| Name: |
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| Date of Birth: |
Month
Day
Year
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| Gender: |
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| Social Security Number: |
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| Driver's License: |
State:
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| Cell Phone: |
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| Email Address: |
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| PERMANENT ADDRESS |
| Street and No.: |
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| City and Zip Code: |
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| Telephone Number: |
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| COLLEGE ADDRESS |
| Street and No.: |
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| City and Zip Code: |
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| Telephone Number: |
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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: |
Month
Day
Year
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| Have you been to Israel? |
Yes
No
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| 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 convicted of any crime, including sex-related or child-abuse-related offense? |
Yes
No
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| Are you a U.S. Citizen? |
Yes
No
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| 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?
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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| Other skills: |
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Please state details on all activities that you marked
"I can teach this": |
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| WORK EXPERIENCE |
| Position/ Responsibilities |
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| Agency name
|
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| Dates Worked
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| Supervisor Name
|
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| Supervisor's Phone Number
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| Supervisor's Email Address
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| Reason for Leaving |
|
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| Position/ Responsibilities |
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| Agency name
|
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| Dates Worked
|
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| Supervisor Name
|
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| Supervisor's Phone Number
|
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| Supervisor's Email Address
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| Reason for Leaving |
|
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| REFERENCES |
| List two references whom you have known for at least one year. Do not include family members or friends. |
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| Reference Name: |
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| Relationship: |
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| Street and No.: |
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| City and Zip Code: |
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| Telephone Number: |
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| Email: |
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| Reference Name: |
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| Relationship: |
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| Street and No.: |
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| City and Zip Code: |
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| Telephone Number: |
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| Email: |
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Please check the dates you are available this summer. It is MANDATORY
for every senior staff member to be Senior Staff Weekend (April 11-13)
and Senior Staff week (June 6-12). It is MANDATORY for every staff
member to be at Staff Orientation (June 12-18). |
CHK Session 1: June 18- July 6
CHK Session 2: July 9- August 3
CHK Session 3: August 6- August 17
GHC Session 1: June 18- July 13
GHC Session 2: July 16- August 3
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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.
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.
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.
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.
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.
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|
| ESSAYS |
| Please answer these questions on an additional page, so that we can get to know you a little better before your interview. |
| 1. What skills, talents or experiences do you have that will help prepare you to work at camp? |
|
| 2. 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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| 3. Describe the ideal camp, including programs, activities, overall feeling, and how Judaism fits into that vision. |
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| Enter the code as it is shown: |
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