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Home // Shlichus Resources // Placement Bureau // Couples Placement


Placement Bureau Sign Up Sheet

This form must be submitted prior to your interview!

Personal Information

Name & Last Name:               Todays Date                                  
Age:                                             Wife's Name:                                 
Cell Phone:                                Wife's Maiden Name:                 
Home Phone:                             Wife's Age:                                    
Mailing Address :                     E-mail Address                           
Present Ocupation:                 How many hours a day?         
Wife's Present Ocupation:     How many hours a day?         
Date you got married:           Number of Children (If applicable)

Positions of Interest (please mark from 1-3 or leave blank)
1. I want to spend the majority of my day in this field
2. I want to spend half of my day in theis field
3.I don't mind this for a smal part of my day (15%)

  Administration  Education - Mesivta  Principal
  Adult Education  General Programming  Rabbanus
  Campus  New Chabad House  Youth
  Education - Cheder

Community Interests

 American Only  Israeli      Russian      Spanish     French  Other

Positions of Interest for wife (please rate 1-3 as above):

 Teach, Preschool  Teach, Elementary  Teach, High School
 Principal  General Programing  Public Shiurim

Wife Willing to work ------------ .
What languages do you speak?  

 

Please write a brief discription of your ideal Shlichus Position:

                                                                                                                            

 

 

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