Rising Register | Leadership WA

EMPLOYMENT AND EXPERIENCE

Name of organisation you are employed by*

Organisation is a*

Commercial Business
Government Department
Not-For-Profit Organisation
Sole Trader

Current position title*

Work Address*

Line Manager's Name*

Line Manager's Title*

Line Manager's Email*

Line Manager's Phone*

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.*

What do you consider your highest or most significant career achievement to date?*

SKILLS

List (multiple choice) your skills*

Please include Skills you would use in your workplace and outside your place of work ( e.g in volunteering roles)

If other, please specify*

Application form

Leadership Western Australia

Street Address

Postal Address

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