Application form Leadership WA’s Rising Leadership Program 1Welcome/Personal details 2Personal details3Social media4Education5Employment and experience6Personal leadership7Payment Thank you for your interest in applying for the Leadership WA Rising Leadership Program. Entry is competitive and will include an assessment of your application and an interview with a selection panel.During the selection process, we aim to bring together a Program cohort from a diverse mix of backgrounds, industries, occupations and experience. This is to ensure the cohort has a wide diversity of thought which makes for a more rewarding experience for all participants.You will be advised of the outcome of your application once the full selection process has been completed. A limited number of full or partial scholarships are available, thanks to the generosity of donors to the Leadership WA Foundation and our other Scholarship partners and donors. Your assessment of suitability for the Rising Leadership Program is not affected by any request for scholarship support.WHEN APPLYING, PLEASE NOTE:• All applications are confidential. Your information is saved on our server as you enter it.• All questions must be completed in full and the declaration must be signed. • You can save and continue your application across the application period. You will be sent a unique link to access it, via email (please keep an eye on your junk folder).• All questions must be completed in full, and the Terms and Conditions agreed to, ahead of submitting.• Individuals may nominate themselves but employed applicants must have the full support of their employer to participate. If you are self-employed, you can support your own application.• You are requested to upload a current headshot (as .jpeg or .gif file) and professional profile / Bio (as Word DOC/DOCX or PDF file) as part of this application. Files must be uploaded prior to submitting the form. (NB: File sizes must not exceed 400kb)• You will be contacted within 4 weeks of submitting your application to arrange an interview. Should you have any queries, please contact Rising@LeadershipWA.org.auWe look forward to receiving your application.Hiddenprogram HiddenYear What intake are you applying for?* March July Are you applying for a Scholarship?* Yes No Which Scholarship are you applying for?* Leadership WA Foundation Scholarship LeadAbility Scholarship Mount Burdett Scholarship *To apply for the Mt Burdett Foundation Scholarship you must: • Living and working anywhere in regional Western Australia• Early/Mid-level in your career• Passionate about creating a positive impact and difference where you live• Keen to build your leadership skills and put them into practice for your communityPERSONAL DETAILSTitle*TitleMrMissMsMrsDrAssociate ProfessorProfessorName* First Last Name of organisation you are employed by* Email* This will be how we send your Program information and acceptance letter. As some work domains may reject our emails as part of their security measures, we recommend a personal address. This email will act as a unique identifier in the Leadership WA database.Phone*Work PhoneWe highly recommend saving your Application at this point. The form can take 20 minutes to complete and by saving now you’ll be able to come back and complete the Application with additional information as needed. The link will be active for 90 days. Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth* DD slash MM slash YYYY Gender* Female Male Other If other, please specify* What do you identify as your cultural background?* If multiple please separate with a comma (,)Do you identify as Aboriginal Australian and/or Torres Strait Islander?* Yes No Where did you hear about us?*ColleagueManagerSearch engineAlumni eventFacebookLinkedInOtherIf other, please specify* SOCIAL MEDIALinkedIn URL Professional Facebook URL Professional Twitter URL EDUCATIONAre you currently studying?* Yes No I have checked the dates of the program and am confident my formal study will not affect my participation in the Rising Leadership Program.* Yes Due to the commitment required for our programs it is not recommended to be engaged in formal study while on a program with Leadership WA. However, participants may be able to accommodate both. We recommend you check the dates of the program and make sure your formal study workload will not lessen your ability to fully participate in the program. If you would like to speak to the Leadership Development Manager about this, please call us on (08) 6381 6700.Highest level of education*Doctoral degreeMaster's degreePost Graduate Certificate/DiplomaBachelor's DegreeAssociate DegreeAdvanced DiplomaDiplomaCertificateHigh School GraduateDid not GraduateInstitution Year completed/expected completionPlease enter a number from 1950 to 2050.Please enter your hobbies and interests Gardening Baking Journaling Fencing Theater Yoga Languages Boardgames Creating and organising a book club Networking events Local meetups Volunteering at a charity