External - TBI Screening Form

Temple Beth Israel Screening Form
Contact Information
Full Name:*

First NameMiddle NameLast Name
Have you ever been known by any other name?*

YESNO
Please specify any/all other names you have been known by:*

First NameMiddle NameLast Name
Please provide a brief reason for your name change:
If applicable, please provide supporting documentation for your name change:

e.g., Change of Name certificate or application from Births, Deaths and Marriages Victoria
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Email:*
example@example.com
Phone Number:*

Country CodeArea CodePhone Number
Residential Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Personal Information
Date of Birth:*

DayMonthYear
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?*

YESNO
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?*

YESNO
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 tutelageI am visiting from another state or country and would like to attend synagogue while I am in MelbourneI would like to move to your congregation from another synagogueI 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?*

YESNO
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?*

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

YESNO
Why do you wish to convert to Judaism?*
Have you ever contacted a Jewish venue about conversion or another religious topic?*

YESNO
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?*

YESNO
Please provide details on your past experience:*
Please upload a copy of your passport.*

Cancelof
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?*

YESNO
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?*

YESNO
Please provide your vehicle's registration:*
Will your contract be ongoing/recurring?*

YESNO

Temple Beth Israel Screening Form