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APPLICATION
Leadership Jacksonville-Onslow
I. Personal
Data
Name
_______________________________________________________________
Last
First Middle
Nickname or preferred name
_____________________________________________
Length of area residence _______
Fax _____________________________ E-mail
______________________________
Business Address
_____________________________________________________
Home Address
________________________________________________________
Business Phone _______________________ Home Phone
____________________
If married, name of spouse ___________________________ No. of
children ______
II. Employment
Present Employer/ Business Name
________________________________________
Date of Hire (If self-employed, date business began)
__________________________
Present Title or position
_________________________________________________
Type of company or organization
_________________________________________
Briefly describe your present
responsibilities:
______________________________________________________________________
______________________________________________________________________
___________________________________________________________________
What do you consider your highest
responsibility, skill, or career achievement to date
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
III.
Business/Professional Activities
(Do not include civic organizations,
public office, or political activities)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
IV. Community
Involvement
(Include community, civic, religious,
political, social, athletic, or other activities)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Have you been as active in
civic/professional/community activities as you would
like to be, why or why not?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
What do you hope to gain from the
Leadership program experience?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
As an emerging
leader in the community, what type of involvement do you envision
for yourself?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
V. Commitment
Have you ever
applied to participate in this program before? _____ If yes, in
what year? __________
Are you willing to
dedicate at least the minimum requirements for the Leadership
Jacksonville.Onslow as outlined in these materials?
___________________________
Do you understand
that an interview may be a part of the selection process? ________
_____________________________________
_________________
Signature of
Applicant
Date
VI. References
Name Phone
Position Company/Organization
-
__________________________________________________________________
-
__________________________________________________________________
-
__________________________________________________________________
VII.
Employer Endorsement
I understand the
time requirements as outlined in this packet and fully support the
above employee in his/her endeavor to participate in the Leadership
Jacksonville.Onslow program.
______________________________________________________________________
Supervisor Signature
Please print or type the
information below.
Supervisor’s
Name
Title
Phone/Fax
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