» Freelance Interpreter Application

Mrs

First Name *

Last Name *

Your Qualifications as an Interpreter

List the Language(s) you Speak FLUENTLY *

Interpreting Certification(s)

Professional Affiliation(s)

Why would you like to be an interpreter in health care settings? *

Contact Details

Your Website (if any)

Email *

Cell Phone *

Home Phone

Address *

Address Line 2

Zip Code *

City *

State/Province *

Country (if outside the US)

Educational Background

High School Degree (or equivalent) *

City *

State / Country *

Latest Degree / Diploma *

College / Technical School *

Year of Graduation *

City

State / Country *

Previous Degree / Diploma

College / Technical School

Year of Graduation

City

State / Country

Previous Degree / Diploma

College / Technical School

Year of Graduation

City

State / Country

Employment History

Latest Agency Name *

City

State / Country *

Your Job Title *

Your Supervisor *

Supervisor's Title *

Phone Number *

Start Date *

End Date

Your Job Duties *

Reason For Leaving *

Previous Agency Name

City

State / Country

Your Job Title

Your Supervisor

Supervisor's Title

Phone Number

Start Date

End Date

Your Job Duties

Reason For Leaving

Previous Agency Name

City

State / Country

Your Job Title

Your Supervisor

Supervisor's Title

Phone Number

Start Date

End Date

Your Job Duties

Reason For Leaving

Volunteer Experience

Latest Organization Name *

City

State / Country *

Phone Number *

Your Title *

Start Date *

End Date

Your Duties *

Reason For Leaving *

Previous Organization Name

City

State / Country

Phone Number

Your Title

Start Date

End Date

Your Duties

Reason For Leaving

Your Availability for Assignments

Note that you will not be required to accept all assignments.

Scheduled

Urgent

Late Night

Monday

Morning (7am-1pm)

Afternoon (1pm-7pm)

Evening (7pm-12am)

Late Night (12am-7am)

Tuesday

Morning (7am-1pm)

Afternoon (1pm-7pm)

Evening (7pm-12am)

Late Night (12am-7am)

Wednesday

Morning (7am-1pm)

Afternoon (1pm-7pm)

Evening (7pm-12am)

Late Night (12am-7am)

Thursday

Morning (7am-1pm)

Afternoon (1pm-7pm)

Evening (7pm-12am)

Late Night (12am-7am)

Friday

Morning (7am-1pm)

Afternoon (1pm-7pm)

Evening (7pm-12am)

Late Night (12am-7am)

Saturday

Morning (7am-1pm)

Afternoon (1pm-7pm)

Evening (7pm-12am)

Late Night (12am-7am)

Sunday

Morning (7am-1pm)

Afternoon (1pm-7pm)

Evening (7pm-12am)

Late Night (12am-7am)

Referral

Name of Person / Organization / Website That Referred You

Required Information

Are you planning to move from your current location within the next year? * *

Yes

If so, please provide details:

Do you have legal authorization to work in the US? * *

Yes

Do you have a S.S. Number? * *

Yes

Do you have reliable transportation? * *

Yes

Do you have a driver’s license? *

Yes

Have you ever been convicted of a felony? * *

Yes

I certify that answers given on this application are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for subcontracting my services as may be necessary in making such a decision, including a possible criminal background check.

I understand that I am applying to provide subcontracted, freelance services with Voices For Health, Inc. (“the Corporation). I will have the ability to control my own schedule by accepting or refusing assignments. In the event that my services are subcontracted, I understand that false or misleading information given in my application or interview may result in the decision to stop subcontracting my services. I also understand that, as a subcontractor, I will be required to abide by all rules and policies of the Corporation or the agencies with whom the Corporation contracts. I acknowledge that any subcontracted relationship with this Corporation is of an “at will” nature, which means that the subcontracting interpreter may choose not to provide services at any time, and that the Corporation may choose not to use the interpreter’s subcontracted services at any time, with or without cause. I understand that any changes to the subcontracted status or this agreement will be made in writing and will be valid only if authorized by an executive of the Corporation or his/her assignee.

I understand that I will be required to provide proof of 1) negative Tuberculosis status every 12 months (skin test, negative chest X-ray or physician’s report) and 2) immunity to rubella, rubeola and varicela (vaccination record or positive titre). I understand that I may also be required to complete paperwork or take a drug/alcohol test as requested by the Corporation’s customers in order to be eligible for assignments.