FOR OFFICE USE

Marks Code No.

Incomplete applications will be rejected.

To be filled by the Applicant

* Please read the instructions given on last
page and in Circular No. 03 (01) 2009, before Last Served Last Served
completing Year Town
* If a child, a family member or a resident of an
2019
applicant is sitting this examination, he/she is
not elegible for the post of Chief Examiner. Code No. Teaching Exp.
The closing date of
School: 2146 AM/SOORIYAPOKUNA MAHA Applications is
VIDYALAYA, DEHIATTAKANDIYA. 20th April 2022. OL/21/X/2666

G.C.E. (O/L) Examination - 2021 (2022)

Application for Selection of Marking Examiners
Preferred medium of marking Sinhala Tamil English

(a) Subject No. & subject applied

01 : (21)-SINHALA LANGUAGE & LITERATURE
for marking

Town No. and town you wish to do marking (Town closest to either your place of work or permanent residence. Please
02
see the list of towns on last page)

(a) First choice: (22) Mahiyanganaya (b) Second choice: (36) Polonnaruwa

03 (a) Name with initials : Mr. L.G.GALKOTUWA

(b) Names denoted by initials : LALITH GUNAWARDHANA GALKOTUWA

: NO.53, MURUTHAGASPITIYA, DEHIATTAKANDIYA,

(c) Permanent address
AMPARA,DEHIATTAKANDIYA

(d) E-mail address : lalithgalkotuwa@gmail.com

(e) Gender : MALE (f) NIC No. : 680641323v

04 Present working (a) District: AMPARA (b) Education zone : Dehiattakandiya

(c) Permanent residential

AMPARA
district:

: AM/DEHI/SOORIYAPOKUNA SECONDARY SCHOOL,SOORIYAPOKUNA

(d) Official address
EC.SCHOOL,SOORIYAPOKUNA,DEHIATTAKNDY,DEHIATTAKANDIYA

(e) Telephone No. : Office: 0712528146 Home: Mobile: 0704620207

05 (a) Date of birth: 1968-03-04 (b) Age as at 08-04-2022: 54-1-4

06 Date of appointment as a teacher: 2006-02-06

(a) Present designation ,Service

07 : Teacher - SLTS Grade I
& grade

(b) Date of appointment to the above post: 2006-02-06

08 (a) Date of appointment as a graduate/higher diplomate teacher : 2008-07-20

(b) Period of service after being appointed as a

Years: 14
graduate/higher diplomate teacher:

09 (a) Academic and professional qualifications: (If this section is incomplete, application will be rejected.)

1
 Class Special
Academic/ Professional/ Course Year Subjects Passed Name of the
obtained (If Passes (If
Other Qualifications Followed Completed (Compulsory) University/Institution
any) any)

Sinhala Sinhala literature

Training Relevant to Giragama Guru
Special 2008 Sinhala Grammer
the subject applied Widyalaya
Cource Sinhala liter

Degree relevant to the

- -
subject applied

Postgraduate Diploma - -

Please attach a descriptive certified copy of the Degree/Diploma certificate relevant to the applied subject.(Compulsory
for new applicants and examiners those who have not produced them last year)

(b) State in brief, If you have participated in national level activities related to the subject. (Contribution to prepare Text
Books, Teacher's Guides, Prototype question papers, Evaluation Reports or publication of subject-related books.)

Please attach copies of relevant letters

10 Fill in 11(a), (b), (c) according to your duties:

i. Complete personal time table approved for year 2021 (with Subjects & Grades)

Write E along with the subject , If you teach in English medium

Monday Tuesday Wednesday Thursday Friday

Time
Subject Grade Subject Grade Subject Grade Subject Grade Subject Grade

ii. No. of periods you teach the applied subject in iii. Results of school at G.C.E. (O/L) - 2020(2021) for the
G.C.E. (O/L) classes per week: subject you applied for marking :

Results of the
Overall results
students you
of the school
Geade 10 taught

Grade 11 (First time Students) No. of students 48 48

Total No. of periods No. of students passed 46 46

Pass percentage 96 96

I hereby certify that the personal time table given above is correct according to the approved time table of the school/
Institution and the results mentioned above are correct.

Name of the Principal/ Deputy Principal/ Assistant Principal/ Head of the institution:

(Official frank) Signature & Date

2
 You are thoroughly advised not to submit incorrect time tables. Disciplinary actions will be taken
against the teachers and heads of institutions who submit false information.

(b) For In-service advisers (ISA)

(Only for already registered ISA) :

(i) Date of appointment to ISA

0000-00-00
service:

(ii) Subject/subject field:

(iii) Education
- Education division: -
zone:

(iv) Your duties related to this subject :(If there are any special projects conducted by you in the year 2021, please
mention them.)

(c) For other officers in the field of education :

(i) Relevant subject field: Date of appointment : 0000-00-00

(ii) Work you are engaged in relation to the subject applied for marking :

I hereby certify that the above information is true.

Date:

Signature of Zonal/ Divisional Director of Education/

(Official frank is compulsory.)
Head of Institution

11 Experience in evaluation:

(a) G.C.E.(O/L) Examination

(i) Experience as an Assistant Examiner for the subject

9 Years
applied

(ii) Last year in which you marked the applied subject 2019 Code No. : OL/21/X/2666

(iii) Experience as an Assistant Examiner of a subject

0 Years
other than the subject applied.

(21)-
Sinhala Year of last appointment
(iv) Subject relevant to (iii) above: 2019
Language & relevant to (iii) above :
Literature

(b) (i) Experience as a Chief Examiner for the subject

0 Years
applied

(ii) Last year in which you were appointed to the above

Code No.:
post:

(iii) Would you like to accept appointment as a Chief Examiner (if Selected) this year?: Yes

(c) (i) Indicate the reasons, If you were appointed as a Chief/ Assistant Examiner last year and unable to accept the
appointment.

12 Is a family member or a resident of your house expected to sit the above examination this year ? No

If yes, from which district is it? -

(a) (i) Is any disciplinary inquiry against you in

13 No (If these boxes are
progress?
not filled application
will be rejected.)
(ii) Are you debarred from examination duties? No

(iii) If yes, give details :

3
14 Declaration of the Applicant:

Date:

Signature of the Applicant

15 Confidential Report of the certifying officer : (Please read the instructions given on the last page, before completing)

(a) Regarding this applicant, his/ her

(i) Competency in the subject, applied for marking (ii) Ability to bear responsibilities

(iii) Dedication to work/ duties (iv) Leadership and ability to lead a group

(b) I hereby certify that the information provided in Sections 01 to 11 and in Section 14 is correct and that the applicant
is suitable to serve as a marking examiner, and I agree to release him/ her if selected.

Name:

Signature of Principal/ Head of

Address :
Institution

(Official frank is compulsory.)

Date:

To be certified and send by the Principal through online for a teacher, by the Zonal/ Divisional Director of
Education for an ISA.