External - TBI Screening Form

Temple Beth Israel Screening Form
Contact Information
Full Name: *

First Name Middle Name Last Name
Have you ever been known by any other name? *

YES NO
Please specify any/all other names you have been known by: *

First Name Middle Name Last Name
Email: *
example@example.com
Phone Number: *

Country Code Area Code Phone Number
Residential Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Personal Information
Date of Birth: *

Day Month Year
Date
Country of Birth: *
Country of Citizenship: *
How long have you lived in Australia, or how long will you be visiting? *
How long have you been an Australian citizen? *
Occupation: *
Place of employment: *
Are you currently, or have you ever been subject to a Good Behavior Bond or an Interim Intervention Order? *

YES NO
Please provide details on any such bonds or orders: *
Have you ever been convicted of an offence involving firearms or weapons, terrorism, violence, organised crime or an offence of sexual nature? *

YES NO
Please provide details on any such charges: *
Please upload a copy of your drivers licence or another form government issued photo ID. *

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Reason For Application
What is the purpose of your application? *
For what reason would you like to visit TBI? *

I am seeking religious guidance or tutelage I am visiting from another state or country and would like to attend synagogue while I am in Melbourne I would like to move to your congregation from another synagogue I would like to join your congregation and I have not previously been a member of a synagogue
Please specify the purpose of your application. *

Joining or Attending Services at TBI
Where are you currently, or where have you previously been a member, or attended service? *
What is your reason for wanting to join or attend services at our synagogue? *
If you have any documents to support your prior envolvment with a congregation, please upload here (eg. receipts from membership fees, reference from congregation members etc.).

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Consultation
What is your current religion? *
Who are you seeking a consultation with? *
Please specify a particular person or role (i.e. rabbi).
Why are you seeking this consultation? *
Have you contacted any other Jewish venues or businesses, or spoken with any other Jewish community members or leaders about this topic? *

YES NO
Please provide details of these venues/businesses/individuals: *

Membership - Attending Services & Classes
What is your reason for wanting to join our congregation? *
What is your current religion? *

Jewish Other
Please briefly explain your family's Jewish lineage: *
Are you interested in converting to Judaism? *

YES NO
Why do you wish to convert to Judaism? *
Have you ever contacted a Jewish venue about conversion or another religious topic? *

YES NO
Please provide details on your past experience: *
Please upload a copy of your passport. *

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Please upload written character references from two seperate individuals. *

Jewish community members are ideal. Please ensure the letter includes the references name, their relation to you, and contact number.
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Conversion
What is your current religion? *
Why do you wish to convert to Judaism? *
Have you ever contacted a Jewish venue about conversion or another religious topic? *

YES NO
Please provide details on your past experience: *
Please upload a copy of your passport. *

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Please upload written character references from two seperate individuals. *

Jewish community members are ideal. Please ensure the letter includes the references name, their relation to you, and contact number.
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Availability for Phone Consultation
To complete the processing of your screening application, we may require an over-the-phone interview.

The interview will take approximately 15 minutes.
Please indicate ideal times/days and we will endeavour to call you within this timeframe.

Employment
How did you hear about this job opportunity? *
What role are you applying for? *
Previous place of employment: *
Will you be driving a car or motorcycle to your scheduled shift/s at TBI? *

YES NO
Please provide your vehicle's registration: *
Please upload your CV *

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Contractors
What company do you work for? *
How long have you worked at this company? *
What is the nature of your contracted role? *
Will you be driving a car or motorcycle to your scheduled shift/s at TBI? *

YES NO
Please provide your vehicle's registration: *
Will your contract be ongoing/recurring? *

YES NO

Temple Beth Israel Screening Form