Australia Awards Fellowships PNG

Australia Awards FellowshipsPapua New Guinea

Course:Certificate IV in Agribusiness

Application Form for Private Sector and Civil Society Applicants

PERSONAL INFORMATION

Title / Mr. Mrs.Ms.Dr.Other_____
First Name / Given Name
Surname / Family Name
Date of Birth (dd/mm/yyyy)
Place of Birth (State/Province)
Current Age
Sex
Province of Origin
Province of Residence
Do you have a passport? / YesNo
If yes, provide passport number / Issue date / / /
Expiry date / / /
Are you a citizen of PNG? /  Yes No
Do you hold a passport of another country? /  Yes
Country Name:
 No
Do you have a birth certificate? / YesNo

CONTACT DETAILS

If you are not contactable, your application may not be considered
Postal Address
Town / City / Postal Code
Province
Home Phone Number/s
Work Phone Number/s
Mobile Phone Numbers/s /
Fax Number/s
Email

EMERGENCY CONTACT DETAILS

First Name / Given Name
Surname / Family Name
Relationship to you
Home Phone Number/s
Work Phone Number/s
Mobile Phone Number/s
Email

CURRENT EMPLOYMENT

Position title
Briefly describe your role in nomore than three sentences
How many years have you been working in your current profession, and with this business/organisation?
(include some detail of current and previous roles)

BUSINESS DETAILS

Name of Business
Do you own this business? /  Yes
 No
Is your business registered with Investment Promotion Authority (IPA)? Please attach a copy of your IPA registration /  Yes
 No
How long has this business been in operation? Please attach a copy of your business profile
Briefly describein one paragraphthebusiness activities

CURRENT MANAGER/SUPERVISOR’S DETAILS

Position title
Name
Email
Phone Number/s

EMPLOYER CONTACT DETAILS

Name of Employer Business or Organisation
Name of direct Manager/Supervisor
Address of Organisation
Town / City / Postal Code
Province
Phone Number/s
Fax Number/s

* Direct Managers/Supervisors will need to complete section 13 of this application form.

COMPUTER LITERACY

How would you rate your computing skills?
 Excellent  Satisfactory  Poor
Do you require additional training in any of the following computer software?
If so, please place a tick () in the box
 Word  Excel  PowerPoint  No

PREVIOUS SCHOLARSHIPS AND EDUCATION

What is your highest level of education?
e.g. Grade 10
Have you previously received, or currently hold a scholarship funded by PNG, Australia or another foreign country? /  Yes – Please provide details below
 No – Go to Section 9
Scholarship Name
Qualification
Start Date (mm/yyyy) / / / / End Date (mm/yyyy) / / /

ENGLISH LANGUAGE PROFICIENCY

Is English your first language / YesNo
If ‘Yes’ go the next section. If ‘No’ answer the following questions:
Was English the language of your highest level of study? / Yes No
Have you taken an IELTS or TOEFL test within the last two (2) years? /  Yes - Please provide details belowNo – Go to Section 10
Test Name
Test Date / Overall Score
Reading Score / Writing Score / Listening Score / Speaking Score

MEDICAL/ DISABILITY DETAILS

Do you have a serious medical condition currently or historically? / Yes No
If yes, please describe the medical condition.
We encourage applications from people who have a disability including those who require additional support to complete their studies
Do you have a disability or special needs? / Yes – see below No - go to Section 11
 Visual impairment  Learning / Intellectual impairment
 Hearing impairment  Physical or mobility impairment
Are there any special requirements which you may need to complete your Fellowship program in Australia? (E.g. wheelchair access, learning aids etc.)

PROJECT

All Fellowship participants are required to develop and implement a small project which utilizes the knowledge and skills gained from the course to contribute to their organization and its objectives. The proposed project should be linked to the course topic describe the change in policy, systems, processes or delivery of services within an organizational context. Projects must be achievable in a three to six-month period of time and not require additional funding or resources from the employer organization. Please answer each question in no more than 150 words.
Outline your Project
(The change in process, policy, services. The project you aim to complete using the Fellowship)
What is the title of your project?
What will the project achieve?
What organisational need, issue or opportunity is the project responding to? (Please attach any report, research or organisational document that identifies the need)
What Organisational objective does the project aligns with? (Organisational Plans) Be specific; include relevant section from organisational plan if possible.
What PNG development priority does the project align with? (from Vision 2050 or other strategic document)

SUPPORTING DOCUMENTS

All candidates are required to submit their detailed Curriculum Vitae (CV) and Job Description with this application.
CV attached /  Yes  No
Job Description attached /  Yes  No

CURRENT EMPLOYER STATEMENT

This section MUST be completed by the applicant’s current supervisor/ manager.
Please explain your working relationship with the nominated applicant (i.e. you are their immediate supervisor or manager)?
Do you support the nominated applicant participation in the Fellowship? /  Yes  No
What skills and knowledge do you hope the applicant will gain during the Fellowship that will be beneficial to your organisation?
Briefly explain how the applicant’s proposed ‘project’ will make positive changes to your organisation?

APPLICANT DECLARATION AND SIGNATURE

I declare this application is a true and correct record.
Name
Date
Signature

CURRENT EMPLOYER’S NOMINATION AND SIGNATURE

This section must be signed by a Senior Representative
of the Organisation. / Official Stamp:
Signed by employer
Name
Position
Phone number
Date signed

This section is for the Australia Awards - PNG Use only

Date received by Australia
Awards in PNG
Signature of Receiving Officer