Application of Selecting ICT Teachers/ISAs/CRC Instructors/PICTEC Instructors for a

Foreign Training Program - 2018

1. Name of the Teacher (with initials in block capitals) -

.............................................................................................................................................
2. Name in Full -
.........................................................................................................................................................
..........................................................................................................................
3. Date of Birth - ............................ Age as at 30.04.2018 Years: .... Months:… Days: …..
4. Official Address - .........................................................................................................................
.........................................................................................................................................................
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5. Permanent Service and Grade-……………………………………………………………...
6. Designation- School Teacher/In Service Advisor(ISA)/CRC Instructor/PICTEC Instructor
7. Name/Address of salary drawn office-…………………………….………………………
……………………………………………………………………………….………………
8. Education zone of salary drawn office-…………………………………………………..
9. Private Address- ..........................................................................................................................
.........................................................................................................................................................
10. E mail Address ...........................................................................................
11. Tel. No. - Mobile:……………………….. Official:…………………………….……….
12. Educational and Professional Qualifications -
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.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................................

13. Date of Appointment in Teaching Service - ......................................................

14. Are you confirmed in the service?.................(Attach a photocopy of the letter)
15. Have you been granted no-pay leave (except maternity leave)?....................( Attach the letter
verified by the Head of the Institution)

16. Have you ever participated for South Korean foreign training program under the
"Gwangju-Sri Lanka MoU”? ........................

17. Have you attended any foreign training program given by the Ministry of Education /
Provincial Council after 2014-05-01? .......................

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18. Service Description after 2014-05-01(Within this period study leave / no- pay leave /
foreign leave has been obtained, details should also be included).
Name/Address of the office Duties performed From…………. To………………

19. Period of Work - Years ......................... Months .............

20. Nature of Appointment & Subject
Nature of Appointment (Graduate/College of Institute earned the Qualification Main Subject Year
Training/Trainee/Other ........................ Mention)

21. Subject/Subjects Presently Teaching/ No. of periods (for a Week)

No. of No. of
Subject Subject
Periods Periods
1. 4.
2. 5.
3. 6.

22. Date started teaching ICT (only for those who appointed for another subject except ICT ) -
..........................................................................
23. Educational and Professional Qualifications related to ICT subject - (Only if any qualification
not mentioned in No. 12)
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
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24. Services provided to the development of ICT subject during the period of service –
(Subject oriented activities/ service rendered as a resource person at workshops/ hardware development/software
development/ Exhibitions etc.- more details could provide in a separate sheet.)

Activity From To Duration School Level /Zonal/

Provincial/National

1.
2.
3.
4.

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 ත ොරතුක්ෂණ විෂය සම්බන්ධතයන් අධයොපන පද්ධතියට සිදු කරන ලද තසේවය - (තකටිතයන්)
25. Service provided for the benefit of the education system other than teaching ICT subject in
brief.[Additional details can be attached separately]
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.................................................................................................................................
26. Other than details of No. 1-25 ISA’s should mention details of services provided to the
education system and ICT subject from the date of appointment as an ISA ( If there are details
other than in No. 24 & 25)
...................................................................................................................................................
...................................................................................................................................................
................................................................................................................................
27. Provincial/ Zonal lecturers of CRCs need to mention details other than services provided as
course coordinator and details other than in no.25.
Service provided as a course coordinator
Name of the Course Date of Date Duration No. of
commencement completed Students

1
2
3
4

28. I hereby certify that the above mentioned details are true and correct.

......................................... .............................................
Signature of the Applicant Date

29. Recommendation for the application

29.1 Recommendation of the principal- (for school teachers)

I hereby certify that the above mentioned details are true and correct and confirm that Mr./ Ms.
……………......................................................................................................... is an ICT teacher of
…………………………………………………………….. MMV/MV and he/she is engaged in
activities conducted to uplift ICT subject.

........................................................ ..............................
Signature and Official Stamp Date

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29.2 Recommendation of Zonal ICT Coordinator (for all teachers/ISAs/CRC Instructors)
I hereby certify that the above mentioned details are true and correct and confirm that Mr./ Ms.
………….........................................................................................................is a CRC instructor/an
In Service Advisor(ISA)/an ICT teacher and he/she is engaged in teaching and uplifting the
subject.

........................................................ ...............................
Signature & Official Stamp Date

29.3 . Recommendation of Zonal Director of Education (for all teachers/ISAs/CRC Instructors)

I recommend and forward the Mr/Ms………………………………………..’s application.

........................................................ ...............................
Signature & Official Stamp Date

29.4 .Recommendation of the Provincial ICT Coordinator. (for all teachers/ISAs/CRC

Instructors/PICTEC Instructors)

I hereby certify that the above mentioned details are true and correct and confirm that Mr./ Ms.
………….........................................................................................................is a CRC instructor/a
PICTEC instructor/an In Service Advisor(ISA)/an ICT teacher and he/she is engaged in teaching
and uplifting the subject.

........................................................ ...............................
Signature & Official Stamp Date

29.5. Recommendation of Provincial Director of Education

(for all teachers/ISAs/CRC Instructors/PICTEC Instructors)

I recommend and forward the Mr/Ms………………………………………..’s application.

……………………………….. …………………….
Signature & Official Stamp Date

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