Enrollment Testing – Prisma Languages

APPLICATION AND ENROLLMENT FORM

I want to apply as: *

Disclaimer

According to the GDPR, our international business handles personal data from NOAM, LATAM, and EMEA internal and external stakeholders, required to make certain disclosures in our privacy policy.

By completing this form, you give explicit and informed consent for us to process your information.

We follow GDPR’s data protection and accountability principles:

Data processing is fair to the data subject.
Data is only be processed for specific and legitimate purposes, outlined in your privacy policy.
We don’t collect more data than we need.
We make sure the data we collect is accurate.
We do not store personal data longer than needed for the specified purpose.
We process data in a way that ensures security, integrity, and confidentiality.
We can demonstrate compliance with these principles.

SMS Terms & Conditions

Equal Opportunity and Assignment Requirements Disclaimer

Prisma International Corporation and its affiliate companies do not discriminate against any applicant, independent contractor, or service provider on any basis protected by applicable law. Information provided through this application will not be used to unlawfully discriminate or deny opportunities.

The disclosure of criminal history or other information requested through this application does not, by itself, result in automatic disqualification from working with Prisma International Corporation.

Certain client assignments may, however, be subject to lawful, assignment-specific requirements, including requirements related to qualifications, credentials, eligibility, safety, security, background, or the particular environment in which services will be provided. In those circumstances, Prisma International Corporation may determine whether an individual can lawfully satisfy the requirements applicable to that specific client or assignment.

Any such determination will be made only as permitted by applicable law and in relation to the requirements of the specific assignment.

By continuing with this application, you acknowledge that you have read and understand this disclaimer.

Identity and Contact Information

Agency Identity and Contact Information

Legal First Name *Enter your legal first name exactly as shown on a government-issued ID or passport.

Legal Middle Name *Enter your legal middle name exactly as shown on a government-issued ID or passport, not just the initial.

Legal Last Name *Enter your legal last name exactly as shown on a government-issued ID or passport.

Legal Agency/Business Name *Enter your legal agency/business name exactly as shown in the Articles of Incorporation or equivalent formation record.

Business / DBA Employer Identification Number (EIN) *Enter your legal agency/business EIN exactly as shown in the IRS registration records.

Preferred Email Address *Enter your preferred email address for assignments and communications.

Billing Email Address *Enter your billing email address for assignments and communications.

Dispatch / Operations Email Address *Same as aboveOther

Mobile Telephone Number *Enter your U.S. mobile telephone number including area/country code.

Business Telephone Number *Enter your U.S. business telephone number including area/country code.

Preferred Contact Methods *Select all that apply.EmailPhone Call & VoicemailSMS TextWhatsApp Message

Residential/Service-origin Address

Address Line 1 *Enter your residential house number and street name.

Address Line 2Enter your residential apt/unit number.

U.S. City *Enter your residential city.

U.S. State *Enter your residential state as a two-letter state abbreviation (e.g. AR, CA, WA, etc.).

U.S. Zip Code *Enter your residential zip code.

Business/Billing address

Address Line 1 *Enter your business address number and street name.

Address Line 2Enter your suite/office apt/unit number.

City *Enter your business address city.

State/Province *Enter your business address state as a two-letter state abbreviation (e.g. AR, CA, WA, etc.).

Zip Code *Enter your business address zip code.

Country *Enter your business address country.

Minority Business Enterprise Status *Prisma International Corporation is a MBE - Minority Business Enterprise Certified Small Business.

Are you a minority business enterprise (certified MBE)?Yes, this business is a certified Minority Business Enterprise (MBE)No, this business is not a certified Minority Business Enterprise (MBE)Other

Ability to Provide Proof of MBE Certification *YesNo

Languages, Education, and Qualifications

Education and ASL Qualifications

Language combinations other than English in which you are professionally proficient *Include proficiency level and whether each language is professional or fluent.0 / 100

Highest Completed Education *Select the highest completed education for which documentation is available.High School / GEDVocational or Technical CertificatesAssociate's DegreeBachelor's DegreeMaster's Degree / MBADoctorate / JD / Postdoctoral Degree

Interpreter or Translator Credentials Currently Held *What other credentials or certifications do you hold aside from your degree? Select all that apply.None, I am not certified or partially certified nor credentialed.ATA Certified TranslatorCoreCHICHIHub-CMICMIState Court Certification (U.S. only)FCCI - Federal Court Interpreter Certification (U.S. only)Other

Minimum 40-hour Interpreter Training Completed *If you are not certified (CHI/CMI, Court, or FCCI), which of these 40-hr minimum-required interpretation basic training did you complete?Bridging the Gap 40-HrBridging the Gap 64-HrThe Community Interpreter 40-HrAnother formal interpreter program of at least 40 hoursNone. I have not been trained as a professional and qualified interpreter and I need information about it.

