Date: Name: Department/Branch: Primary Phone # Email Address: Position:

GROWING OUR OWN Tomorrows Managers Entry Level Management Positions Application _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________

How long have you been in your current position? _______________________________________ EDUCATION Name & Location of School From- To Degree Major

Scholastic Honors and Awards

Extracurricular Activities, Awards and Responsibilities:

School/College Leadership positions:

EMPLOYMENT (including employment outside of PLCH) From-to Name & Location of Employer Position Reason for Leaving

ORGANIZATIONS AND ACTIVITIES Please list membership in community, civic, business, professional, religious and social organizations that have been of significant to you.

Organization

From To

Responsibilities of position held

Attach a separate page if necessary.

CREATIVE SOLUTIONS Answer the two questions below in responses of not more than 100 words each. a. What is one of the greatest challenges youve faced in the workplace, how did you handle it, who did you involve, what outcomes resulted and what did you learn from it? b. Identify a significant role model in your career and describe how that person impacted your life and leadership style. 2. What are up to 3 of your greatest accomplishments? Briefly describe the situation, actions taken, the results and your leadership role 3. Describe your biggest failure and what you learned from the experience. 4. Why should you be selected for this program? 2 1.

ATTENDANCE REQUIREMENTS A participant is expected to attend all sessions. Those who miss more than two sessions will be denied graduation and asked to withdraw from the program. Kickoff 5 full-day sessions (all full-day sessions are from 8:30 a.m. 4:30 p.m.) 4 half-day group coaching sessions (half day sessions are either from 8:30 noon or noon 4:30, depending upon the availability of coaches and coachees) 2 individual coaching sessions Optional activities planned to meet the needs of the group Graduation

YOUR COMMITMENT Will you be able to fulfill this commitment? Yes No No

Do you have full support of your manager for the required time off? Yes REFERENCES

Please list the person who is most knowledgeable about your leadership performance and potential and have her/him complete the separate confidential recommendation form. No other recommendations are required. No more than two additional letters may be submitted. Primary Reference Names Department/Branch Email address Phone

I understand the purposes of the Grow Our Own Leadership I Program and will devote the time and energy necessary to make it a successful experience if I am selected to be a participant. __________________________________________ Candidates Signature ________________________________ Date

05/28/2010