Program Application Form 2018-09-18T23:01:10+00:00

PROGRAM APPLICATION FORM

Application Process

  1. Applications close COB Wednesday 7th November 2018.
  2. Shortlisted applicants will then be invited to attend a panel interview.
  3. All applicants will be notified of the outcome by COB Friday 7th December 2018.
  4. The formal program will commence in February 2019.

Advice & Instructions

Participation in the Leaders for Geelong (LfG) program requires a significant time commitment over two years. Applicants must be able to meet this requirement as detailed in the Participant Agreement section of this form.

Participants are chosen on merit as well as fit within the overall balance of the group. Diversity is a major determinant in the success of the program so it is important to ensure representation from across local government; community sectors; private enterprise; professional industries; ages, cultures and backgrounds. Please note that individuals may nominate themselves.

The Committee for Geelong (CfG) invites broad representation and inclusion in the program, therefore individuals or organizations with economic barriers should not be discouraged from applying. Please contact CfG to discuss individual circumstances in confidence.

How to Apply

  1. Please complete all sections of this form

Please contact Janelle Meyes on 03 52278073 if you have any questions regarding the recruitment process.

PERSONAL DETAILS

Surname: *
First Name: *
Preferred Name: *
Date of Birth: *
Male Female NB
Organisation/Employer: *
Current Job Title: *
Business Address: *
P/Code: *
Mobile: *
Business email: *
Personal Email: *
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: *
Relationship: *
Mobile: *

PERSONAL

What do you hope to gain from the Leaders for Geelong program?

Personal: *
Organisational: *
Community: *
How did you hear about the Leaders for Geelong program?: EmployerReferralSocial MediaWebsite
Other (please specify)

COMMUNITY AWARENESS

What do you believe are the two most exciting opportunities currently in the Geelong Region?

1 *
2 *

What do you feel could be done to enhance/leverage one of these opportunities?

What do you believe are the two most significant issues / challenges facing the Geelong Region?

1 *
2 *

What do you feel could be done to address one of these issues?

PARTICIPANT AGREEMENT

TIME

LfG is a two-year program commencing February 2019 and concluding November 2020. As a guide, the time commitment and attendance includes:

Year One ( 2019 ):

  • 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 ( 2020 ):

  • Action Learning Project
  • Monthly program events
  • Coaching/Mentoring Opportunities
  • Project Presentation Breakfast
  • 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 total fee for the two year Leaders for Geelong program is $6,500 plus GST. 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 Janelle Meyes on Janelle.meyes@committeeforgeelong.com.au or 03 52278073 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. A copy of the CfG Privacy Policy is available on the website at www.committeeforgeelong.com.au/terms-conditions/

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:

  1. I will devote the required time to attendance and personal involvement;
  2. I agree that any information and photographs throughout the program may be used for promotion - including the CfG leadership programs and associated websites;
  3. I consent to have my email address shared amongst participants; and
  4. 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: *
Date: *

EMPLOYER AGREEMENT/RESPONSIBILTY

(Or self if self-nominating)

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

Employer/organisation: *
Employer name: *
Job title: *
Signature: *
Date: *