Other Training Completed0 / 50

Are you a Prisma International Corporation recent BTG graduate (Bridging the Gap) eligible for the $5.00 USD bonus per assignment differential? *This is our thank you and give back, to maximize your investment by taking the class with us.Yes, I completed the BTG program at Prisma International Corporation.No, I want to learn more about the bonus pay.

If not RID-certified, describe the basic ASL interpretation education or training completed. *0 / 100

Position or Qualification Tier Sought *Which position are you interested in?Bilingual Associate (An internal contractor or FTE who occasionally delivers domestic onsite interpretation assignments)Independent Contractor - Entry-Level Interpreter (A bilingual candidate who will formally enroll at Prisma Languages training, within 3 months of contract offer)Independent Contractor - Qualified and Trained Interpreter (An applicant who has completed a 40-hour minimum professional interpretation formal certificate program)Partially Certified Interpreter (Hub CMI, CoreCHI)Fully Certified Interpreter (CMI, CHI)State or Federally Certified Court Interpreter (State, FCCI)

Assignment Preferences and Mobility

Assignment Preferences, Coverage, and Transportation

Preferred Assignment Sectors *Select all that apply.Medical Interpreter: Primary Care, Urgent Care, Specialty Clinics, Hospitalizations, Dental Care, Mental Health and Rehabilitation ServicesLegal Interpreter: Depositions, Attorney-Client Meetings, Document Sight Translations, Workers’ Compensation CasesCourt Interpreter: Hearings, Proceedings, Trials, Immigration (USCIS), Industrial CommissionGovernment Interpreter: City Council, Local Government, Child Protective Services (CPS), Department of Homeland Security (DHS), Department of Health and Human Services (DHHS), Federal Emergency Management Agency (FEMA), etc.Educational Interpreter: Classroom, Assessments, State Testing, Psychological Evaluations, IEP/504/PTA Meetings, Sight TranslationsReligious Interpretation: Sermons, Prayers, Pastoral Care, Live Interpretation in a church setting or eventCommunity Interpreter: NPO, Health Fairs, Home Visits, Legal Clinics, Homeless Outreach, Shelters, Environmental, Voting Support, Refugee Settlements, othersSports and Entertainment: UFC Interpreter, MLB Interpreter, World Cup Interpreter, Miss Universe Interpreter, MLS Interpreter, Television Broadcasts, NewsBusiness Interpreter: Simultaneous Interpretation for corporate meetings, Conventions, Trade Shows, Employee Meetings, Training Services, Delegations, Negotiations, and Escort Interpretation

Maximum One-way Driving Distance *Select the (one-way) mileage you are willing to drive for a single assignment.Up to 50 milesUp to 75 milesUp to 100 milesUp to 150 milesGreater than 150 miles

Maximum One-way Service Range *Select the (one-way) mileage you/your interpreters are willing to drive for a single assignment.Up to 50 milesUp to 75 milesUp to 100 milesUp to 150 milesGreater than 150 miles

Out-of-State Assignment Preference *Are you willing to take assignments out of state?
Prisma reimburses round-trip mileage when you drive or books hotel, flights, etc. for traveling assignments that required non-drivable commutes, for multi-day assignments.Yes, but only neighboring states.Yes, any U.S. state (Continental U.S.).Case-by-case (depending on the location or assignment)No

Ability to Accept Out-of-State Assignments *Are you/your interpreters willing to take assignments out of state?YesNo

Willingness to Fly for Multi-day or Shift Assignments *Are you willing to fly to take assignments out of state?
Prisma handles the logistics when you fly.YesNoCase-by-case

Ability to Fly for Multi-day or Shift Assignments *For multi-days/shift assignment, are you/your interpreters willing to fly out of state for assignments?YesNo

Reliable Transportation *Do you have reliable transportation to take onsite assignments? Prisma does not reimburse share rides (Uber, Lift, Taxi, or similar services).I confirm I own reliable transportation.I confirm I use public transportation in supported metropolitan areas.No

Reliable Transportation *Do you/your interpreters have reliable transportation to take onsite assignments?YesNo

Prisma only assigns appointments to independent contractors who have reliable transportation.

