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Talent Information
Name
(Required)
Phone
(Required)
Do not have an email
Do not have an email
landline only
landline only
Email
Preferred Language
What languages do you speak?
Albanian
Amharic
Arabic
Armenian
Bengali
Chinese (including Mandarin and Cantonese)
Creole
Czech
Danish
Dutch
English
Finnish
French (including Cajun and Louisiana Creole)
German
Greek
Gujarati
Haitian Creole
Hebrew
Hindi
Hmong
Hungarian
Italian
Japanese
Khmer (Cambodian)
Korean
Lao
Lithuanian
Navajo
Norwegian
Oromo
Other
Persian (Farsi)
Polish
Portuguese
Punjabi
Romanian
Russian
Serbo-Croatian (Bosnian, Croatian, Serbian)
Slovak
Somali
Spanish
Swahili
Swedish
Tagalog (Filipino)
Tamil
Thai
Turkish
Ukranian
Urdu
Vietnamese
Yiddish
Email
Preferred Language
What languages do you speak?
Albanian
Amharic
Arabic
Armenian
Bengali
Chinese (including Mandarin and Cantonese)
Creole
Czech
Danish
Dutch
English
Finnish
French (including Cajun and Louisiana Creole)
German
Greek
Gujarati
Haitian Creole
Hebrew
Hindi
Hmong
Hungarian
Italian
Japanese
Khmer (Cambodian)
Korean
Lao
Lithuanian
Navajo
Norwegian
Oromo
Other
Persian (Farsi)
Polish
Portuguese
Punjabi
Romanian
Russian
Serbo-Croatian (Bosnian, Croatian, Serbian)
Slovak
Somali
Spanish
Swahili
Swedish
Tagalog (Filipino)
Tamil
Thai
Turkish
Ukranian
Urdu
Vietnamese
Yiddish
Where are you located?
Country
United States
States
Choose the states
Alabama
Alaska
American Samoa
Arizona
Arkansas
Baker Island
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Howland Island
Idaho
Illinois
Indiana
Iowa
Jarvis Island
Johnston Atoll
Kansas
Kentucky
Kingman Reef
Louisiana
Maine
Maryland
Massachusetts
Michigan
Midway Atoll
Minnesota
Mississippi
Missouri
Montana
Navassa Island
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palmyra Atoll
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
United States Virgin Islands
Utah
Vermont
Virginia
Wake Island
Washington
West Virginia
Wisconsin
Wyoming
City
Choose the city
Ward
Choose the ward
Certifications and Licenses
Select all that apply
CHW
HHA
CNA
CHES
CD(DONA)
CLD
ICBD
CHPNA
NCPS
CPSS
NBC-HWC
CHWC
Not certified
Other certification or license
List Professional Affiliations
(e.g., NACHW, DONA International, etc.)
Populations You Have Worked with?
Select all that apply
At-risk children
At-risk mothers
American Indian, Alaskan Native, Asian, African
American/Black, Latino/Hispanic, Native
Hawaiian, or Pacific Islander communities Rural residents
Disability community
Economically disadvantaged
Farm workers
Individuals with chronic health conditions
Individuals with limited English proficiency or limited literacy
Individuals with mental illness
Justice involved individuals
LGBTQIA+ community
Older adults (over 65 years of age)
Uninsured or underinsured
Pregnant/postpartum
Youth
Skills
Select all that apply
Labor and birth support techniques
Postpartum care and breastfeeding support
Advocacy for birthing person’s preferences
Youth engagement and mentorship
Support for emotional and social development
Crisis intervention
Recovery and wellness planning
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