifications, teaching experience, & credentials.

Please note that only paid full-time teaching experience for a minimum of one full academic year makes

an applicant eligible for a higher GET level & salary. TEFL and TESOL must have at least 100 course hours

which should be proven official documentation. Details on GET Level & Pay are attached & can also be

found in our website. Please list the pay level that you CURRENTLY qualify and your expected qualification

level (based on the completion of TEFL/TESL certification and/or teaching experience) for SY2010-2011.

LEVEL 3(beginning

salary)

LEVEL 2 LEVEL 2+ LEVEL 1(top entry

level)

CURRENT QUALIFICATION

EXPECTED QUALIFICATION


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-1-1 PROVINCIAL PLACEMENT PREFERENCES (please read)PROVINCIAL PLACEMENT PREFERENCES (please read)

EPIK is a national program that places teachers all over Korea. EPIK tries intentionally to place successful

applicants according to provincial/metro preferences using an unbiased first-come, first-serve placement

system. However, the final provincial/metro recommendation depends on the availability of the remaining

slots at the time EPIK receives your complete required documentation. Therefore, because of the first-

come, first-serve placement assignment of education offices, applicants must ultimately be flexible

about working anywhere in Korea in case preferred placements are unavailable at the time your

completed documents are received.

PLEASE ALSO NOTE: The final acceptance/placement decision is made solely by the Provincial Office of

Education to which you have been recommended and not the National EPIK Office. Successful applicants

are unable to select specific cities within a province or specific districts within a city-province.

-2 PREFERENCE FOR PROVINCE TYPE-2 PREFERENCE FOR PROVINCE TYPEANYWHERE PROVINCIAL

TOWNPROVINCIALCITY

Please check the kind of province you would prefer to work in:

-3 PREFERENCE FOR PROVINCE LOCATION-3 PREFERENCE FOR PROVINCE LOCATION

The 15 Provincial/Metro Offices of Education that comprise the EPIK program are (c indicates a

city-province):Busan (c) Ulsan (c) Chungbuk (Chungcheongbuk-do) Gyeongbuk (Gyeongsangbuk-do)

Daegu (c) Chungnam (Chungcheongnam-do) Gyeongnam (Gyeongsangnam-do)

Daejeon (c) Gangwon (Gangwon-do) Jeju (Jeju-do)

Gwangju (c) Jeonbuk (Jeollabuk-do)

Incheon (c) Jeonnam (Jeollanam-do)

FIRST SECOND THIRD FOURTH FIFTH

List your location preferences in

**Please note that applicants who successfully pass the interview will only be recommended for placement to a

province/metro upon successful submission of all the required documents based on an impartial first-come, first-

serve basis. Please also note that the final acceptance decision is made by the Provincial Office of Education and not the

National EPIK Office.

-4 PREFERENCE FOR TYPE OF EDUCATIONAL SETTING-4 PREFERENCE FOR TYPE OF EDUCATIONAL SETTINGPRIMARYSCHOOL

MIDDLESCHOOL

HIGH SCHOOL TRAININGINSTITUTE

In numerical order (1 being most preferred),list which type of school best matches your

****Please note that as much as Education Offices place successful applicants based on the strength of

qualifications, credentials, and backgrounds, other factors such as availability of slots and priority programs


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of districts just to name a few are also considered. As such the student body and school set-up setting

cannot be guaranteed or known in advance. The proper forum and venue for this is during the EPIK

orientation.

YES NO

- 5 Are you aware that provincial/metro recommendations are made only after thesuccessful submission of all the required documents on a first-come, first-serve basis?

- 6 Are you aware that specific school location and student body is determinedsolely by the education office and is known only during EPIK orientation?

-7 Are you aware of the potential that you might work at more than one school(hours are the same) and/or your additional school(s) could be in adjacent small

- 8 Are you aware that, although the Provincial Offices of Education try intentionallyto place you as close to your school(s) as possible, you may be required to commute


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PERSONAL MEDICAL ASSESSMENTPERSONAL MEDICAL ASSESSMENT

Applicants do not require an authorized medical exam before they arrive in Korea; all successful

applicants must take a medical exam in Korea (including an HIV and TBPE drug test**) in accordance

with the requirements of the Korea Immigration Service and the EPIK program. If the results show that the

applicant is unfit to be an EPIK teacher, all costs for entry, stay, and departure will be borne by the EPIK

applicant.

