Yeshivas Kayitz Program The Hershey & Raisy Friedman Campus

Personal Info

• First Name
• Last Name
• Date Of Birth
• Hebrew Name בן
• Mothers Hebrew Name
• Home Phone
• Cell Phone
• Email Address
• Street
• City
• State
• Zip
• Country
• Select Size Youth Small Youth Medium Youth Large Youth XL Small Medium Large XL XXL Sweatshirt Size
• Select Size Youth Small Youth Medium Youth Large Youth XL Small Medium Large XL XXL Sweatpants Size
• Select Size 4 5 6 7 Yarmulka Size

Position

• Select Option Mechina Mesivta Beis Medrash Program

Education

• Yeshiva attended this year
• Shiur
• Teachers Name

Camp Experience

• Year
• Camp
• Position
• Head Counselor

• Year
• Camp
• Position
• Head Counselor

References

Please list the names and phone numbers of two people (not relatives) who know you well and can speak about your character and work habits.

• Name
• Position
• Phone

• Name
• Position
• Phone

Yeshivas Kayitz Guidelines

• As a staff member, I understand that my actions are seen and affect the bochurim.

• Answer

• I understand that getting drunk is unacceptable and will not be tolerated.

• Answer

• I understand that smoking is not allowed on camp grounds.

• Answer

• I understand the negative effects of using my phone in front of bochurim and will refrain from using it when in front of bochurim.

• Answer

• I understand that I may not give my phone to bochurim for calls or for any other use.

• Answer

• I understand that as a staff member I am to behave like a Dugma Chaya and how a Chossid should.

• Answer

• I understand I am expected to be by Minyan 3 times a day.

• Answer

• I will not use inappropriate language.

• Answer

• I understand my responsibilities and will keep to them at all times.

• Answer

Questionaire

• As a staff member what do you consider your main responsibilities and objective?
  

• Explain

• What contributions do you think you can make at Yeshivas Kayitz?
  

• Explain

• What special skills or talents do you have?
  

• Explain

• Do you have any allergies? (if yes please list)
  

• Explain

• Do you have any eating limitations? (if yes please list)
  

• Explain

• Do you take any medications? (if yes please list)
  

• Explain

• Have you been diagnosed with any condition?
  

• Explain

• Have you ever needed psychological or psychiatric attention?
  

• Explain

• Do you have any health history? (if yes please list)
  

• Explain

• Please provide your medical insurance information.(carrier, policy name, id number...)
  

• Explain

• What is your preference, Coke or Diet Coke?
  

• Explain

• What is the ice cream flavor of your choice?
  

• Explain

• What is your favorite pizza topping?

• Explain

Harassment

The camp’s policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious, and other forms of harassment. Have you ever been accused of harassment of any person including, but not limited to, workplace harassment? (Note: a prior accusation is not an automatic bar to employment. The type of accusation and when it occurred will be evaluated by the camp before any decision is made.)

• No
• Yes
• Please Explain

Criminal Record

Have you ever been convicted of a crime, other than a minor traffic offense? If yes, please describe. (Note: a prior conviction is not an automatic bar to employment. The type of conviction and when it occurred will be evaluated by the camp before any decision is made.)

• No
• Yes
• Please Explain

Authorization