UNITED STATES DISTRICT COURT FOR THE DISTRICT OF HAWAII 300 Ala Moana Blvd., Rm. C-338 Honolulu, Hawaii 96850 Registration Form for Interpreters/Translators Name: (Print Last Name) (Print First Name) (Middle Initial(s))Mailing Address: (Number & Street or P.O. Box) (City) (State) (Zip Code)Date of Birth: Social Security No.: (This information is required for admission to the State of Hawaii Dept. of Corrections.) Telephone: (Residence) (Business) (Cellular) (Pager) Are you a U.S. Citizen? ____ yes ____no (if no, are you authorized to work in the United States? .) Language(s) Interpreted/Translated: 1. Language: ___________________ Rating (check one): Certified by the Administrative Office of the U.S. Courts on Professionally Qualified by the Administrative Office of the U.S. Courts on Conversational proficiency ____Other __________________________________________________________________ 2. Language: Rating (check one): Certified by the Administrative Office of the U.S. Courts on . Administrative Office of the U.S. Courts Professionally Qualified on . Conversational proficiency ____Other ___________________________________________________________________ 3. Language: Rating (check one): Certified by the Administrative Office of the U.S. Courts on . Administrative Office of the U.S. Courts Professionally Qualified on . Conversational proficiency ____Other ___________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com>>>> 2(Attach additional sheets as needed.) Education and Training Name of School Location Majo r Course of Degree/Certificate Month/Year Study Received ReceivedInterpreting/Translating Employment Experience: Please list previous interpreting and/or translating experience. Specify the type of setting for which you have been an interpreter (state/federal court, court-related programs, law office, immigration office, etc. Specify types of documents you have translated.)Please enclose original and verifiable copies of test results and other evidence of qualifications listed. Court/Agency/Office: Location(City & State): Dates of interpreting: From: To: (Month & Year) (Month & Year)Exam taken as condition of employment on: Rating: Conference or Seminar Interpreter: No: Yes: (Frequency of interpretation, e.g., 1-2 time per month)Other:(Describe type of interpreting/translation rendered and frequency) Court/Agency/Office: Location(City & State): Dates of interpreting: From: To: (Month & Year) (Month & Year)Exam taken as condition of employment on: Rating: Conference or Seminar Interpreter: No: Yes: (Frequency of interpretation, e.g., 1-2 time per month)Other:(Describe type of interpreting/translation rendered and frequency) Court/Agency/Office: Location(City & State): Dates of interpreting: From: To: (Month & Year) (Month & Year)Exam taken as condition of employment on: Rating: Conference or Seminar Interpreter: No: Yes: (Frequency of interpretation, e.g., 1-2 time per month)Other:(Describe type of interpreting/translation rendered and frequency) -2- American LegalNet, Inc. www.USCourtForms.com>>>> 3(Attach additional sheets as needed.) Membership in Professional Interpreters Association Name of Association: Location (City/State): Sponsors: (Names and addresses of three active members of the association who interpret the same language and can attest to your interpreting ability.) Name of Association: Location (City/State): Sponsors: (Names and addresses of three active members of the association who interpret the same language and can attest to your interpreting ability.) Please enclose original and verifiable copies of test results and other evidence of qualifications listed above. Availability - I am available to work on the following days and hours: Monday: From to Tuesday: From to Wednesday: From to Thursday: From to Friday: From to I declare under penalty of providing false statements that the information provided to the U.S. District Court for the District of Hawaii is true and correct. I understand that completion of this registration form does not ensure my inclusion on the courts interpreter list and that inclusion on the interpreter list does not constitute appointment as an employee of the U.S. District Court, other than as an independent contractor; therefore, I am responsible for the filing and/or payment of any applicable federal and state taxes, etc. I also understand that failure to report any change of information directly to the court may be cause to delete my name from the interpreter list. Signature: Date: -3- American LegalNet, Inc. www.USCourtForms.com