ALIYAH QUESTIONNAIRE. For office use:

Transcription

1 ALIYAH QUESTIONNAIRE or office use: ile number: Date received: Expected Aliyah Date: / / Aliyah Representative: This questionnaire is the basic document used for processing your Aliyah application. Please provide all of the relevant details, so that we can give you prompt attention and accurate information. Please write clearly in block letters; put an x or check the appropriate places; if a question is not applicable, please indicate this with "N/A". Questions regarding your background are designed to provide an overall picture that will help those assisting in your Aliyah preparation to anticipate your absorption needs. Some of this information is also used for statistical purposes. If you have any questions about filling in the application, please feel free to contact your local Aliyah office or the Global Aliyah Center. You can find a list of toll free numbers at APPLICANT PERSONAL DETAILS Last name irst name Please write your name as it appears in your passport Maiden name (if applicable) ormer names (if applicable) Hebrew spelling of your first and last name, as above Date of birth (dd/mm/yyyy) Marital status single married separated / / divorced widowed partners Gender male female Religion: Jewish Other (specify) Mother s full name Mother s maiden name ather s full name ather s former name (if applicable) Israeli ID number (if applicable) Year Israeli ID issued (if applicable) Religious affiliation (check one or more): Orthodox Traditional Conservative Progressive Reform Reconstructionist Secular Other (specify) Country of birth Nationality Additional nationality/ies (if applicable) ormer nationality (if applicable)

2 Country issuing passport Passport # (including letters) Country of residence (where you will have lived one year before your Aliyah)? Do you have a valid driving license (in the country where you will have lived one year before your Aliyah)? Occupation Education: (check one) High school Some college Bachelor s Degree Master s Degree PhD hiva other (please specify) Have you been a member of youth organizations/ movements? If so, which one(s): Have you ever been to Israel? Have you ever been an Israeli citizen, temporary resident, permanent resident, oleh, or none of these? If yes, what year(s)? Have you ever owned a home in Israel? If yes, do you still own it? If no, when was it sold? I have have not resided in Israel over 18 months in the past 3 years I have have not resided in Israel over 3 years in the past 7 years Have your parents ever lived in Israel? Have your parents ever been Israeli citizens? Have you served in the military?, ID, other (specify) HEBREW KNOWLEDGE RANK YOUR KNOWLEDGE ROM 0 TO 5, WITH 0 AS NONE, 5 LUENT Speaking Reading Writing I WOULD LIKE TO APPLY OR A VISA OR: Immigration (oleh visa) Temporary residency Other

3 DECLARATION I declare that I have not committed any criminal offense. I declare that I have not committed any act directed against the Jewish people or the security of the State of Israel. There is no judicial warrant of arrest against me and I am not wanted by the police of any country. I confirm that the information on this questionnaire is full and accurate, and has been provided in the awareness of the fact that it will serve as a basis for the consideration of my application. I will notify the Aliyah office of any changes occurring prior to my Aliyah. Signature of Applicant The aliyah questionairre was signed before, Aliyah representative. Date: Signature of Jewish Agency Representative Please attach a photo and a photo of spouse (if applicable)

4 SPOUSE PERSONAL DETAILS Last name irst name Please write your name as it appears in your passport Maiden name (if applicable) ormer names (if applicable) Hebrew spelling of your first and last name, as above Date of birth (dd/mm/yyyy) Marital status married separated partners / / Gender male female Religion: Jewish Other (specify) Mother s full name Mother s maiden name ather s full name ather s former name Israeli ID number (if applicable) Year Israeli ID was issued (if applicable) Religious affiliation (check one or more): Orthodox Traditional Conservative Progressive Reform Reconstructionist Secular Other (specify) Country of birth Nationality Additional nationality/ies (if applicable) ormer nationality (if applicable) Country issuing passport Passport # (including letters) Country of residence (where you will have lived one year before your Aliyah) Do you have a valid driving license (in the country where you will have lived one year before your Aliyah)? Occupation Education: (check one) High school Some college Bachelor s Degree Master s Degree PhD Advanced yeshiva other(please specify) Have you been a member of youth organizations/ movements? If so, which one(s):

5 Have you ever been to Israel? Have you ever been an Israeli citizen, temporary resident, permanent resident, oleh or ne of these? If yes, what year(s)? Have you ever owned a dwelling in Israel? If yes, do you still own it? If no, when was it sold? I have have not resided in Israel over 18 months in the past 3 years I have have not resided in Israel over 3 years in the past 7 years Have your parents ever lived in Israel? Have your parents ever been Israeli citizens? Have you served in the military?, ID, other (specify) HEBREW KNOWLEDGE RANK YOUR KNOWLEDGE ROM 0 TO 5, WITH 0 AS NONE, 5 LUENT Speaking Reading Writing I WOULD LIKE TO APPLY OR A VISA OR: Immigration (oleh visa) Temporary residency Other DECLARATION I declare that I have not committed any criminal offense. I declare that I have not committed any act directed against the Jewish people or the security of the State of Israel. There is no judicial warrant of arrest against me and I am not wanted by the police of any country. I confirm that the information on this questionnaire is full and accurate, and has been provided in the awareness of the fact that it will serve as a basis for the consideration of my application. I will notify the Aliyah office of any changes occurring prior to my Aliyah. Signature of Applicant The aliyah questionairre was signed before, Aliyah representative. Date Signature of Jewish Agency representative

6 Children - Please list all children under age 25. In addition, children over age 18 who will be making Aliyah should open their own Aliyah file. irst and last name Date of birth (dd/mm/yyyy) Gender Country of birth Israeli ID Number (if applicable) Is this child making Aliyah with you? 1. M 2. M 3. M 4. M 5. M 6. M 7. M Will the whole family be making Aliyah together? Do any of the above minor children have a parent who will not be making Aliyah? PLANS UPON ARRIVAL IN ISRAEL Expected Aliyah date Expected place of residence address: Rental Relatives Other (please specify) Phone number in Israel (yours, or contacts who will know how to reach you upon arrival) Are you interested in being matched with a volunteer family to assist you through your initial absorption period? Total number of family members making Aliyah: CONTACTS IN ISRAEL Name and relationship Address (include city) Phone

7 CURRENT CONTACT DETAILS Address City State Zip Code Country Home Phone ax Applicant Work Phone Mobile Phone Spouse Work Phone Mobile Phone