** The TBPE (** The TBPE (tetrabromophenolphthalein ethyl ester) is a comprehensive drug test for use of all kinds of stimulant drugs.tetrabromophenolphthalein ethyl ester) is a comprehensive drug test for use of all kinds of stimulant drugs.

Sex: HEIGHT IN

CENTIMETERS:

c

m

WEIGHT IN KILOGRAMS: kg

When and for what reason did you last consult a

physician? (Please explain in the adjacent space)

QUESTION YES NO IF YES, PLEASE EXPLAIN

Are OR were you HIV (AIDS) Positive?

Have you ever had an infectious disease that poses

a risk to public health (such as, but not limited to,

tuberculosis and other STDs)?

Have you ever had any of the following:

1. allergies?

2. high blood pressure?

Have you ever suffered from, or been treated for,

depression, anxiety, or any other mental or mood

disorder? (If you have received treatment, please

explain and attach an official medical report).

Have you ever been addicted to alcohol?

Have you ever abused any narcotic, stimulant,

hallucinogenic or other substance (whether legal or

prohibited)?

If necessary, are you prepared to undergo physical

tests to verify the answers given in questions

and above?

Have you been hospitalized in the last two (2)

years?

Have you had any serious injury, ailment or

sickness in the last five (5) years?

Do you have any visual or hearing impairments?

Do you have any physical disabilities?


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Do you have any cognitive/mental disabilities?

Are you taking any prescribed medication?

Are you on a special diet?

O n average, how many standard servings of alcohol do you consumeeach week?

YES NO IF YES, EXPLAIN BRIEFLY

Have you ever been charged (whether

convicted or dismissed) with more than aminor traffic violation?**

Have you ever had your drivers licensesuspended (even for less than 24 hours?)

Have you ever applied to teach at a public

school in Korea? Where did you apply?

Are you currently applying for other ESLpositions? In which provinces or countries?

Have you ever visited Korea before?

Do you have any Korean language skills?

Are you a vegetarian or vegan?

Are you aware that, although Korean dishescontain a lot of vegetables, a large numbercontain small amounts of meat or meat

products?

Have you ever lived or travelled abroad for 3months or more?

Do you have any tattoos or piercings?

Are you familiar with the job description andworking environment for GETs described on

the EPIK website?*

** Driving under the influence ofalcohol or other substances is NOTconsidered a minor offence.

Are you aware that you will be expected toplan lessons in advance and sometimes leadEnglish classes?

Do you agree to notify EPIK within 48 hours ifyou drop out after you have received theNotice of Appointment?

Were you recommended to the EPIK program

by a current EPIK teacher? If yes, please listtheir contact information.**

Full NameMobilephoneEmail

addressMain School


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City/Province Where did you first learn about EPIK? Personal Referral EPIK website School/Institut

e

Embassy/

Consulate

Other websites Other

** The Referral Bonus will be given only for applicants who applied directly to EPIK (not agency or consulate/embassy

applicants).

REQUIRED DOCUMENTS REQUIRED DOCUMENTSIf you successfully pass the EPIK interview, you will be required to submit all the necessary

documents to complete your application. More information about the required documents can be

found at our website and will also be emailed to you. **DOCUMENTS SUBMITTEDTO EPIK WILL NOT BE

RETURNEDREGARDLESSOFTHEFINALOUTCOMEOFTHESELECTIONPROCESS.**

The answers I have provided throughout this application are true and correct to theThe answers I have provided throughout this application are true and correct to the

best of my knowledge and I will bear full legal and financial responsibility for anybest of my knowledge and I will bear full legal and financial responsibility for any

errors or falsehoods contained herein.errors or falsehoods contained herein.

FIRST NAME MIDDLE INITIAL LAST NAME

MM

/ DD

/ YYYY

SIGNATURE

(ONLINE APPLICANTS MUST TYPE HERE AND SUBMIT INK SIGNATURES LATER)

DATE


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PERSONAL ESSAYPERSONAL ESSAY

Please write an essay below (minimum 300 words; maximum 1 page)

We are interested in your ability to succeed as an ESL teacher in a public school in

Korea. In the space below, please share with us your reasons for wanting to teach

ESL in Korea, your educational philosophy and your thoughts on

encountering/managing cultural differences.

FIRST NAME MIDDLE INITIAL LAST NAME

2010 epik application form

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