Leaders for Geelong Program Application

INSTRUCTIONS

To apply for the 2020/21 Leaders for Geelong program, please complete the application form below and upload your current CV and supporting statement as accompanying documents. A shortlisting process will then be undertaken before an interview. If you have any questions, please contact Vicki Strachan on victoria.strachan@committeeforgeelong.com.au or 03 5227 8075.

PLEASE COMPLETE THE FORM USING FIREFOX OR CHROME WEB BROWSER

Surname: *

First Name: *

Preferred Name: *

Do you identify as an Aboriginal or Torres Strait Islander? * YesNoPrefer Not to Answer

Do you identify as a person with a disability? * YesNoPrefer Not to Answer

Do you identify as LGBTIQ+? * YesNoPrefer Not to Answer

How would you describe your cultural/ethnic background? *

Organisation: *

Job Title: *

Business Address: *

P/Code: *

Mobile: *

Business Email: *

Personal Email: *

Please Upload CV here: * (Max upload size 2MB)

Dietary requirements: (If applicable):

Any other special needs: (E.g. Access, language, literacy, numeracy)

LinkedIn Address: (If applicable)

Twitter Handle: (If applicable)

Invoice Contact Details: * (Who is responsible for payment)

Emergency Contact: *

Emergency Contact Mobile: *

LEADERSHIP DEVELOPMENT QUESTIONS

What Personal Leadership Learnings do you hope to gain from the LfG Program?*

What Organisational Leadership Learnings do you hope to gain from the LfG Program?*

What Community-based Leadership Learnings do you hope to gain from the LfG Program?*

How did you hear about the Leaders for Geelong program?: EmployerReferralSocial MediaWebsite

Other (please specify)

PARTICIPANT AGREEMENT

TIME

LfG 2020/2021 commences February 2020 and concludes November 2021. As a guide, the time commitment and attendance includes:

Year One ( 2020 ):

Opening Residential Conference ( 2 days/1 night )
One Seminar per month ( 9am – 5pm )
One Evening Workshop per month ( 5pm – 8pm )
Canberra Delegation ( 2 days/2 nights )

Year Two ( 2021 ):

Community Based Action Learning Project
Bi-Monthly Program Events
Project Presentation Event
Closing Residential Conference ( 2 days/1 night )
Graduation Dinner

ATTENDANCE

Participants are required to maintain a minimum attendance of 80% across all core program events. Inability to meet the 80% attendance requirement may result in consultation with the participant’s employer and/or possible release from the program before completion date.

FEES

The fee for the 2020/2021 Leaders for Geelong Program is $6,700+GST (not including the cost of return flight to Canberra). This fee may be paid by the participant or the employer and is payable on acceptance into the program.
Individuals or organisations with financial or economic barriers should not be discouraged from applying. Contact Margaret Foulkes on Margaret.foulkes@committeeforgeelong.com.au or 03 52273868 to discuss individual circumstances in confidence.

CANCELLATION/WITHDRAWAL FROM THE PROGRAM

All cancellations (and/or subsequent withdrawals from the program) must be advised in writing. Charges for cancellations and withdrawals will be applied, as stated below, to cover fixed cost commitments and administration fees. Cancellations received prior to the commencement of the program will incur a 10% cancellation fee. Please note that program places are non-transferrable.

Notification of withdrawal within 3 months of the program commencement will incur a 50% cancellation fee. No refunds will apply after this point as places cannot be offered to other candidates.

PRIVACY

The Committee for Geelong are committed to protecting and respecting the privacy of its members, staff and participants by handling all personal information securely and with care in accordance with Australian privacy laws.

DISCLOSURE STATEMENT

Your personal information is collected on this form for the purpose of your participation in the Leaders for Geelong Program. The Company may disclose your personal information kept on our database to third party organisations for the purpose of functions, events, programs and initiatives of the Company. If you would like to access your personal information held by us, or would like to withdraw your consent to share personal information at anytime, please contact the Chief Executive Officer (CEO) of CfG.

DECLARATION AND PARTICIPANT AGREEMENT

I declare that the information supplied by me is true and correct.I understand the goals of the program and the time commitment required of a participant in the Leaders for Geelong program. If selected for the program:

I will devote the required time to attendance and personal involvement;
I agree that any information and photographs throughout the program may be used for promotion - including the CfG leadership programs and associated websites;
I consent to have my email address shared amongst participants; and
I understand that as a CfG alumni, beyond the program, I commit to increased involvement and leadership in the community.

I confirm that I understand and agree to the conditions outlined.

Applicant name: *

Applicant signature: * (Max upload size 2MB)

Date: (dd/mm/yyyy)*

EMPLOYER AGREEMENT/RESPONSIBILTY

(Or self if self-nominating)

This candidate has my full support to participate in the 2020/2021 LfG program. I am aware of the time commitment, organisational and financial contribution.

Organisation: *

Employer name: *

Job title: *

Supporting Statement: *

Signature: * (Max upload size 2MB)

Date: (dd/mm/yyyy)*

Committee For Geelong



Level 1 Sally Walker Building,
1 Gheringhap Street,
Geelong, Victoria, 3250



+61 3 5227 8075



9:00am – 5:00pm

Monday to Friday

The Committee for Geelong acknowledges Aboriginal and Torres Strait Islander people as Australia's First Nations people and the Traditional Custodians of the land and waterways. We pay our respects to the local Wadawurrung people of this land, their Elders past, present and emerging.