GSIL Referral Profile - Interpreter Survey

Greetings,

In order to receive Interpreter Referral requests from GSIL, please take a moment to create or update your confidential profile. We appreciate your participation and look forward to working with you in the future. Feel free to use this survey to update your information with us at anytime.

If you have any questions, comments, or concerns, please contact Jodie Novak at 1-603-228-9680 ext. 2106, VP: 1-866-349-8235, or email the Referral Department at Interp@gsil.org.

Thank you,

GSIL Interpreter and CART Referral

P.S. (Optional) Please email a current picture of yourself to the email address above.

1

*

Name and Address:

Name and Address: Name
Address
City
State
Zip Code

2

Phone Numbers:

Phone Numbers: Home Phone
Cell Phone
Pager
Video Phone
TTY
Fax

3

*

E-mail Address:

E-mail Address: Requests
Documents

4

State Licenses Held:

State Licenses Held: State/Expiration
State/Expiration
State/Expiration
State/Expiration

5

National Certifications Held:

National Certifications Held: Certification
Certification
Certification
Certification
Certification
Certification

6

"Specialties"/Areas of Interest:

7

Team Preferences:

8

Potential Conflicts: (persons/situations for which you do not want to be requested)

Potential Conflicts: (persons/situations for which you do not want to be requested) Consumers
Hiring Entities
Interpreters
Types of Assignments

9

Brief Biography (to be shared with consumers and hiring companies upon request i.e. background, related credentials, education, philosophy, etc.)

10

Availability (Please indicate blocks of time for which you DO NOT want to receive requests. If your availably is open or changes often, simply leave the fields blank. Please note, if you are specifically requested by a consumer or hiring entity, we will include you in the request, regardless of availability on file or profile status.)

Availability (Please indicate blocks of time for which you DO NOT want to receive requests. If your availably is open or changes often, simply leave the fields blank. Please note, if you are specifically requested by a consumer or hiring entity, we will include you in the request, regardless of availability on file or profile status.) Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays

11

Notes/Comments: