Language Services - Collection Instrument

U.S. Department of State

OFFICE OF LANGUAGE SERVICES CONTRACTOR APPLICATION FORM
Interpreter • English Language Officer • Translator

APPLICATION INSTRUCTIONS AND CHECKLIST
The following items need to be submitted together in order to be considered for contract freelance work with the U.S.
Department of State, Office of Language Services:

Application Form
• The entire first page must be completed. On the second page, only complete those sections of
the application for which you are interested in applying. You do not need to complete all three
sections if you are not interested in working in all three.

Résumé with References
• Please submit a copy of your résumé and at least three professional references with telephone
numbers, preferably who are familiar with your linguistic work. Your résumé should highlight your
translating and/or interpreting work.
Translation Samples (only if applying for written translation work)
• If applying for written translation, you MUST submit a short translation sample (150-200 words)
using the third page of the application form.
•

If applying for multiple language combinations, you may submit multiple samples using the
translation sample form included in this application. DO NOT SUBMIT MORE THAN ONE
SAMPLE PER LANGUAGE COMBINATION.

•

The Office of Language Services does not provide documents for you to translate in order to
submit samples to our office. Please select something you have translated previously. If you do
not have any of your prior work at your disposal, please select something and translate it. If
possible, your sample translation should deal with current events, politics, government, law, or
business. Avoid translations of patents, biomedical texts, literature, and highly technical prose.

•

If not applying for written translation work, it is not necessary to submit the translation sample
page of this application.

SUBMISSION INSTRUCTIONS
Please submit your application packet by one of the following methods:
US Mail
Attn: Testing Manager
U.S. Department of State
Office of Language Services SA-1
2401 E. St. NW, Room 1400
Washington, DC 20522
Email
LSapplications@state.gov
Fax
(202) 261-8807

DS-7651
xx-2009

Instruction Page 1 of 1

OMB APPROVAL NO. xxxx-xxxx
EXPIRES: xx/xx/xxxx
ESTIMATED BURDEN: 30 MINUTES

U.S. Department of State

OFFICE OF LANGUAGE SERVICES CONTRACTOR APPLICATION FORM
Interpreter • English Language Officer • Translator

TESTING INFORMATION
Today's Date (mm-dd-yyyy)

Have you applied previously? If yes, when?
Yes

No

How did you hear about us?

(mm-dd-yyyy)

PERSONAL INFORMATION
Name

Last

Mr.

Mrs.

First

Ms.
City

Street Address

Address

Middle Initial

State

ZIP Code

Phone (Home)

Phone (Work)

Phone (Cell)

Fax

Email

How long have you lived in the United States?

Do you have a Social Security Number (SSN)?

Place of Birth (City/State/Country)

Yes

No

U.S. Citizenship?
Yes

Date of Birth (mm-dd-yyyy)

No

Dual Citizenship?
Yes

Can you work legally
in the U.S.?

If you are not a United States citizen, please complete below:

No

Your Citizenship

Visa You Hold

Yes

No

BACKGROUND INFORMATION
Foreign Residence: Do not include brief visits.
Dates of Residence (mm-dd-yyyy)

Country

From

To

Foreign Languages: List languages (other than English) in which you have a fluent command and in which you are prepared to take a formal test.
How learned? (Home, school, residence, work)

Language

Education
Institution

Location

Dates (mm-dd-yyyy) Attended
From
To

Major Subject
(if applicable)

Certificate
Awarded

Secondary
University
University
Professional
What is your regular occupation or profession?

Work Status
Employed

Self-Employed

Student

Retired

Unemployed

If employed, describe your present employment.

FOR OFFICE USE ONLY

DS-7651
xx-2009

Page 1 of 3

PLEASE INDICATE IN THE THREE BOXES AT THE LEFT WHICH TEST(S) YOU ARE APPLYING FOR:
I am applying for the ORAL INTERPRETING TEST
Applicants with experience in Conference Interpreting should attach a list of conferences where you have interpreted.
Interpreting Experience Level:
None

Interpreting Modes:
Professional

Informal (e.g., for friends and family)

Not Sure

Simultaneous-Seminar

Conference- Consecutive

Consecutive

Simultaneous-Court

Conference-Simultaneous

Availability:
Year-round

Seasonally (Specify season(s))

Three weeks or longer

Only for short assignments (Specify maximum length)

Available for domestic travel

Available for international travel

Available locally in Washington, DC

I am applying for the ENGLISH LANGUAGE OFFICER (ELO) TEST
The ELO test verifies the suitability of applicants to accompany English-speaking visitors to this country under U.S. government-sponsored exchange
programs, for up to six weeks at a time.
Do you have a degree from an institution of higher learning?
Yes

If yes, what type of degree and from which institution?

No

Availability:
Are you able to travel with a group of international visitors for at least six weeks at a time?
Yes

No

I am applying for the WRITTEN TRANSLATION TEST.

Please specify:

Freelance

Internship

YOU MUST SUBMIT A SHORT (150-200 words) TRANSLATION SAMPLE USING THE FORM ON THE NEXT PAGE IF YOU WANT TO BE
CONSIDERED FOR FREELANCE TRANSLATION WORK.
Applicants with professional experience should attach a list of assignments/projects to their résumé, listing clients, subject matter, source, and target
language(s).
* Internships are intended for students and/or recent graduates only.
Translation Experience
None

Informal (e.g., for friends and family, in school)

Professional

What type of translation degree and/or certification, if any, do you hold (and from what organization/institution?)

List the language combinations for which you are applying to take a translation test (strongest
combination first):

What is your native language?

Source Language

(Into) Target Language

Source Language

(Into) Target Language

How many years have you been translating?

How many words per day can you translate?

Are you able to use:

What is your typing speed?

(Check all that apply)

Computer

Email

MS PowerPoint

MS Excel

When translating, what are your preferred subject areas?

What computer-assisted translation tools (e.g. SDL/Trados) do you use in your work?
Fax Machine

Privacy Act Statement
This form is authorized by 5 U.S.C. 3109 and 48 CFR 1.9. The information solicited on this form is necessary for consideration for contract positions
with the U.S. Department of State Office of Language Services. The information on this form may be shared with potential employers, credit
institutions, rental offices, etc. requesting verification of employment and/or earnings. The information may also be released to other government
agencies having statutory or other lawful authority to maintain such information. DOS will protect the collected information pursuant to the Privacy Act
of 1974, as amended and the Freedom of Information Act, as applicable. For additional information on the Privacy Act of 1974 and the Freedom Act go
to http://foia.state.gov/refer.asp. Giving us the information we ask for is voluntary. However, if you do not give us each item of information we request,
your application may not be processed in a timely manner or at all. This may affect your contract prospects.
Paperwork Reduction Act (PRA) Statement
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing
data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do
not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this
burden estimate and/or recommendations for reducing it, please send them to: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington,
DC 20522-2202
DS-7651

Page 2 of 3

TRANSLATION SAMPLE (150-200 words only). Only complete and submit translation samples if applying for written translation work.
Name
Mr.

Last
Mrs.

First

Middle Initial

Ms.

Please indicate the source language, and insert source text (150-200 words only) below.
Source language

Please indicate the target language, and insert target text (150-200 words only) below.
Target language

DS-7651

Page 3 of 3