Today's Date *

MM

DD

YYYY

Is this your first time filling out the questionnaire or are you updating your information? *

First Time

Update

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Do you hold RID and/or NAD certification? *

Yes

No

Have you been fingerprinted for the purpose of providing interpreting services? Some customers require this of their employees or contractors, such as schools, FBI, etc.

Fingerprinted by a County

Fingerprinted by a State

Fingerprinted by Federal

I have not been fingerprinted

Do you interpret in the state of Connecticut, and have you registered with the CT CDHI (Connecticut Commission on the Deaf and Hearing Impaired)?

Yes, I have registered

No, I do not work in CT

Are you willing to receive calls during non-business hours for 5pm-8am AND have the appropriate qualifications and training for such emergency work? *

Non-business hours: Medical emergencies

Non-business hours: Psychiatric emergencies

Non-business hours: Legal emergencies

I am not willing to go on/do not have training for emergeny requests

Generally, what is the maximum mileage radius you are willing to travel for an assignment?

25 miles

50 miles

75 miles

100 miles

If you are in the NY/NJ/CT area, please select the locations you are willing to work. *

Not Applicable

Manhattan

Staten Island

Queens/Long Island

Brooklyn

Bronx

Dutchess/Orange Counties

Putnam/Rockland/Westchester Counties

New Jersey

Connecticut

Do you own/have access to a vehicle?

Yes

No

Are you interested in the SLR Mentorship Program (SLR-MP)? *

No

Yes, as a mentee

Yes, as a mentor