| Personal Information |
| * First Name |
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| Middle Initial |
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| * Last Name |
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| * Date of Birth |
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| * I will be 21 by the beginning of camp |
Yes
No |
| Sex |
M
F
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| Social Security # |
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| Phone |
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| * Cell Phone |
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| * Email Address |
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| * T-Shirt Size |
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| * Drivers License |
Yes
No |
| Driver's License # |
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| Driver's License State |
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| Permanent Address |
| * Line 1 |
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| Line 2 |
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| * Permanent City |
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| * Permanent State |
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| * Permanent Zip |
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| * Permanent Country |
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| College Address |
| College Address Line 1 |
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| College Address Line 2 |
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| College City |
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| College State |
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| College Zip |
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| College Country |
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| Send mail to |
Permanent Address
College Address
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| SCHOOL |
| Name of School |
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| Major |
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| Dates at College |
from:
to:
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| Graduation |
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| Have you been to Israel? |
Yes
No |
| Name of Program |
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| Length of time |
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| Do you have |
Current Lifeguard training certification?
First Aid Certification?
Archery certification?
CPR?
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| Other Certification? |
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| * Have you ever been arrested for, or charged with, or convicted of any crime, including but not limited to a sex-related or a child-abuse-related offense? |
Yes
No |
| * Are you a U.S. Citizen? |
Yes
No |
| If not U.S. Citizen what country are you a citizen from? |
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| Have you ever worked at WBT Camps? If so, CHK or GHC, what position, and what years? |
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| Have you ever been a camper at WBT Camps? If so, CHK or GHC and what years? |
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| If you have you worked at another Jewish camp, which one? |
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| Hebrew Education |
Do you Speak?
Read?
Write?
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| Jewish Education |
Bar/Bat Mitzvah?
Confirmation?
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| Other |
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| Temple Affiliation, City, State |
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| How did you hear about our camps? Recruitment trip, internet, friend or other? |
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| LEADERSHIP SKILLS |
| Mark the following activities as "I can teach this" or "I can assist with this" |
| Swimming |
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| Golf |
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| Basketball |
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| Soccer |
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| Waterpolo |
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| Volleyball |
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| Ropes Course |
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| Tennis |
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| Archery |
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| Modern Dance |
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| Israeli Dance |
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| Songleading |
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| Arts&Crafts |
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| Video Production |
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| Audio/Visual |
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| Photography |
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| Environmental Ed. |
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| Surfing |
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| Drama Production |
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| Journalism |
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| Improv |
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| Camping and Hiking |
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| Office Management |
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| Other skills |
|
Please state details on all activities that you marked
"I can teach this" |
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| ESSAYS |
| Please answer these questions, so that we can get to know you a little better before your interview. |
| What skills, talents or experiences do you have that will help prepare you to work at camp? |
|
| Describe a work/volunteer situation when you feel you failed. What did you learn? What would you do differently if confronted with that situation again? |
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| Describe the ideal camp, including programs, activities, overall feeling, and how Judaism fits into that vision. |
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| WORK EXPERIENCE |
| Work Experience 1 |
| Position/Responsibilities 1 |
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| Agency name 1 |
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| Dates Worked 1 |
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| Supervisor Name 1 |
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| Supervisor's Phone Number 1 |
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| Supervisor's Email Address 1 |
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| Reason for Leaving 1 |
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| Work Experience 2 |
| Position/Responsibilities 2 |
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| Agency name 2 |
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| Dates Worked 2 |
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| Supervisor Name 2 |
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| Supervisor's Phone Number 2 |
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| Supervisor's Email Address 2 |
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| Reason for Leaving 2 |
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| REFERENCES |
| List two references whom you have known for at least one year. An email will be sent to each of them with a link to the online reference form. It is up the applicant to follow up with their references to make sure they received the email and have completed and sent in the reference form. Do not include family members. |
| Reference 1 |
| Name (First & Last) |
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| * Email Address |
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| Home Phone |
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| Work Phone |
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| Cell Phone |
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| Relationship |
|
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| Reference 2 |
| Name (First & Last) |
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| * Email Address |
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| Home Phone |
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| Work Phone |
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| Cell Phone |
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| Relationship |
|
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| Position Applying For (e.g. Counselor, Unit Head, Ropes Course Specialist) |
|
| I'm available to work... |
| CHK Session |
Session 1: 6/23-7/11
Session 2: 7/14-8/8
Session 3: 8/11-8/22
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| GHC Session |
Session 1: 6/23-7/18
Session 2: 7/21-8/8
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| AGREEMENT |
* 1. California State Law (P.C. Section 11105.3) provides for an employer to obtain records regarding convictions for crimes related to sex, drugs or violence, for any person seeking a position working with minors. Fingerprints and any other data may be required prior to employment.
Yes
No
* 2. I hereby acknowledge that the information on this application is accurate and complete. I authorize the Wilshire Boulevard Temple Camps to contact any references and examine any records which may attest to my character.
Yes
No
* 3. I understand that misrepresentation or omission of the facts called for herein, receipt of unsatisfactory references, or failure to submit a completed health form may be sufficient cause for dismissal even if I shall have been employed.
Yes
No
* 4. I further understand if I shall be employed, either of us may terminate our work relationship if it is felt I will not meet job demands or show an inability to adapt myself to the requirements and duties of my employment.
Yes
No
* 5. I understand that employment at the Wilshire Boulevard Temple Camps requires work which is physically exerting, on uneven grounds and non-paved, limited access roads.
Yes
No
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