Availability

General Availability *What is your availability and/or preference to take onsite assignments? Select all that apply.AnytimeMornings — 06:00 AM - 12:00 PMAfternoons — 12:00 PM - 06:00 PMOvernight — 06:00 PM - 08:00 AMWeekendsHolidays

Agency Coverage Availability *What is your agency availability and/or preference to cover assignments? Select all that apply.AnytimeMornings — 06:00 AM - 12:00 PMAfternoons — 12:00 PM - 06:00 PMOvernight — 06:00 PM - 08:00 AMWeekendsHolidays

Minimum coverage (# of hours) *Specify the minimum required billable hours to accept an ad-hoc on-site assignment. Note: Most assignments range 1-2 hrs; depending on the nature of the work. i.e., PT, Clinical, Therapy, etc.1.00 Hour (OT, PT, Speech Therapy, Clinical)2.00 Hours3.00 Hours (Legal, Court)Half Day (Business Events)Full Day (Conferences, Events)

Eligibility and Compliance

Agency Eligibility and Compliance

Age Eligibility *Are you at least 18 years old?YesNo

Minimum-age Attestation *The agency certifies that personnel it assigns to Prisma will be at least 18 years old.

U.S. Work Authorization *I confirm I am legally authorized to work in the United States without sponsorship for an immigration-related work benefit (i.e., work visa, work permit, etc.).

U.S. Work-authorization Compliance Attestation *You/your interpreters must be eligible to work legally in the United States without sponsorship.The agency certifies that it will not assign any individual who lacks legal authorization to perform the services in the United States and that it will satisfy all employment-authorization verification obligations applicable to workers it employs.

Is your business listed on the GSA Schedule for Government Contracts? *YesNo

Are you able to perform the essential functions of the assignment, with or without reasonable accommodation? *Prisma International Corporation is an EEO employer. The law requires an employer to provide reasonable accommodation to an employee or job applicant with a disability (ADA) unless doing so would cause significant difficulty or expense for the employer ("undue hardship").Yes, I can perform the job/deliver the assignment without special accommodations.No, I need special accommodations to perform the job/deliver the assignment.

Reasonable Accommodations Request *Provide details about the accommodations you require to perform the essential functions of the assignment.0 / 100

Is your organization able to perform the essential functions of the assignment, with or without reasonable accommodation? *Prisma International Corporation is an EEO employer. The law requires an employer to provide reasonable accommodation to an employee or job applicant with a disability (ADA) unless doing so would cause significant difficulty or expense for the employer ("undue hardship").Yes, our organization can perform the job/deliver the assignment without special accommodations.No, our organization needs special accommodations to perform the job/deliver the assignment.

Background Inquiry and Record Status *Have you ever been convicted of a crime, felony, or misdemeanor, other than a minor traffic violation?YesNoI choose not to disclose (I am a CA or NY resident)

Conviction Details and ContextProvide details about the nature of the offense, date, location, and final resolution. Answering "Yes" does not automatically disqualify you from contractor opportunities.0 / 250

Client Assignment Eligibility Attestation *Under penalty of perjury, are you able to satisfy the lawful eligibility and qualification requirements applicable to client-specific assignments?YesNo

Background Check Consent *Should the specific assignment require it, would you agree to a background check?YesNo

Under penalty of perjury, are you listed in any of the following exclusion lists? *- Federal List of Excluded Individuals and Entities
- Federal System for Award Management (SAM), formerly EPLS
- Any U.S. state exclusion listNo, I am not listed in any of the abovementioned entities.Yes, I am excluded from working in at least one of the agencies listed.

Exclusion-status Details *Identify the program or list, issuing authority, status, effective date, and any termination or reinstatement date.0 / 250

Under penalty of perjury, are you/your interpreters listed in any of the following exclusion lists? *- Federal List of Excluded Individuals and Entities
- Federal System for Award Management (SAM), formerly EPLS
- Any U.S. state exclusion listNo, none of our staff or vendors are listed under any of the abovementioned entities.Yes, our organization (or an associated staff member or vendor) is excluded from working in at least one of the agencies listed.

Exclusion-status Details *Identify the person or entity, program or list, issuing authority, current status, effective date, and any termination or reinstatement date.0 / 250

Client-required Vaccination Documentation *If requested by a client, can you provide documentation for COVID-19 or other vaccinations required for healthcare settings? Prisma does not independently require vaccination records.YesNo

Rates, Insurance, and Commercial Terms

Minimum Hourly Rate $ *Enter your minimum hourly rate for interpretation services, ad-hoc PRN (Per Request Needed) assignments. Include $XX.XX / hour.

USD

Discounted Hourly Rate $ *Enter your discounted hourly rate for B2B, half-day, full-day, multi-day, or recurring assignments. Include $XX.XX / hour.

