Building inclusive leaders Application form 2019-20 programme

BUILDING INCLUSIVE LEADERS PROGRAMME 2019 – 2020 APPLICATION FORM SUBMISSION DEADLINE: STRICTLY, 4pm Thursday 28th February 2019 In applying to the programme you must be able to attend all face-to-face elements of the programme. Should there be any difficulty with your availability, before submitting an application, please contact the Chief Executives’ Forum on 028 9081 6440 to discuss the situation. Please note that this programme includes one mandatory overnight residential and a one day event in Dublin with optional overnight stay. All travel connected with this programme will be organised and paid for by the participants’ sponsoring organisations. COMPLETING THE APPLICATION FORM: Save as a PowerPoint file to your computer. Click inside each answer box, type in your response (noting word limit) and save. Either email your application to mail@ceforum.org or alternatively you can print off your completed form and post it (duly endorsed) to the address below. NB: As your form must be approved and authorised by your Chief Executive, your email submission MUST be cc’d to your chief executive’s email address to confirm that the required endorsement is in place. POSTAL RETURN ADDRESS: CHIEF EXECUTIVES’ FORUM Clare House 303 Airport Road West BELFAST BT3 9ED T. 028 9081 6440 E. mail@ceforum.org W. www.ceforum.org

PART A: YOU AND YOUR JOB Name: Organisation: Job Title: Address for Correspondence: Primary Purpose of Your Job: Reporting Structure/Grade: (typically you should hold a second or third level post reporting directly, that is, to the chief executive or to a director) Date appointed: Telephone: Email Address:

Describe your career path, including key milestones, and your most significant developmental experiences: (max 100 words) 2. Please demonstrate your direct involvement in: Development strategic direction (max 50 words) Leading change management (max 50 words) Contributing to new ways of working (max 50 words)

INSERT YOUR NAME here Building inclusive leaders Programme Tell us a little bit about yourself here : (Overwrite your answer on this text)– whatever you are comfortable sharing. My passion for leadership and for being of service: What inclusive leadership means to me: What I most want to achieve on this programme and how I hope it will impact my future career plans: The strengths that you can expect to see from me are and why I‘m a good fit: What I will be working on to improve myself over the next 12 months: What I want feedback on during this programme: Please stick to the space provided on this page to answer all questions.

Signed Date Print Name Signed Date Print Name I understand that I am applying for a place on the 2019-2020 CEF Building Inclusive Leadership Programme and undertake to attend all modules (Applicant) I approve and authorise this application: (Chief Executive) Signed Date Print Name Signed Date Print Name