Centre for Public Sector Excellence
2016Graduate future leaders

Please complete all seven sections and attach your resume (of no more than 5 pages). Completed application forms should be emailed to d must be received by5:00pm Friday 11 March 2016.

Section 1
Applicant’s details
Gender / Choose an item. /
Title / Choose an item. /
First name
Surname
Preferred name
Date of birth / Date / Month / Year
Work email
Alternative email
Work phone
Mobile
Do you identify as Aboriginal or Torres Strait Islander? / Choose an item. / This information will assist the Commission to improve learning and development outcomes for Aboriginal employees.
Do you consider yourself to have a disability impairment or long-term condition that may affect your participation in this program? / Choose an item. /
If yes please specify:
This will not hinder your application but assists the Commission to provide appropriate support. / If selected, would you like to discuss this? / Choose an item. /
Section 1 continued
Employment details
Agency
Branch/Division
Postal Address
Postcode:
Employment status / Choose an item. /
Date employed at agency / Date / Month / Year
Substantive position title / Level:
Acting position title / Level:
Date and duration of acting
Are you based regionally? / Choose an item. / Region: / Choose an item. /
Education history
Qualification
Institution
Year completed
Qualification
Institution
Year completed
Section 2
Applicant’s personal statement
This section is an opportunity for you to tell us about yourself and address the selection criteria.
Briefly explain your public sector career to date i.e. what tasks you perform, what learning/development/leadershipopportunities you have had.
Why do want to participate in the Graduate future leaders program?
How do you imagine your participation in the Graduate future leaders program will assist you?
Where do you envisage yourself in the next three to five years?
Section 3
Applicant’s declaration of commitment
I declare to the best of my knowledge the information on this form is correct and complete.
In completing this application form I agree to:
 / the conditions outlined in theGraduate future leaders Programguide
 / attend Introduction day, all modules and the Recognition Ceremony
 / undertake all required coursework to the best of my ability
 / participate in and make myself available for the group project
 / notify the Commission of any changes to my circumstances
 / actively participate in the program evaluation and provide feedback to the Commission.
Is there anything you wish to add in support of your application?
Signed
Electronic signatures are acceptable / Date:
How did you hear about this program?
 / colleague /  / manager
 / Learning & Development/HR Unit /  / Direct email
 / advertisement /  / Intersector
 / PSC event /  / PSC website
 / other PSC program /  / Other
Section 4
Line manager’s details
Full name / Choose an item. /
Position title
Branch/Division
Work email
Work phone
Mobile
Please comment on why you support this application.
Line manager’s endorsement
As the applicant’s manager, you are aware of the commitment required by participants to complete all aspects of Graduate future leaders.
In endorsing this nominee, I confirm that I agree to:
 / the conditions of the Graduate future leaders program which state the participantmust abide by the policies and administrative guidelines set out by the Program Manager
 / release the applicant to attend all aspects of the program, including time to work on the group project
 / provide the applicant with sufficient opportunity to incorporate learnings and activities in the workplace
 / ensure budget is available and payment is approved.
Signed
Electronic signatures are acceptable / Date:
Section 5
Payment details
The Graduate future leaders program fee is $600*(GST exempt) per participant. The fee includes:
  • A 30% cost subsidisation by the Public Sector Commission
  • materials and resources
  • face-to-face delivery of all modules by content experts
  • administrative costs associated with the program and workshops.
The invoice for the program fee will be raised after attendance at Introduction day. Fees are to be paid in full once the invoice is received.
Program fees are non-refundable but substitute participants may be accepted. Please refer to the Program guide for withdrawal conditions.
*pending approval from the Department of Treasury
Invoices should be addressed to
Full name
Position title
Agency
Branch/Division
Email
Phone
Postal Address
Postcode:
Section 6
Chief Executive Officer endorsement
Full name / Choose an item. /
Position title
As Chief Executive Officer I agree:
 / that I endorse and support the candidate’s application
 / to release the applicantto attend all aspects of the Graduate future leaders program
 / approve the $600 program participant fee.
Would you like to add any comments in support of this application?
Signed
Electronic signatures are acceptable / Date:
Section 7
Agency application coordinator details
Only one copy of this form is to be completed per agency.
To ensure a broad cross section of the sector is represented and to enhance the participants’ learning experience, applications may be limited to one successful participant per agency per intake. However, agencies are encouraged to nominate all suitable applicants to enable the Commission to determine demand for additional and future intakes.
Should there be more than one application from your agency, please assign priority ranking for each applicant:
Applicant 1
Applicant 2
Applicant 3
Applicant 4
As the agency applicationcoordinator, you will be the point of contact for the Commission in relation to the application process. You must ensure:
  • the agency priority list is complete and signed
  • all applicants meet the eligibility criteria
  • all sections of the applicant’s form are completed in full and signed by the relevant person
  • the application form is submitted to the Commission by the due date.

Full name
Position title
Agency
Branch/Division
Email
Phone
Postal Address
Postcode:

Applications for both intakes close 5:00pm Friday 11 March 2016

Applications and attached resume should be sent to .
Late applications will not be accepted. Enquiries may be directed to the Program Manager at on(08) 6552 8604.

Graduate future leaders2016 Nomination form Page 1 of 8