Application form 2018
Jawun Partnerships

Section 1

Applicant details

Surname
Given name/s
Gender
Agency
Division/Branch
Position title
Classification
Work address
Work phone number / Mobile number
Work email address
Qualifications (please list)
Emergency contact / Phone number
Do you identify as Aboriginal and/or Torres Strait Islander? / ☐Aboriginal ☐Torres Strait Islander ☐ No
☐I choose not to give this information
Do you have accessibility requirements and/or need other adjustments in order to participate in this program? / ☐Yes ☐No ☐I choose not to give this information
(If yes, please specify):
Driver’s License / ☐Yes ☐No / If yes: ☐Manual ☐Automatic
Off-Road Experience / ☐None ☐Minimal ☐Moderate ☐Extensive
Current first aid certificate / ☐Yes ☐No

Curriculum Vitae (CV)

☐A copy of my CV is attached

Preference of location/dates (please number)

East Kimberley (Kununurra or surrounding areas): 29 April 2018 – 9 June 2018
West Kimberley (Broome or surrounding areas): 20 May 2018 – 30 June 2018

Section 2

Applicant skill set

Please indicate your skills and degree of capability in the below areas by selecting the box. If you believe you have a skill set that is beneficial to the program, please add it below. / Very High / High / Medium / No Experience
Administration (General) / ☐ / ☐ / ☐ / ☐ /
Business Analysis / ☐ / ☐ / ☐ / ☐ /
Business Improvement (systems, processes, analysis) / ☐ / ☐ / ☐ / ☐ /
Business Planning/Enterprise Development / ☐ / ☐ / ☐ / ☐ /
Business Strategy Development / ☐ / ☐ / ☐ / ☐ /
Commercial assets, scoping of opportunities and investments / ☐ / ☐ / ☐ / ☐ /
Communications/Marketing/ Public Relations / ☐ / ☐ / ☐ / ☐ /
Contract Management / ☐ / ☐ / ☐ / ☐ /

Section 2

Applicant skill set
Please indicate your skills and degree of capability in the below areas by selecting the box. If you believe you have a skill set that is beneficial to the program, please add it below. / Very High / High / Medium / No Experience
Corporate Governance/Governance Support/Risk Management / ☐ / ☐ / ☐ / ☐ /
Data Analysis / ☐ / ☐ / ☐ / ☐ /
Engineering / ☐ / ☐ / ☐ / ☐ /
Evaluation/Survey Design / ☐ / ☐ / ☐ / ☐ /
Finance / ☐ / ☐ / ☐ / ☐ /
Hospitality / ☐ / ☐ / ☐ / ☐ /
Human Resources (including development of HR Systems, Performance Management, Learning and Development and Recruitment) / ☐ / ☐ / ☐ / ☐ /
Information Management / ☐ / ☐ / ☐ / ☐ /
Information Technology / ☐ / ☐ / ☐ / ☐ /
Legal / ☐ / ☐ / ☐ / ☐ /
Marketing / ☐ / ☐ / ☐ / ☐ /
Media / ☐ / ☐ / ☐ / ☐ /
Policy Design/Development / ☐ / ☐ / ☐ / ☐ /
Program Research/Design/Development/Implementation / ☐ / ☐ / ☐ / ☐ /

Section 2

Applicant skill set
Please indicate your skills and degree of capability in the below areas by selecting the box. If you believe you have a skill set that is beneficial to the program, please add it below. / Very High / High / Medium / No Experience
Project Management / ☐ / ☐ / ☐ / ☐ /
Research Analysis / ☐ / ☐ / ☐ / ☐ /
Strategy / ☐ / ☐ / ☐ / ☐ /
Stakeholder Engagement / ☐ / ☐ / ☐ / ☐ /
Statistician (Census Data) / ☐ / ☐ / ☐ / ☐ /
Training / ☐ / ☐ / ☐ / ☐ /
Website Development/Design / ☐ / ☐ / ☐ / ☐ /
Work, Health and Safety / ☐ / ☐ / ☐ / ☐ /
Writing (Business) / ☐ / ☐ / ☐ / ☐ /
Writing (Creative) / ☐ / ☐ / ☐ / ☐ /
Other / ☐ / ☐ / ☐ / ☐ /
List your three strongest skill set areas:

Section 2

Applicant skill set

What are three potential key learning opportunities/development areas you wish to gain from this opportunity:
1 / In 250 words or less, please outline reasons for nominating to participate in the 2018 program.

Section 2

Applicant skill set

2 / The program seeks applicants who show professional and personal attributes such as emotional intelligence, resilience and adaptability. In 250 words or less outline a situation in which you displayed these attributes (What was the situation? What attributes did you need to display? What was the task? What was the action and result?).
3 / The program seeks to creative a positive outcome and transfer of learning in a short time frame. In 250 words or less describe a situation in which you were able to achieve positive outcomes/transfer your knowledge in a short timeframe (What was the situation? What was the action and result?).

Section 2

Applicant’s Information and declaration of commitment

By signing this form I confirm that I,______,agree to the following:
(Insert applicants name)
☐the information submitted is accurate at the time of signature
☐actively participate in the program and commit to be away from home for a six week
period
☐undertake the identified project to the best of my ability
☐notify the Commission of any changes to my circumstances
☐actively participate in the program evaluation and provide feedback to the Commission
Signature of applicant: ______Date:

Section 3

Manager endorsement and support

I endorse this nomination and support the applicant’s participation in the Jawun Program
I have read the nomination against the selection criteria and confirm that this applicant is a high-performing employee who has the potential to contribute and benefit from participation in the Program
Name
Title
Signature
Date

Section 4

Statement of commitment and endorsement– Chief Executive Officer

In my capacity as the CEO, I confirm that my agency will:
release the applicant from their duties to participate in the secondment
will ensure the applicants’ salary remains in place for the duration of the secondment
Name
Title
Signature
Date

Office use only

Comments

Recommended for interview Not recommended for interview

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