PROTECTED ONCE COMPLETED
This area to be completed by IRB
SIN No:
Interpreter Application Form
Given name and surname
Date of birth (yyyy/mm/dd)
Place of birth
Mailing address (number and street) Apt. # City Province Postal code
Telephone number
(
)
Fax number
( )
Other
( )
Electronic mail address
Status
Canadian citizen
Permanent resident
Other:
The Immigration and Refugee Board of Canada (IRB) is committed to equity and diversity. From time to time, the IRB may have specific contract work that requires
a contractor of a specific gender. For example, a request may be made for interpretation services for a victim of sexual violence to be provided by someone of the
same gender. You are not required to self-identify, however if you are interested in self-identifying for this purpose, please do so below.
I identify as (gender):
LANGUAGE(S) SPOKEN LANGUAGE(S) WRITTEN LANGUAGE(S) READ
Official language(s)
English
French
Both
French
Both
English
English
French
Both
Interpretation language(s)
Interpretation experience:
No
Yes (Please specify below)
Availability (Indicate days of week and time)
EDUCATION
Elementary:
Completed
Uncompleted
Secondary:
Completed
Uncompleted
Number of years completed:
Post-secondary:
Completed
Uncompleted
Graduation year:
Title of diploma:
Immigration and Refugee Board of Canada
http://www.irb-cisr.gc.ca
Interpreter Information Sheet
Disponible en français
IRB / CISR 693 (2018-03)
Page 1 of 2
EMPLOYMENT EXPERIENCE
Are you presently, or have you ever been an employee of the Federal Public Service, a Crown
Corporation, the RCMP, the Armed Forces or a Governor-in-Council Appointee?
Yes
No
If yes, and have been an employee, are you receiving a government pension?
Yes
No
If yes, include your retirement date (yyyy/mm/dd):
Business number (GST-HST), if applicable:
1.
Name of present employer
From (yyyy/mm/dd)
To (yyyy/mm/dd)
Address (number and street)
Apt. # City Province Postal code
Job title and description of duties:
Casual
Indeterminate
If yes, and are presently an employee, are you a :
2.
Name of previous employer
From (yyyy/mm/dd)
To (yyyy/mm/dd)
Address (number and street) Apt. # City Province
Postal code
Job title and description of duties:
EMPLOYMENT OR VOLUNTARY INTERPRETING EXPERIENCE
1. Name
From (yyyy/mm/dd)
To (yyyy/mm/dd)
2. Name
From (yyyy/mm/dd)
To (yyyy/mm/dd)
3. Name
From (yyyy/mm/dd)
To (yyyy/mm/dd)
4. Name
From (yyyy/mm/dd)
To (yyyy/mm/dd)
NAME THREE PERSONS WHO KNOW OF YOUR WORK AND WHOM WE MAY CONTACT CONFIDENTIALLY:
1. Name and position title
Employed by
Telephone number
(
)
2. Name and position title
Employed by
Telephone number
(
)
3. Name and position title
Employed by
Telephone number
( )
ALL INTERPRETERS MUST SUCCESSFULLY PASS A SECURITY SCREENING LEVEL OF RELIABILITY STATUS
All of the information I have given in this form is true to the best of my knowledge.
Signature
Date (yyyy/mm/dd)
Immigration and Refugee Board of Canada
http://www.irb-cisr.gc.ca
Interpreter Information Sheet
Disponible en français
IRB / CISR 693 (2018-03)
Page 2 of 2
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