Attachment 2 - DHHS Interpreter Information Request - Individual.docx

ATTACHMENT 2

Interpreter Information Request - INDIVIDUAL

Name:

1. LINGUISTIC ABILITY

In the table below, please list the language(s) and dialect(s) and indicate the level of proficiency the bidder can interpret or translate in language(s). Refer to Attachment 4 – Proficiency Levels. Bidders should also present evidence of proficiency in his/her resume. Bidder can add more lines if necessary.

Level of Proficiency Translation Level of Proficiency

2. RESUME

The bidder should provide a resume detailing his/her translation and/or interpreting experience. DHHS will consider the resume as a key indicator of the bidder’s capability to carry out the requirements of the RFQ in addition to assessing its experience.

Resumes should not be longer than three (3) pages. Resumes should include, at a minimum, professional experience, professional certifications, academic background and degrees, and at least two (2) references (name, address, and telephone number) who can attest to the competence and skill level of the individual. The resume should indicate if the bidder is a native speaker of any language(s).

3. ADDITIONAL INFORMATION

Are you willing to work and travel to the following location(s):

DHHS Facility: ______________ DHHS Office: ______________ Client’s Home: ______________

Are you regularly or periodically availability during any of the following timeframes?

After 5 pm on Weekdays: __________ On Weekends: __________ On Holidays: __________

Are you willing to accept Medicaid fund related referrals, subject to the provisions of Service Attachment B? Y / N

4. COUNTIES

In the table below, please indicate with an ‘X’ in the appropriate box any county you are willing to work.

If you are able to work in ALL counties, indicate with an ‘X’ here: _____________

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