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PROOF OF ENGLISH PROFICIENCY

Participant’s Name: Interview Date:

Name of Interviewer: Position:
Interview Location: Start Time: ________ End Time: _______
Score: ____ / 4 Score: _____ / 100

English Proficiency Rating:

4. Native Speaker: English is the applicant’s first language and is the official/primary
language in the applicant’s home country.
3. Excellent: Thinks in English. Comprehends at normal speaking speed. No noticeable
grammatical errors and is accustomed to speaking with native English speakers.
2. Good: Able to speak easily with some grammatical errors. Comprehends most
conversation the first time hear at normal speaking speed. May have to ask native
English speakers to explain some terms.
1. Fair: Able to speak with limited vocabulary. Comprehends simple, slowly spoken
conversation. Will have to ask native English speakers to slow down.

Explain why you believe the applicant should be given the above rating:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Would this applicant be able to function on day-to-day basis in all English-speaking

environment?
Yes ____ No ____

Explain:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

If the applicant has an emergency in the U.S. will his/her English be sufficient to communicate
with emergency personnel who only speak English?
Yes ____ No ____

Explain:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
 INTERVIEW REPORT

Does the applicant fully understand the nature of the jobs that he/she is applying for and the
expectations of the employer?
Yes ____ No ____

Eligible applicants must be mature and responsible. Discuss and list examples that
demonstrate the applicant’s ability to:

Excellent Good Fair Poor

Adapt to new situations
Problem solve
Demonstrate Good Judgment Skills
Cooperate with Others
Initiate Conversation
Be Patient
Be Flexible

Why does the applicant want to participate on the Work & Travel Program?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Overall Rating Excellent (4) Good (3) Fair (2) Poor (1)

Explain why the applicant would or would not be a good candidate for the program. Please
provide examples:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________

Signature and Verification of Agent & Applicant Interview Meeting

This certifies that both the Applicant and the Interviewer have met in person to conduct the Work & Travel
Interview Questionnaire. Both parties assure that the interview was conducted entirely in English and are aware
that any misrepresentation of this student’s English ability may result in their expulsion from the Work & Travel
Program.

Applicant’s Signature _____________________ Date __________________

Interviewer’s signature ______________________ Date ___________________