Diverse Supplier Development Program Application
Diverse Supplier Development Program Application
Please answer the following questions accurately and concisely. Upon completion of this application, please send a completed electronic version to Ashley Turner, Diversity and Education/Training Specialist at by May 22, 2015.
A)Company Background:
1)Company name: Click here to enter text.
2)Company address:
Click here to enter text.
3)Owner(s) name and contact information (telephone number and e-mail):
Click here to enter text.
4)Is your company based in Newfoundland and Labrador?
☐ Yes ☐ No
5)Is your business 51% or more owned, managed and controlled by one of the following groups? Please check all that apply.
☐Women
☐Aboriginal peoples
☐Persons with disabilities
☐Visible minorities
6)Is your business currently certified with a national diverse supplier certifying organization(s)? Please check all that apply and provide applicable certification number.
☐CAMSC Certification #:Click here to enter text.
☐WEConnect InternationalCertification #: Click here to enter text.
☐WBE CanadaCertification #: Click here to enter text.
☐Other, please specify: Click here to enter text.
☐None
7)Is your business currently a member of a supplier organization/association? Please check all that apply.
☐NLOWE
☐Qalipu Business Network
☐Noia
☐Other, please specify: Click here to enter text.
☐None
8)If you are a member of a diverse supplier or other supplier organization, is there a contact person with the organization that you wish to provide as a reference for you? (Optional)
Reference 1 (if applicable)
Contact Name: Click here to enter text.
Telephone: Click here to enter text.
E-mail: Click here to enter text.
Reference 2 (if applicable)
Contact Name: Click here to enter text.
Telephone: Click here to enter text.
E-mail: Click here to enter text.
Do you provide Husky with permission to contact the above reference(s)?
☐ Yes ☐ No
9)Number of employees: Click here to enter text.
10)How many years has the company been in business? Click here to enter text.
11)Are you a Husky Energy supplier (for informational purposes only)?
☐ Yes ☐ No
12)How does your company demonstrate commitment to the community?
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B)Product and Service Information:
1)Describe your products/services.
Click here to enter text.
2)List some of the major clients/industries that you supply to.
Click here to enter text.
3)Have your products/services and/or business earned any accreditations, awards or recognition? If so, please describe.
Click here to enter text.
C)Strategic Vision:
Please respond to each of the below questions in 150 words or less.
1)What is your vision for your business?
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2)What are your short-to-mid-term goals for your business?
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3)What are your long-term goals for your business?
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4)What challenges, if any, have you faced or anticipate facing in achieving your goals?
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5)Is supplying to the oil and gas industry, including large corporations or their prime (tier 1) suppliers, part of your growth plan for your business? Please explain.
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6)Have you been successful in receiving purchase orders or contracts with large corporations, particularly in the oil and gas industry? Please explain.
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7)What challenges, if any, have you faced in supplying to large corporations?
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D)Supplier Development
1)Please select the top three areas in which you need development in order of priority (1- highest to 3- lowest).
1.Choose an item.
2.Choose an item.
3.Choose an item.
If other, please specify: Click here to enter text.
2)In order of priority (highest to lowest), please explain why you feel you need development in each of the areas you identified and clearly explain how mentorship in these areas will build the capacity of your company in relation to your strategic vision/goals.
- Click here to enter text.
- Click here to enter text.
- Click here to enter text.
3)Have you ever participated in a development or mentorship program in the past?
☐ Yes ☐ No
If yes, please describe:Click here to enter text.
4)What are you hoping to achieve from having a Husky mentor? Please state two objectivesin relation to your business that the Husky Energy Diverse Supplier Development Program could help you meet.
- Click here to enter text.
- Click here to enter text.
5)Are you willing to commit at least 2 hours per quarter for one yearfor meetings with your mentor?
☐ Yes ☐ No
6)Should you be chosen to become a mentee, are you willing to report progress on an ongoing basis and participate in a feedback/evaluation process at the end of the year?
☐ Yes ☐ No
7)Should you be chosen to become a mentee, are you willing to become a Program Ambassador if requested?
☐ Yes ☐ No
E)Signature:
I Click here to enter text., the owner of Click here to enter text.confirm that the information contained in this application is accurate and complete.
☐ I hereby acknowledge my understanding that participation in the Diverse Supplier Development Program is for supplier development purposes only and does not provide my company with any advantage in Husky Energy’s full and fair procurement process.
______
OwnerOwner (if applicable)
Date: Click here to enter a date.
Please submit applications to Ashley Turner, Diversity and Education/Training Specialist at by May 22, 2015.
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