Dear Sir/Madam, Thank you for your interest in working with us. In order to register your details in our database, please fill out and return the form below by completing all fields which apply. NOTES: • Please underline or make bold appropriate answers for fields with several options. • Native Language(s) - specify only languages which are native to you. • Source Language(s) - specify languages from which you can translate. • Target Language(s) - specify only languages in which you can translate fluently. • If something is not applicable to you, leave it blank. • Include a proof of your qualifications by attaching a copy of all certificates, diplomas, references and any other supporting information. Preferred Salutation Mr. /Ms. /Mrs. /Dr. /Prof. Name Surname Middle Name/Patronymic Date of Birth Gender Mobile Number (Including country code, no spaces) Land line Phone Number (Including country code, no spaces) Fax Number (Including country code, no spaces) Primary email Secondary email Home Address - Street Home Address - City Home Address - County/State Home Address - Postal Code Home Address - Country Work Address - Street Work Address - City Work Address - County/State Work Address - Postal Code Work Address – Country 1 www.modernpolyglots.ie | 2014 Are you working as Self Employed/ Employed/ Both Business Name / Company Position Website - Personal Website - Work / Business Service Type Translator Interpreter - Consecutive Interpreter - Simultaneous Agency Tour Guide Graphics Designer Web Developer Programmer Tester Editor Proof-reader Sectors Medical, Pharmaceutical Legal Marketing, Advertising Technical, Engineering, Industrial, Manufacturing IT, Telecoms, Internet Taxation, Audit, Accounting Business, Finance, Insurance Government, Public Sector Labour, Health & Safety, Security Media, Digital, Publishing Education, E-Learning Tourism, Entertainment, Leisure Food, Nutrition, Diet Environment, Nature, Energy Import & Export, Transport, Logistics Globalisation, Internationalisation Retail, Shopping, Fashion Art, Literature Gaming Other: Specialisation Interpreting – Conferencing Interpreting - Courts, Solicitors, Police Voiceover, Subtitling, Dubbing Editing, Proofreading Catalogues 2 www.modernpolyglots.ie | 2014 Documentation, Manuals DTP, Typesetting Graphic Design Web Design Website Localisation Software Localisation Software Programming Databases Testing Computer Games Poetry Sign Language Literature Availability (Specify weekdays and hours) Morning /Noon /Afternoon/ Evening /Weekends Native Language(s) Source Language(s) Target Language(s) Bachelor’s Degree (s) Qualifications (provide details) Masters Language Course(s): Other relevant for this service CAT /Translation Memory SDL Trados Tools and Software Dejavu TM-database Word fast Omega T Memo Q Global Sight MemSource Rate per Hour Rate per Page Rate per Word Rate per 1600 characters Currency € Member of professional organisation(s) If you have translator's ID card, From which companies? 3 www.modernpolyglots.ie | 2014 PPS Number (For Irish residents only) Tax No. (Specific for your country) PayPal Email/ Skrill (Money Bookers) Email Preferred Payment Method PayPal Bank Transfer Western Union Cash Skrill (Money Bookers) MoneyGram Web Money Other Bank Name and Country Beneficiary Name Bank Account Number Bank Sort Code (For Irish residents only) Bank IBAN Bank SWIFT or BIC Are you Irish resident? Yes /No Do you have a car? Yes /No Do you give your permission? To conduct Garda Vetting? Yes /No Do you give your permission To forward your CV to agencies Who may be looking for your Services for prospective jobs? Yes /No Notes / Comments / Additional information Signature Date: 4 www.modernpolyglots.ie | 2014