Mini-Gan Head Counselor Information
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Last Name
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First Name
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Hebrew Name
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Mother's Hebrew Name
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Age
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Date of Birth
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Born after Sunset
Yes No |
Hebrew Birth Date
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Home Address
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City
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State
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Zip
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Home phone
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Cell phone
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Email
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Social Security
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Citizenship
USA Other -
Specify |
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Completed Seminary 1
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Name of Seminary attending/attended
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Certification |
Are you First Aid certified?
Yes No |
If yes, when does it expire? If yes, please submit a copy of your certification form by email to [email protected].
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Are you CPR certified?
Yes No |
If yes, when does it expire? (If yes, please submit a copy of your certification form by email to [email protected])
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Are you generally healthy? Please list any specific allergies, medical issues or dietary kashrus requirements that we should know about. |
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Do you have a driver’s license?
Yes No |
If yes, how many years have you been driving?
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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 |
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Experience |
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. |
Preschool Name & Dates
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Position & Brief description of duties
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Name of Reference & Contact Number
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Preschool Name & Dates
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Position & Brief description of duties
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Name of Reference & Contact Number
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Preschool Name & Dates
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Position & Brief description of duties
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Name of Reference & Contact Number
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