Counselor/Rosh Ayda Application

Summer of (Year): *

Application for the Position of: *

Counselor

Rosh Aydah

How did you hear about Camp Yavneh?: *

Dates of Employment: Counselor June 23rd‐August 19th Rosh Aydah June 20th‐August 19th

Personal Information

Full Name: *

Name Usually Called: *

Hebrew Name:

Date of Birth: *

Cell Phone Number: *

Email Address: *

T-Shirt Size: *

Permanent (Home) Address: *

City: *

State: *

Zip Code: *

Home Phone: *

Present Address (if different e.g. school):

City:

State:

Zip Code:

Synagogue Affiliation: *

Rabbi: *

City: *

State: *

Denomination: *

Are you legally permitted to work in the USA?: *

Yes

Medical Issues: *

Yes

Are there any medical conditions or other issues that might impact or affect your ability to
participate in or fully perform your job?

If Yes, Please Explain:

Have you ever been convicted of a crime?: *

Yes

If Yes, Please Explain:

Please state your preference for an age group assignment:

Gurim	Kfirim	Arayot	Leviim	Maalot
Grades 2-4	Grades 5-6	Grade 7	Grade 8	Grade 9
Ages 8-10	Ages 11-12	Ages 13	Age 14	Age 15

First Choice: *

Second Choice: *

Third Choice: *

Please state any circumstances of which we should be aware in making an assignment:

e.g. sib in aydah, etc. Please be specific.

Camper Information

Did you attend Camp Yavneh as a camper?: *

Yes

If yes, what year were you in Kerem?:

If you did not attend Kerem, what was your last year in camp?:

Did you attend Naaleh?: *

Yes

If yes, what year?:

Educational Background

High School Name: *

Year of Graduation: *

Dates Attended: *

College Name: *

Year of Graduation: *

Dates Attended: *

Graduate School Name:

Year of Graduation:

Dates Attended:

Hebrew School Name:

Year of Graduation:

Dates Attended:

Have you taken any Jewish studies college courses? Please list/describe: *

Hebrew Skills: Please rate your knowledge of Hebrew in a scale of 1 to 5 (1 being none and 5 being fluent)

Israel Experience

Please list all Israel Programs in which you have participated. If you went with family , put “family”
under program heading.

Program Information/Dates:

Work Experience

List most recent employment under each heading. Please indicate if any are volunteer positions.

Camp Employment History

Dates:

Position:

Name of Camp:

Age of Campers:

Dates:

Position:

Name of Camp:

Age of Campers:

Dates:

Position:

Name of Camp:

Age of Campers:

Dates:

Position:

Name of Camp:

Age of Campers:

General Work Experience

Dates:

Position:

Name of Workplace:

Contact Person:

Dates:

Position:

Name of Workplace:

Contact Person:

Dates:

Position:

Name of Workplace:

Contact Person:

Dates:

Position:

Name of Workplace:

Contact Person:

Describe any other experiences you have had working with children:

Reference Information

Please give us the name, address, phone number, and your relationship to the person providing the reference:

Name: *

Address: *

Phone Number: *

Relationship: *

Name:

Address:

Phone Number:

Relationship:

Name:

Address:

Phone Number:

Relationship:

Name:

Address:

Phone Number:

Relationship:

Extra-curricular Activities/Interests

Please list all your extra‐curricular activities and clubs in which you participate:

e.g. Hillel, USY, AIPAC, gymnastics, newspaper, student council, etc.

Please list any special interests, hobbies or talents: