Preliminary Questionnaire
Jews for Jesus, 60 Haight St, San Francisco, CA 94102
GENERAL INFORMATION
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be
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Name (Last, First, Middle):
*
2. Birth Date:
*
-
Month
-
Day
Year
Date
3. Address (street/city/state/postal code/country):
*
4. Phone (Home):
*
(Cell):
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Skype:
FAMILY LIFE
5. Marital status:
*
Single
Married
Widowed
Divorced
Separated
Engaged
6. Name of spouse:
Is your spouse a believer in Jesus?
Yes
No
7. Names and birth dates of dependent children (if applicable):
Name
DOB:
-
Month
-
Day
Year
Date
Name
DOB:
-
Month
-
Day
Year
Date
Name
DOB:
-
Month
-
Day
Year
Date
Name
DOB:
-
Month
-
Day
Year
Date
8. From the selection below, please indicate which (if any) of your immediate family members are Jewish:
*
Father
Mother
Paternal Grandmother
Maternal Grandmother
Paternal Grandfather
Maternal Grandfather
Other
9. Do you have a current driver's license?
*
Yes
No
10. Do you have any health considerations that we should be aware of?
*
Yes
No
If yes, please explain:
VOCATIONAL INFORMATION
11. What is your current occupation?
How long have you been at your present job?
12. Have you ever been dismissed from employment?
Yes
No
If yes, please describe the circumstances:
RELATIONSHIP WITH JEWS FOR JESUS
13. Which Jews for Jesus publications do you enjoy reading? Check all that apply:
ISSUES
Havurah
Newsletter
Realtime
Books
Website/blogs
Other
14. I have participated in one or more of the following Jews for Jesus events or programs:
Ingathering
New York Summer Campaign/Fall Outreach
"Behold Your God" campaign
Camp Gilgal
Massah
Project Joshua
Halutzim
Other
Please indicate the year you participated in each event:
15. Do you personally know any of our staff workers?
*
Yes
No
If yes, please list the individuals you know best:
SPIRITUAL LIFE
16. When did you become a believer in Jesus?
*
17. Home congregation:
*
18. Address (city/state/zip):
19. Phone (Main):
20. Leader's name:
21. Leader's e-mail:
22. Are you a member?
*
Yes
No
23. Have you been baptized?
*
Yes
No
24. Please list any other Christian groups you are involved with:
25. Are you currently involved with any Jewish mission agency other than Jews for Jesus?
*
Yes
No
If yes, please list the agency and describe your involvement:
26. Please answer the following questions (3-4 sentences each):
a. "Reaching Jewish people with the Gospel is important to me because..."
*
b. "If it were up to me, I would reach out to the Jewish people in my community in the following way..."
c. "I would like to serve with Jews for Jesus because..."
*
27. How did you become a believer in Jesus? (Please attach your 1-2 page testimony.)
*
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Thank you for filling out this questionnaire! We will contact you after we have reviewed your completed form. If you have questions, please email
hr@jewsforjesus.org
or call the HR Department at 415.864.2600 ext. 1151 or ext 1130.
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