centre Public speaking Exploring other cultures Dancing Camping Playing a musical instrument Reading Writing Sketching Photography Design Blog writing Painting Basketball Football Volleyball Marathon running Skiing Tennis Cycling Swimming Baseball Mountain climbing EMPLOYMENT AND EXPERIENCECurrent position title* Organisation is a* Commercial Business Government Department Not-For-Profit Organisation Sole Trader Work Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Line Manager's Name* First Last Line Manager's Title* Line Manager's Email* Line Manager's Phone*Please tell us about the financial situation of your organisation and the need for financial assistance or your personal financial hardship*Please note Scholarships are available for those who are self-employed in small businesses and those working in the not-for-profit sector in a small to medium sized organisation.If you are successful and are offered a Scholarship please tell us how participation in the leadership program will benefit yourself, your organisation and enhance your capacity to make a positive impact on the community?*A critical consideration for the Mt Burdett Foundation and Leadership WA is how you will demonstrate that your participation in this program will help you make a marked difference in your community? ie Tell us what you will commit to doing? How will this have a lasting impact in your community?*What inspires you about your regional community and why?*Please attach a brief letter from a member of your community who will provide a character reference to support your application. It needs to include how they know you and what they see as your current and/or potential contribution(s) to your community.*Max. file size: 128 MB.What do you consider your highest or most significant career achievement to date?*Please describe the structure, size and scope of the team you lead? This can be direct reports or a project team. If you don’t currently lead a team, that is fine, please help us understand in what way you are leading other people and will be able to apply the learning as you go through the program.*SKILLSList (multiple choice) your skills* Administration & Office Support Advertising & Media Agriculture Audit & Risk Banking & Financial Services Board Experience Call Centre & Customer Service Coaching/Mentoring Communications/PR/Marketing Community Engagement Community Services Construction Consulting & Strategy Creative/Preforming Arts Data Design & Architecture Digital/Cybersecurity Education & Training Engineering Environment & Conservation Event Management Finance & Accounting Fundraising/Sponsorship & Grants General Management Governance Government & Defence Healthcare & Medical Hospitality & Tourism Human Resources Industrial Relations IT/Information & Communication Technology Insurance Legal Manufacturing Mining/Resources & Energy Occupational Safety and Health Organisational Development Policy and Legislation Project Management Real Estate & Property Retail & Consumer Products Sales Science & Technology Small/Own Business Management Sport & Recreation Stakeholder Engagement Strategic Planning Tendering Trades & Services Transport & Logistics Other (please specify below) Please include Skills you would use in your workplace and outside your place of work ( e.g in volunteering roles)If other, please specify* PERSONAL LEADERSHIPHow will you apply your leadership learning back to your own community to create a marked difference?*How would you describe your leadership style/s?*What are your key values and why? (approx. 250 words)*Who inspires you as a leader or role model and why? (approx. 250 words)*What skills or knowledge do you think leaders need to develop or know for the future? (approx. 250 words)*What is it about your desire to improve your leadership that makes you want to participate in this program? (approx. 250 words)*Please outline any leadership training/courses/subjects you have completed via studies, employment or voluntary work.*What were the specific learning outcomes/tools/frameworks you covered in the above?*Upload Resume*Accepted file types: pdf, Max. file size: 128 MB.Please upload a PDF version of your resume Upload Headshot*Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.This can be a similar style to a photo you use for your LinkedIn profile i.e., does not need to be a professional headshot. PAYMENTHave you discussed payment with your employer?* Yes No How will payment be made? My employer will Pay I will be paying *please note we are referring to the "employer contribution" portion on the payment. Name of company/person to be invoiced.* * I understand that Leadership WA may contact my manager to discuss my application If unsuccessful I would like Leadership WA to contact me about other opportunities* Yes No * I have read and understood the privacy policy and the terms and conditions of Leadership WA Terms & condtions Privacy Policy Code of ConductCommentsThis field is for validation purposes and should be left unchanged. Δ