Language Services Associates

Please complete the form below. Try to fill in as many fields as you can. Items marked with a red * are required.

1. General Information

Identification Information

First Name: *

Last Name: *

Address:

City:

State (if applicable):

Zip Code:

Contact Information

Primary Phone: *

Home Phone:

Business Phone:

Mobile Phone:

E-Mail Address: *

Availability Date:
Date Format: MM/DD/YYYY

Language Skills

Country of Origin:

Skills:

Certification:

Occupation:

Previous Interpretation Training: Yes No

Languages Spoken

Primary:

Second:

Third:

Fourth:

Fifth:

Sixth:

Additional Information

Gender: Female Male

Date of Birth:
Date Format: MM/DD/YYYY

Residency Status:

Areas of Interest:

Education:

Please paste your resume into this box: *
The length of resume is limited to 6000 characters.

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2. Direct Language Exposure

In what countries have you resided?

Country 1:

From:
Date Format: MM/DD/YYYY

To:
Date Format: MM/DD/YYYY

Activities (childhood, school, travel, work, etc.):

Country 2:

From:
Date Format: MM/DD/YYYY

To:
Date Format: MM/DD/YYYY

Activities (childhood, school, travel, work, etc.):

Country 3:

From:
Date Format: MM/DD/YYYY

To:
Date Format: MM/DD/YYYY

Activities (childhood, school, travel, work, etc.):

Additional countries, remarks:

3. Reference Works

List the dictionaries you own (title, publisher, year of publication):

Do you have any other language references, such as a thesaurus, style manual, grammar book, etc.?
If so, name them:

Where would you go for additional references if you needed to look up something you could
not find in your own library?

4. Language Acquisition - Part 1

General Information

Degree of fluency in English (1-10; 10=fluent)

How did you learn it?

What is your native language or mother tongue (the one you learned first)?

What do you consider your dominant language at present (the one you feel most comfortable
speaking in most situations)?

What languages do you use actively (speak, read, write fluently)?

Language 1

Name/Dialect:

Country where it is spoken:

Fluency (1-10):

Language 2

Name/Dialect:

Country where it is spoken: