**This form works best on computer, not on a cell phone**
The dates for Summer Camp this year are August 8-19, 2022 (with an optional week as a Bonus Week from August 22-26). Staff must arrive on Thursday, August 4 through Friday, August 19. Head Staff must be going into seminary or Post-Sem. Counselors must be going into 11th or 12th grade or older. Junior Counselors are going into 10th grade. CITs are going into 9th grade.

CGI at The Shul welcomes all staff applications. Please keep in mind that we receive more applications than positions available. Each application will be reviewed and considered. We will be choosing our staff based on their qualifications and suitability for our program.

Please fill out ALL relevant information to the best of your ability. Incomplete applications may not be reviewed or accepted. All complete applications will undergo a careful review process, including reference checks. For help filling out this form or any other staff inquiries please contact Rabbi Yishai Eliefja at [email protected] or Rochel Leah at [email protected]

All fields in bold are mandatory.

Position applying for: Other (Please explain):
Complete Job Descriptions are available by contacting our office.

Last Name: First name:
Father's Name: Father's Cell #:
Mother's Name: Mother's Cell #:
Mother's Jewish Name (if different than above):

Address: City: State:
Cell Phone: Home Phone:

Date of Birth: T-Shirt Size:

Current School/Job
Upcoming Grade in Fall/Position

Medical Info:
Do you have any known allergies?
Are you on any medication?

Emergency Contact Info:    
Emergency Contact Name:

Phone #:


Physician Name:
Physician Phone #:

How did you hear about CGI at The Shul?

Are you applying with a group? Yes No
Who is in your group?

Past Work History
Provide a record of recent camp work history (paid and volunteer). Include all information including dates, camp, position and names and contact info. of supervisor.
Minimum, one year required.


Camp Name, City & State

Name & Contact info of Director

Your Position

Give names and contact info. of at least two people (not relatives) having knowledge of your character, experience, work habits and ability.


Phone Number

Email Address


CPR/1st Aid Certification
I am certified in CPR/1st Aid through the end of August of this year.
I am not CPR/1st Aid certified, and will require training in camp.
I am not CPR/1st Aid certified, and will arrange for my own training.

Driver's License
I have a valid driver's license. State:

What contributions do you think you can make at Camp Gan Israel?

What contributions do you think a well-run camp can make to children?

Are there any details we should know about you and your work habits?
(This can include special skills, allergies, illnesses, special food requirements, likes and dislikes or anything else we should know about you. Please elaborate)

Harassment - The camp's policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious, and all 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 or conviction is not an automatic bar to employment. The type of conviction or accusation and when it occurred will be evaluated by the camp before any decision is made.)
Yes No
If 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.)
Yes No
If yes, please explain:

Authorization to Invest
I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability in connection with same. I understand that, if employed, I will be an at-will employee unless there is an agreement or law which alters that status. Furthermore, I understand that any agreement must be in writing and signed by the designated camp official. I also understand that untrue, misleading, or omitted information herein or in other documents completed by the applicant may result in dismissal, regardless of the time of discovery by the camp.

Name: Date: