Camp Moshava of Wild Rose, WI
ONLINE TZEVET APPLICATION
Thank you for taking the time to apply for a position at one of our summer programs. We will be contacting you shortly to discuss the summer in more detail. Please note that only complete application forms will be considered.
NOTE: Fields in red are required.
    GENERAL INFORMATION
First Name:   
Last Name:   
Social Security Number:   
Are you 18 years of age or older?  Yes   No
Date of Birth (optional if over 18):       
Will you be a high school graduate by summer 2008?  Yes   No
Are you legally authorized to be employed in the United States?  Yes   No
Present Address Line 1:   
Present Address Line 2:   
City:   
State:   
Zip:   
Country:   
Present Address Valid Until:  
Present Phone:   
Email:   
The best way for Camp Moshava to contact you is:   
    PERMANENT ADDRESS(If Different From Above)
Address 1:   
Address 2:   
City:   
State:   
Zip:   
Country:   
    PERMANENT TELEPHONE(If Different From Above)
Home Phone:   
Work / College Phone:   
    EMPLOYMENT DESIRED
Please rank the tafkidim you're interested in (1 being highest). Rank only those tafkidim you are interested in; you do not have to rank each position.
 Madrich/Madricha for: entering 4th-9th graders
 Kollel/Midrasha
Select Preference: Rosh Eidah   Sgan/Sganit  
 Avodah - (Madrich/Madricha for entering 10th or 11th graders in work based program)
 Machal or Mach-hach - (Madrich/Madricha for entering 10th or 11th graders)
Select Preference: Rosh Sport (Head of Sports/Scheduling)   Rosh Mitbach (Head of Kitchen Staff)  
Plugah: (Select Preferences)
Sports   Lifeguard   Arts and Crafts   Music   Drama   Driver  
Canteen   Tzofiyut   Website   Secretary   Peuton/Gan  
Zip Line  
    AVAILABILITY
During which session(s) do you wish to work?
1st Period: Fri. 6/16/06 - Tues. 7/18/06   2nd Period: Tues. 7/18/06 - Thurs. 8/17/06   Both  
What is the latest date you can be notified of your acceptance or rejection?
Are you available for the full session indicated, or:
  • Do you need to arrive late and/or leave early?
  • Are there specific dates you will need to leave machaneh (personal matter, family simcha, etc.)
I'm available the full session   I have the following conflict: (please explain and list dates you would miss)  
 
    EDUCATION
Please select the level of education completed at close of current academic year:
College:      Graduate School: 
High School Information:
Name of School: 
Location (City & State): 
Years Attended: 
Post High School Information:
yeshivah or midrashah
Name of School: 
Location (City & State): 
Years Attended: 
Major/Degree 
College Information:
Name of School: 
Location (City & State): 
Years Attended: 
Major/Degree
Graduate Work/ Special Training Information:
Name of School: 
Location (City & State): 
Years Attended: 
Major/Degree 
Where will you be studying next year, if applicable?  
    CAMP EXPERIENCE
Name of Camp
or Bnei Akiva program:
 Location:
Name/age level of program attended;
staff positions held:
 Years Attended:
Name of Camp
or Bnei Akiva program:
 Location:
Name/age level of program attended;
staff positions held:
 Years Attended:
Name of Camp
or Bnei Akiva program:
 Location:
Name/age level of program attended;
staff positions held:
 Years Attended:
Name of Camp
or Bnei Akiva program:
 Location:
Name/age level of program attended;
staff positions held:
 Years Attended:
    WORK EXPERIENCE
Company Name and Location:
 Position:
 Dates of Employment:
Name of Supervisor:
 Supervisor's Phone Number and email:
Company Name and Location:
 Position:
 Dates of Employment:
Name of Supervisor:
 Supervisor's Phone Number and email:
Company Name and Location:
 Position:
 Dates of Employment:
Name of Supervisor:
 Supervisor's Phone Number and email:
Company Name and Location:
 Position:
 Dates of Employment:
Name of Supervisor:
 Supervisor's Phone Number and email:
    REFERENCES
Please list three references other than relatives or friends.
Name:  Daytime Phone: 
E-mail Address:  Relationship: 
Name:  Daytime Phone: 
E-mail Address:  Relationship: 
Name:  Daytime Phone: 
E-mail Address:  Relationship: 
    MISCELLANEOUS
How did you hear about Camp Moshava? 
Are you a member of Bnei Akiva?  Yes   No
If yes, please list shevet name: 
What tafkidim have you held in Bnei Akiva or other youth organizations? (please specify organization) 
Have you been to Israel?  Yes   No
If so, when and on what program? 
Have you ever been convicted of any crime, including sex and child abuse offenses? Yes   No
If yes, please explain:    
    LANGUAGE FLUENCY
  Please describe your proficiency (strong or weak) in the following:
ENGLISH            Reading          Writing          Verbal
IVRIT            Reading          Writing          Verbal
    SPECIAL SKILLS AND TALENTS
  Please indicate all certifications that apply:
Red Cross Water Safety Instruction(WSI)       Expiration Date   
Red Cross Advanced Life Saving (ALS)       Expiration Date   
Lifeguarding Instructor (LGI)       Expiration Date   
Other Certifications:    
Please select which of the following hobby groups you would be interested in teaching:

Aerobics   Baking   Carpentry   Dance - Hip-Hop   Dance – Israeli   Golf   Guitar  
Headband Making   Model Building   Newspaper   Rocketry   Tennis   Torah Reading  
Please list and describe any special skills or talents that you have an ability to teach, or in which you have had experience (music, karate, arts and crafts, golf, tennis, dance, drama, etc.):     
    YOUR INTEREST IN CAMP MOSHAVA
As a tzevet member at Camp Moshava of Wild Rose, WI, you make a commitment to all the chanichim and your fellow tzevet members that you will perform your responsibilities and duties to the best of your ability , treat chanichim and tzevet respectfully, and vigilantly protect the safety of the entire camp community.

What you offer Camp Moshava:
1) Why do you want to work at Camp Moshava of Wild Rose, WI? 
2) What characteristics do you have that will facilitate your functioning as an effective tzevet member? 
Situational scenarios - Please tell us how you would handle the following:
3) A chanich who is not in your kvutzah is consistently mean toward another chanich in the kvutzah. 
4) When performing nighttime shmirah you enter a cabin and find that a chanich is missing. 
5) You stumble onto tzevet members who are engaging in an activity that is a known violation of camp policy and grounds for dismissal. 
6) A 16 year old chanich confides to you that: he had (or still has) a substance abuse problem, his parents don't know, he does not have any substances with him in camp, and he is trying to quit. 
    AGREEMENT
Please read carefully before sending this application.
Working at Camp Moshava is a serious and demanding commitment. Your initial to this application indicates your willingness to give your best efforts and performance in camp. Your initial also gives Camp Moshava permission to contact references and previous work supervisors.

"I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that falsified statements, misrepresentation, or omission of facts on this application shall be grounds for refusal to hire or termination of employment. If hired, I will comply with all Camp Moshava's staff policies."
Please Initial: