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Mini Gan Teacher Application Form

Mini Gan Teacher Application Form

 Email

 CAMP GAN ISRAEL 2017

Teacher Information
Last Name
First Name
Hebrew Name
Mother's Hebrew Name
Age
Date of Birth
Born after Sunset
Yes No
Hebrew Birth Date
Home Address
City
State
Zip
Home phone
Cell phone
Email
Social Security
Citizenship
USA Other -
Specify
 
 
Certification
Are you First Aid certified?
Yes No
If yes, when does it expire? (If yes, Send the form by email to Camp@ChabadRiverdale.org)
Are you CPR certified?
Yes No
If yes, when does it expire? (If yes, Send the form by email to Camp@ChabadRiverdale.org)
Please list any specific allergies:
Do you have a driver’s license?
Yes No
If yes, how many years have you been driving?
Do you feel comfortable with having the responsibility of driving the counselors? Yes No
Driving a mini-van? Yes No
Do you have experience and feel comfortable driving on highways? Yes No
Experience
Have you worked with children before? Yes No
List 3 positions within the past 3 years in which you were in a preschool classroom. Include the date, for whom you worked and their contact information, name of the institution and a brief description of the job requirements:
Company Name
Position
Name of Reference & Contact Number
Company Name
Position
Name of Reference & Contact Number
Company Name
Position
Name of Reference & Contact Number

References
Personal
Reference Name
Relationship to Applicant
Phone
Reference Name
Relationship to Applicant
Phone


Emergency Contact Information
Contact 1
Phone
Relationship to Applicant
Are there any medical concerns that we should be aware of?
Contact 2
Phone
Relationship to Applicant
Parent's Daytime Phone
Parent's Daytime Phone
Parent's Daytime Phone
Please list any specific dietary kashrus requirements: shechita, milchig, etc…
Family Physician
Phone
Address

Talents
Please choose and number according to preference:
Mark areas in which you are talented:

Organization

Responsibility

Camp Spirit

Creativity

Sports

Drama

Computers

Art

Choir

Dance

Music
 
Do you play an instrument? Yes No If yes which one?
Would you like to be the coordinator of extra-curricular activities for the staff? Yes No


Tee Shirts
You will be required to wear a camp T-shirt every camp day. Please select your t-shirt size. T-shirts can shrink and tend to run small. When in doubt, order the next size.
SIZE: Small Medium Large Extra Large


Signature
Teacher's Signature Date
 Email
Camp Updates
Summer 2017

June 29-July 31
Register your child today!
Upcoming Events
There are no events posted at this time. Please contact us for more info about our events.
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