Download The application process

WCLP 2013 APPLICATION FORM
THE APPLICATION PROCESS

This Application Form must be completed and sent via email, with signatures to
[email protected]

This Application Form must be signed and returned to Geoff Pawsey by Friday 20 July
2012.

MAV will advise applicants of the outcome of their application by 31 July. If selected by
the MAV/VisionSuper panel , applicants will then proceed to the interview process held
by LV.

If you have any questions whilst completing this Application, please contact Geoff on
9667 5526.
YOUR PERSONAL DETAILS
ABOUT YOU
First name
Middle name
Preferred name
Last name
Date of birth
Address Line 1
Address Line 2
State
Postcode
Country
Home phone
Mobile Phone
Personal email
Interests/hobbies
YOUR EDUCATION
Institution
City & country
Years from & to
Level achieved
Major studies
PLEASE LIST ANY OTHER LEARNING & DEVELOPMENT ACTIVITIES OR TRAINING YOU HAVE
COMPLETED WHICH MAY BE RELEVANT.
YOUR SIGNIFICANT ACHIEVEMENTS – HONOURS, AWARDS, VOLUNTARY WORK, EXTRA
LEADERSHIP TRAINING ETC.
1
1
2
3
YOUR EMPLOYMENT DETAILS
Organisation
Position
Division
Work Address Line 1
Work Address Line 2
Wok State
Work Postcode
Work Country
Work phone
Mobile Phone
Work email
Title on
commencement
Start Date
Current title
Date
YOUR PREVIOUS EMPLOYMENT
Employer
Responsibility/Title
Years From & To
Reason for leaving
HOW MANY DAYS PER MONTH DOES YOUR WORK REQUIRE YOU TO BE AWAY FROM MELBOURNE?
Number of days
Can this change?
SELECT THE INDUSTRY SECTOR YOUR ORGANISATION IS PRIMARILY INVOLVED IN.
DOUBLE-CLICK ONE CHECK BOX TO SELECT IT.
Agriculture/Mining
Government (Local)
Science/Research
Arts/Entertainment
Health
Small Business
Banking/Finance/Insurance
Hospitality
Sports/Recreation
Charitable/Religious
Manufacturing
Trade Unions
Communications & IT
Media/Print/Publishing/Recorded Media
Transportation
Construction
Pharmaceuticals/Biotechnology
Utilities
Education
Professional/Business Services
Welfare & Community
Emergency Services
Property Services
Wholesale
Government (Federal/State)
Retail/Wholesale
Other, please specify
SELECT THE AREA THAT BEST DESCRIBES YOUR DAILY WORK ACTIVITIES.
DOUBLE-CLICK ONE CHECK BOX TO SELECT IT.
Academia
Human Resources
NFP activities
Business Development
Information Technology
Project Management
Corporate Social Responsibility
Legal Services
Purchasing
Customer Service
Logistics
Research & Development
Editor/Journalist/Writer
Manufacturing
Sales
Finance & Accounting
Marketing & PR
Senior Manager
Health Professional
Office Administration
Training & development
Other, please specify
SELECT THE AREA THAT BEST DESCRIBES YOUR CURRENT ROLE.
DOUBLE-CLICK ONE CHECK BOX TO SELECT IT.
CEO/MD
GM/Senior Executive
Self-Employed/Business Owner
Consultant
Manager
Supervisor/Team Leader
Director/Chairperson
Professional/Specialist/Technical
Support/Operations/Administration
Other, please specify
BRIEFLY DESCRIBE YOUR ROLE AND RESPONSIBILITIES (ROLE, BUDGET, STAFF, SPECIALITY).
YOUR PROFESSIONAL INTERESTS
SELECT 3 AREAS THAT ARE OF PERSONAL, PROFESSIONAL OR EDUCATIONAL INTEREST.
DOUBLE-CLICK EACH CHECK BOX TO SELECT IT.
Administration
Human Resources
Project Management
Communication
Information Technology
Purchasing
Customer Service
Logistics
Research & Development
eBusiness
Management/Leadership
Sales
Finance & Accounting
Marketing & PR
Training & Development
Other, please specify
YOUR COMMUNITY VIEW
WHAT ARE YOU MAJOR COMMUNITY INTERESTS? (PLEASE LIST THREE)
1
2
3
LIST, IN THE ORDER OF IMPORTANCE TO YOU, UP TO FIVE COMMUNITY, CIVIC, PROFESSIONAL,
BUSINESS, RELIGIOUS, SOCIAL, SPORTS OR OTHER ORGANISATIONS YOU ARE OR HAVE BEEN A
MEMBER OF. PLEASE INDICATE ANY POSITIONS OF RESPONSIBILITY YOU HOLD OR HAVE HELD.
Organisation
Years from & to
Position held
Still involved?
1
2
3
4
5
IF YOU ARE STILL INVOLVED, HOW MUCH TIME DO YOU COMMIT EACH MONTH?
WHAT DO YOU CONSIDER YOUR MOST IMPORTANT ACHIEVEMENT IN ONE OF THESE
ORGANISATIONS AND WHY?
ARE YOU AS ACTIVE IN A COMMUNITY ROLE AS YOU WOULD LIKE TO BE? (TYPE
YES OR NO):
IF NO, CAN YOU EXPLAIN THE BARRIERS TO YOU BECOMING INVOLVED?
IF IN THE PAST YOU HAVE NOT HAD THE TIME OR INTEREST IN BECOMING INVOLVED IN
COMMUNITY ACTIVITIES, WHAT HAS CHANGED THAT NOW ENABLES YOU TO PARTICIPATE?
YOUR WORLD VIEW
WHAT DO YOU BELIEVE ARE THE EMERGING ISSUES AND / OR OPPORTUNITIES OF IMPORTANCE
THAT WILL DEMAND EXCEPTIONAL LEADERSHIP IN THE COMING DECADE?
1
2
CHOOSE ONE OF THE EMERGING ISSUES AND / OR OPPORTUNITIES THAT YOU IDENTIFIED AND
DESCRIBE YOUR APPROACH TO CREATING A REAL AND WORKABLE SOLUTION FOR IT
WHEN YOU THINK OF CURRENT LEADERS AND LEADERSHIP, OVERSEAS AND LOCALLY, WHAT
