Application form Leadership WA’s Rising Leadership Program 1 Welcome/Personal details 2 Personal details3 Social media4 Education5 Employment and experience6 Personal leadership7 Payment We are delighted you are interested in applying for Leadership WA’s Rising Leadership Program. Entry to the Program is competitive. You will be contacted within 4 weeks of submitting your application form to arrange an interview. All applications are then assessed by a selection panel and you will be advised of the outcome of your application once the selection process has been completed. During the selection process, we aim to make the Program cohort 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. A limited number of full or partial scholarships may be available, thanks to the generosity of donors to the Leadership WA Foundation. Your assessment of suitability for the Rising Program is not affected by any request for scholarship support. Alternatively, submitting your application early may create the opportunity for an early offer of a place so you may then be able to source your own funding support, if required. WHEN APPLYING, PLEASE NOTE:• All applications are confidential. • All questions must be completed in full and the declaration must be signed. • 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 can save and continue this form by clicking the link at the bottom of the page. A unique link will be sent to your email. Please note this link will only be active for 90 days. programYearAre you applying for the Aboriginal Regional Scholarship?*YesNoTo apply for the Aboriginal Regional Scholarship you must identify as Aboriginal and based in Regional Western Australia.P{reference is given to applicants from Not for Profit Organisations or Small Businesses What intake are you applying for?*MarchJulyPERSONAL DETAILSTitle*TitleMrMissMsMrsDrAssociate ProfessorProfessorName* First Last 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 CountryAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Date of Birth* Date Format: DD slash MM slash YYYY Gender*FemaleMaleOtherIf 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?*YesNoUpload Resume*Accepted file types: docx, doc, pdf.Upload Headshot*Accepted file types: jpg, gif, png, pdf.Where did you hear about us?*ColleagueManagerSearch engineAlumni eventFacebookLinkedInOtherIf other, please specify* SOCIAL MEDIALinkedIn URLProfessional Facebook URLProfessional Twitter URL EDUCATIONAre you currently studying?*YesNoI 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 GraduateInstitutionYear 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 EXPERIENCEName of organisation you are employed by*Organisation is a*Commercial BusinessGovernment DepartmentNot-For-Profit OrganisationSole TraderCurrent position title*Work Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Line Manager's Name* First Last Line Manager's Title*Line Manager's Email* Line Manager's Phone*PREVIOUS EMPLOYMENTPlease list your previous roles.*What do you consider your highest or most significant career achievement to date?*SKILLSList (multiple choice) your skills* Accounting Administration & Office Support Advertising & Media Arts Audit and Risk Banking & Financial Services Board Chair Call Centre & Customer Service Coaching/Mentoring Communications/PR Marketing Community Engagement Community Services Construction Consulting & Strategy Data Design & Architecture Education & Training Engineering Event Management Farming, Animals & Conservation Finance & Accounting Fundraising and/or Philanthropy General Management Governance Government & Defence Healthcare & Medical Hospitality & Tourism Human Resources Industrial Relations Information & Communication Technology Insurance IT/Digital/Cybersecurity Legal Manufacturing, Transport & Logistics Mining, Resources & Energy Occupational Safety and Health Organisational Development Other (Specify) Policy & Legislation Project Management Real Estate & Property Retail & Consumer Products Sales Science & Technology Self Employment Sport & Recreation Stakeholder Engagement Strategic Planning Tendering Trades & Services Mining Resources & Energy Marketing Farming Animals & Conservation If other, please specify* PERSONAL LEADERSHIPWhat do you consider your highest or most significant leadership achievement to date?*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.* PAYMENTHave you discussed payment with your employer?*YesNoHow will payment be made?My employer will PayI will be payingI intend on applying for a scholarshipI am applying for the Aboriginal Regional Scholarship*please note we are referring to the "employer contribution" portion on the payment. How I intend for payment to be made*My employer will PayI will be payingPlease 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.