Date: 1/22/2017

Application Form

Language Resource Center

Thank you for your interest in joining our team of independent contractors. We look forward in utilizing your services to bridge language communication between our clients and their consumers. Someone from our office will contact you once we review your information. Thank you!!

Office Location

Select Office Location:

Personal Information

First Name * Address 1 *
Last Name * Address 2
City *
Home Phone * Zip *
Work Phone
Mobile Phone
Email *

Section 1 - Application

Number Question Effective Date Expiration Date
1 Are you legally authorized to work in the United States? (required)  
2 Are you 18 years of age or older? (required)  
3 Have you ever been convicted of a felony within the last five years? (required)  
4 Do you have a valid driver license and reliable transportation? (required)  
5 Which position are you applying for? (required)  
6 Are you currently working anywhere? (required)  
7 Have you worked for an interpreting agency before? (required)  
8 How far are you willing to commute from your home to cover interpreting assignments? (required)  
9 Please select the availability that best matches your current schedule: (required)  
10 Are you willing to accept assignments with less than 2 hours notice? (required)  
11 List all the languages that you speak, read and/or write? (required)  
12 What language(s) can you interpret proficiently? (required)  
13 What is your native language? (Please include dialect if applicable.) (required)  
14 What is your country of origin? (required)  
15 Select the level that best describes your fluency in the language into which you are competent to interpret in: (required)  
16 The following immunization records are required: Influenza, Hepatitis-B, MMR, Varicella, TB. Which of the following best describes your ability to provide these records? (required)  
17 Would you be willing to attend the initial training required before covering assignments? (Spoken Language Interpreters ONLY). (required)  
18 When would you be available to come in for an interview? (required)  
19 What is your desired hourly pay? (required)  
  (Numeric Answer Only)    
20 How many years of experiences do you have interpreting professionally? (required)  
  (Numeric Answer Only)    
21 Select the highest level of education that you have completed. (required)  
22 List all related training / education you have had in the past that supports your qualification. (required)  
23 List all the interpretation services that you are experienced in: Medical, Legal, Mental Health, Government, Business, etc. (required)  
24 Would you be willing to attend additional optional trainings, workshops and seminars to further your education? (required)  
25 List 2 professional references with the follwing information: 1) Name 2) Contact information 3) Relationship to you (required)  
26 How did you hear about us? (required)  
27 Your comments:  
28 Copy and paste your resume in the box below. (required)  

I certify that information contained in this form is true and complete. I understand that false information may be grounds for not using my services or for immediate termination of my services at any point in the future if I am conducting services. I authorize the verification of any or all information listed above on this form.