USD

Discounted B2B / C2C Hourly Rate $ *Enter your discounted B2B / C2C interpretation service hourly rate for interpreting for ad-hoc PRN (Per Request Needed) assignments. Include $XX.XX / hour.

USD

Comprehensive Mileage Reimbursement Rate $ *Enter your mileage rate for ad-hoc PRN (Per Request Needed) assignments. Include $0.XX cents / mile.

USD

Discounted B2B / C2C Mileage Rate $ *Enter your discounted B2B / C2C mileage rate for assignments this fiscal year. Include $0.XX cents / mile.

USD

Terms and Conditions for assignments with Prisma *Prisma has a standard 24-hour cancellation policy. What other terms and conditions would you like to share to be considered as a vendor? Include your cancellation policy, minimum coverage in hours, and any other restrictions or information to consider for contract work.0 / 250

Payment Policy Notice

Prisma International Corporation does charge its clients for premium rates, after hours, rush fees, travel time, holiday pay, differential, or overtime; therefore we do not pay either for such fees. Appointments are for specific time allocations, within the minimum booking fee, not per site, per LEP client. The rates paid are per hour on labor and per mileage driven to/from assignment from your residence to/from client locations. We reimburse only for mileage roundtrip, parking at cost, and tolls at cost (with itemized receipts). We do not pay for travel time, valet parking, ride shares (Uber, Lyft, etc.). Our payroll cycle is on the 20th of each month, covering services rendered in the previous month. All our payments are via ADP/direct deposit. Payments returned due to IC (1099 Contractor's) incorrect information will be processed on the next pay eligible cycle. If the error is made internally, due to a data-entry error; we will proceed to disburse the payment immediately via check or Direct Deposit). Prisma Languages does not pay for subcontracted assignments when an Individual is booked for an assignment and someone else impersonates on their behalf. If you are an agency, you must enroll as a Vendor.

Insurance Status *Are you able to furnish proof of insurance coverage for General Liability and/or Errors and Omissions for Professional Liability insurance with a $1,000,000 USD minimum (per claim) in insurance coverage for professional and general liability.

An ACORD certificate of insurance, a business license or Article of Incorporation may be required to enroll you as a B2B vendor.

Can you provide proof of insurance?Yes, I am fully insured and can provide proof of insurance for my business.No, I am not ensured, but I will be procuring insurance before my first assignment.No, I am not insured / my business is not insured.No, I am an individual and do not have insurance.

Insurance Status for B2B Subcontractor Enrollment *If you provide an EIN# rather than a SSN#, you are considered a B2B (Business to Business) subcontractor.

You will be required to furnish proof of insurance coverage for General Liability and/or Errors and Omissions for Professional Liability insurance with a $1,000,000 USD minimum (per claim) in insurance coverage for professional and general liability.

An ACORD certificate of insurance, a business license or Article of Incorporation may be required to enroll you as a B2B vendor.

Can you provide proof of insurance?Yes, I am fully insured and can provide proof of insurance for my business.No, I am not ensured, but I will be procuring insurance before my first assignment.No, I am not insured / my business is not insured.

Referrals, Voluntary Disclosures, and Acknowledgments

Referral Participation *Do you have a language professional to refer to Prisma’s paid referral network?

Prisma International Corporation pays a one-time referral fee for each referral you submit when they complete their first assignment. We request referrals for any language, in any U.S. state and its territories.

You’ll be notified if they join our network and are successfully booked through our referral system.Yes, I have a referral.No, I do not have a referral.

Referral Participation *Do you have an ASL professional to refer to Prisma’s paid referral network?
Prisma International Corporation pays a one-time referral fee for each referral you submit when they complete their first assignment.
You’ll be notified if they join our network and are successfully booked through our referral system.Yes, I have a referral.No, I do not have a referral.

Referral First Name *

Referral Last Name *

Referral Mobile Number *

Referral Email Address *

Referral Language Combination *

File Uploads

Instructions

Upload your CV and any formal interpreter education credentials when submitting your application. After submission, our HR/Vendor Enrollment team will email you a list of additional items needed to complete your provider profile. If you have any questions about this form or the next steps, feel free to contact us at hr@prisma-international-corporation.com.

CV - Resume *

No file chosen

Formal Interpretation Certificate of Successful Completion (40-hr minimum)

No file chosen

Formal ASL Interpreter Education or Training Documentation

No file chosen

Proof of Certification or Alternative Qualification DocumentationWe may consider alternative documentation regarding certification evidence or available records of experience, training, assessment results, references, or other supporting material.

