Questionnaire for Individual Pilot Trip Candidates

A.  Personal Details

 First Name: ______________________                    Last Name: ___________________

Address: ___________________________________________________________

City/State: _______________________                                Country: ________________

Home Phone: 00 1 _______  __________________

           city code                            number

Fax:  00 1 _______  ___________________

                       city code                            number

Cellular Phone: 00 1 _______  ___________________

                code                  number

E-mail: _____________________________________________

What is your intended date of Aliyah?_______________________________________

Intended dates of your Pilot trip:  Arriving _____________ until ________________

                                                                                    day    month       year              day       month         year   

Family Status:  ___________________

Children:

Religious requirements:  What are your needs and preferences regarding communities and education?  Please be specific!  

_____________________________________________________________________

_____________________________________________________________________

Will you be joined on the pilot trip by any other family members (spouse, children?)  Please specify:______________________________________________________

B.  Employment:

(please fill out a separate copy of this page for each job-seeking adult)

NAME: ____________________________________________

Profession:  _________________________________________

Age:  _______

Current Employment, & brief outline of responsibilities:

_____________________________________________________________________

What kinds of information do you want to gather and/or contacts do you want to develop during your private pilot trip?  _______________________________________

_____________________________________________________________________

Have you already developed contacts in any of these areas, and/or in potential work places?  Specify:

_______________________________________________________________________________________________

Please attach your resume(s).

Languages:

What is your level of Hebrew?  _______________________________________________________________________

What other languages do you speak? _____________________________________

Have you ever been to sraelbefore?  Yes  ___ / No___.  If so, when and in what capacity? _____________________________________________________________________

Please indicate days available for informational interviews and networking appointments:

______________________________________________________________________

C.  Details Regarding Klitah Contacts During Your Visit

In areas other than employment, please indicate which subjects you would like to learn about during your visit.  (Be as specific as possible)

          1.      __________________________________________________________

2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________

Have you already developed contacts in any of these areas?  Specify:

__________________________________________________________________________________________________________________________________________

If you would like to visit a Jewish Agency Absorption project or an Absorption Center, please consult with your shaliach regarding your eligibility and which options are relevant to you.  _____________________________________________________

NOTE:  If you want to visit an absorption project, it is the shaliach’s responsibility to check and confirm your entitlement.

About which geographical areas of the country are you interested in learning?  Please specify communities of particular interest to you: 

North / Galilee / Golan   _____________________________________________

Jerusalem and Surroundings _________________________________________

Tel Aviv and Gush Dan ______________________________________________

Netanya and Central (from Hadera until Ashkelon) _________________________

Be’er Sheva and the South ____________________________________________

Please indicate days available for informational interviews and networking appointments:

______________________________________________________________________

If you have already develped your own contacts, and/or arranged your own meetings, please indicate what/when/who, and keep AACI updated in order to avoid conflict:

 _____________________________________________________________________

D.  Logistics:

Where will you be staying while in Israel? _________________________________

Arrangements and costs for room, board and insurance are the responsibility of the participant.  AACI may be able to help through our Ophir Tours/Travel Experience program – email us at pilottrips@aaci.org.il  if you need more information.

Phone Number:   _________________________ c/o (name)  _________________

Cellular Phone Number: ______________________

Transportation:  Will you have a car at your disposal?   Yes  /  No

Transportation, either private vehicle or public transportation, is the financial responsibility of the participant.  AACI may be able to help with car rental through our Ophir Tours/Travel Experience – email us at pilottrips@aaci.org.il  if you need more information.

Will you have access to your e-mail while you are in Israel?   Yes ___ /  No ___

Very Important:

I, the undersigned, understand that neither AACI nor the Jewish Agency  bear any responsibility regarding my health or my security during my stay in Israel for the individual pilot trip.  I will be responsible for any medical care or hospitalization if it should be required during my stay in Israel, and I am fully aware that I must arrange my own health insurance coverage.

Name: __________________  Signature:_________________  Date:______________

E. Information In Case Of An Emergency:

Address Outside of Israel

Name:___________________           Address: ____________________________________

City/State:______________________           Phone: 00 1 - ________  ________________

city code                      number

Cellular Phone:  00 1 _____  _____________________

    number

Relationship: _______________________________________________

Address in Israel:

Name:___________________           Address: ____________________________________

City:______________________         Phone: ________________

Cellular Phone:  05 ___________________

 number

Relationship: _______________________________________________

AACI PRIVATE PILOT TRIPS

Keep in mind

AACI will do its best to arrange visits and meetings according to your requests, however we cannot guarrantee that every request will be granted.

Many of the representatives and institutions with whom meetings are scheduled agree to meet on a voluntary basis, and with the belief that the giving of their time and efforts will contribute to the facilitation of your successful aliyah and klitah.  Therefore, we ask you please not to change, postpone or cancel the scheduled meetings.  Such changes can lead to unpleasant feelings with the representatives or organizations.

Participant’s signature: _______________________                Date: ________________

Name of Shaliach: _______________________  Israel Aliyah Center ____________

Please return by email, along with resumes, to info@aaci.org.il

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For AACI Internal use :

Date of receiving request: ___________________________

AACI Klitah staff member coordinating Employment: _____________________

AACI other Klitah staff member: _________________________

AACI Membership # _________________________________