COMPELLING LEADERS OR LEADERSHIP EXAMPLES COME TO MIND AND WHY?
WHEN YOU THINK OF INNOVATION BROUGHT ABOUT BY LEADERSHIP, WHAT ENDEAVOURS OR
SITUATIONS COME TO MIND AND WHY?
YOU AND THE WCLP
USING A FEW PHRASES, HOW WOULD YOUR CLOSEST FRIENDS DESCRIBE YOU?
WHAT PARTICULAR STRENGTHS AND EXPERIENCES DO YOU THINK YOU WILL BRING TO THE
WCLP?
HAVE YOU IDENTIFIED YOUR CORE VALUES AND BELIEFS? IF SO, WHAT ARE THEY?
THE WCLP WILL CHALLENGE YOUR VALUES, BELIEFS, THOUGHTS AND IDEAS. ARE YOU OPEN TO
BEING CHALLENGED, AND WHAT DO YOU BELIEVE YOU WILL GAIN FROM THE PROCESS?
SOMETIMES OUR CORE STRENGTH IN ONE SITUATION CAN BE OUR ACHILLES HEEL IN ANOTHER. IS
THERE ANY SPECIFIC BEHAVIOUR YOU FEEL YOU SHOULD CHANGE TO BECOME A BETTER
LEADER? IF SO, WHAT IS IT?
WHAT DO YOU HOPE TO GAIN FROM YOUR PARTICIPATION IN THE WCLP?
LV ALUMNI COMMIT TO A LIFETIME OF SOCIAL IMPACT THROUGH LV. IN WHAT WAYS DO YOU SEE
YOURSELF 'GIVING BACK' TO THE COMMUNITY AFTER GRADUATION?
PLEASE LIST ANY SPECIAL ACCESS REQUIREMENTS RESULTING FROM DISABILITY OR OTHER
CAUSE.
PROGRAM DATES AND PROGRAM OUTLINE
Leadership Victoria will advise successful applicants of the 2013 program outline and program dates
at the time of offer.
WCLP FEES
The program fee for WCLP 2013 is $11,400 plus GST. This figure comprises:
 your employer’s/sponsor’s contribution of $9,800 plus GST,and
 your personal contribution of $1,600 plus GST.
No individual is discouraged from applying for economic reasons. All candidates are invited to submit
their applications, as all places are determined on merit. Through the support of our alumni and
others, fees can be reduced in some instances, particularly for individuals employed by smaller nonprofit organisations, or people who have experienced disadvantage, including disadvantage
experienced as a result of a disability. Individuals from outside metropolitan Melbourne may be
eligible for a travel and accommodation subsidy. Special arrangements can be discussed with LV
during the selection process.
Limited financial support may be available and can be discussed with LV during the selection process.
WCLP TERMS AND CONDITIONS
Before you submit this form, please read the following terms and condidtions.
EMPLOYER/SPONSOR SUPPORT
Your employer/sponsor must fully support your WCLP application. You will need to:
 gain sign off from your organisation’s CEO, confirming that you can participate in all programrelated activities
 request the employer financial contribution of $9,800 plus GST (which is in addition to your
personal contribution).
CANCELLATION POLICY
Cancellations received prior to December 31 incur a $1,600 (ex GST) cancellation fee. There is no
refund for cancellations received from January 1. Substitutions and transfers between programs will
not be accepted. Cancellations must be received in writing via email or fax.
In the event of program cancellation by LV, customers will be entitled to a full refund.
PRIVACY POLICY
Leadership Victoria is committed to protecting the privacy of personal information it collects, holds,
and administers. Leadership Victoria is bound by the Victorian Privacy Laws, the Information Privacy
Act 2000, as well as other laws, which impose specific obligations when it comes to handling
information. The organisation has adopted the respective Privacy Principles contained in the Victorian
Privacy Laws as minimum standards in relation to handling personal information. Your personal
information will be used only for the primary purpose as outlined in this document or a directly related
purpose, or another purpose with your consent, or as required by law.
SIGN OFF
EMPLOYER/SPONSOR COMMITMENT
I am the CEO of the organisation that employs the applicant; or
I am the applicant’s sponsor.
I understand there is a time commitment required of the applicant, and I commit to paying the
employer/sponsor financial contribution. The candidate has my full support to participate in the WCLP.
Name
Title
Organisation
email
Signature
Date
APPLICANT’S REFEREES
Provide two referees, other than your employer or sponsor, who can articulate your past leadership
performance and your potential.
Name of
referee 1
Title
Organisation
Phone
Relationship to
applicant
email
Name of
referee 2
Title
Organisation
Phone
Relationship to
applicant
email
PERSONAL COMMITMENT
1.I understand and commit to the time required for participating in the WCLP.
2.I understand I am committing myself to increased involvement in the community upon graduating, via
the range of projects, activities and initiatives offered to Leadership Victoria Alumni
Full name
Signature
Date