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?
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?
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?
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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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?
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?

Other
Please briefly explain your family's Jewish lineage:
Are you interested in converting to Judaism?
Why do you wish to convert to Judaism?
Have you ever contacted a Jewish venue about conversion or another religious topic?
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?
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.

Temple Beth Israel Screening Form