No file chosen

Language List for Covered Languages *

No file chosen

Capability Statement *

No file chosen

Secretary of State - Article of Incorporation *

No file chosen

ACORD Certificate of Insurance *

No file chosen

By submitting this application, you certify that all information provided is accurate and complete to the best of your knowledge. Any false or misleading information may result in your disqualification from employment or termination of contract. Providing false information could result in legal consequences under penalty of perjury. *Yes, I certify that all information provided is true and complete to the best of my knowledge.

By submitting this application, the authorized representative certifies that all submitted information is accurate and complete and acknowledges that materially false or misleading information may result in disqualification or termination of the vendor relationship. Providing false information could result in legal consequences under penalty of perjury. *Yes, I certify that all information provided is true and complete to the best of my knowledge.

Privacy Acknowledgment *I acknowledge that the information submitted through this form will be processed by Prisma International Corporation / Prisma Languages for enrollment, application, onboarding, or business relationship purposes. I confirm review of the Privacy Policy.

Terms of Use Acceptance *I, the authorized representative, agree to the applicable Prisma's Terms of Use on behalf of the agency.

SMS Communications Consent — OptionalBy checking this optional box, you agree to receive recurring SMS text messages from Prisma International Corporation / Prisma Languages at the mobile number provided above regarding your enrollment or application, onboarding steps, scheduling, assignment opportunities, service coordination, and other operational updates related to your relationship with Prisma. Message frequency varies. Message and data rates may apply. Reply STOP to opt out at any time. Consent to receive SMS messages is not a condition of submitting this form or doing business with Prisma. View Prisma's SMS Terms & Conditions.I agree to receive recurring SMS text messages from Prisma International Corporation / Prisma Languages at the mobile number provided above regarding my enrollment or application, onboarding steps, scheduling, assignment opportunities, service coordination, and other operational updates related to my relationship with Prisma.

SMS Communications Consent — OptionalBy checking this optional box, the authorized representative agrees to receive recurring non-marketing text messages from Prisma International Corporation / Prisma Languages at the mobile number provided above regarding vendor enrollment, onboarding, scheduling, assignments, and related operations. Message frequency varies. Message and data rates may apply. Reply STOP to opt out at any time. Consent to receive SMS messages is not a condition of submitting this form or doing business with Prisma. View Prisma's SMS Terms & Conditions.I, the authorized representative, agree to receive recurring SMS text messages from Prisma International Corporation / Prisma Languages at the mobile number provided above regarding vendor enrollment, onboarding, scheduling, assignments, and related operations.

Certification and Electronic Signature *I certify that I am the person identified in this questionnaire and that all information and supporting documents I have submitted are true, accurate, complete, and not misleading as of the date signed. I have reviewed my responses and had the opportunity to correct them before signing.

I understand that Prisma International Corporation and its affiliated companies may rely on the information provided when evaluating my enrollment, qualifications, onboarding, eligibility for assignments, and contractor relationship. I understand that any material false statement, misrepresentation, or omission may result in disqualification, suspension or withdrawal of assignments, or termination of the contractor relationship, subject to applicable law and any governing agreement.

By checking the acknowledgment box, entering or signing my name, and submitting this questionnaire, I confirm my intent to sign electronically. I consent to the use and retention of this electronic record and agree that my electronic signature has the same force and effect as my handwritten signature.I have read, understand, and agree to the Certification and Electronic Signature statement above.

Certification of Authority, Accuracy, and Electronic Signature *I certify that I am authorized to complete and sign this questionnaire on behalf of the agency or business identified in this submission. I further certify that all information and supporting documents submitted concerning the agency, its ownership, personnel, qualifications, insurance, eligibility, and ability to provide services are true, accurate, complete, and not misleading as of the date signed. I have reviewed the submission and had the opportunity to correct it before signing.

I understand that Prisma International Corporation and its affiliated companies may rely on the submitted information when evaluating the agency’s enrollment, onboarding, eligibility for assignments, and vendor relationship. I understand that any material false statement, misrepresentation, or omission may result in disqualification, suspension or withdrawal of assignments, or termination of the vendor relationship, subject to applicable law and any governing agreement.

By checking the acknowledgment box, entering or signing my name, and submitting this questionnaire, I confirm my authority and intent to sign electronically on behalf of the agency. I consent to the use and retention of this electronic record and agree that my electronic signature has the same force and effect as my handwritten signature.I have read, understand, and agree to the Certification of Authority, Accuracy, and Electronic Signature statement above.

E-Signature *