Le Tautua

Emerging Leaders 2014

Application Form

SECTION 1

Le Va is New Zealand’s Pacific national coordination and workforce development programme.. Our dream is to Create opportunities for families and communities to flourish through embracing Pacific Solutions.

Growing Pacific leadership in mental health, disability, addictions and public health sectors, is a key component of developing the capacity and capability of the Pacific workforce, to ensure we have the right people, in the right place, at the right time, with the right skills, delivering the right services to our families.

The Le Tautua leadership programme supports participants to develop their unique cultural leadership perspectives and enhance their leadership and management skills.

The 2014 programme consists of a two day workshop held on the 13thFebruaryand 14th February 2014, followedby a final presentation workshop held on 3rdand 4thMarch 2014. Selected participants will be required to actively participate in discussions andcomplete a group assignment in theirown time between workshops.

Le Tautua Emerging Leaders programme2014 is limited to 20 participants.

Please ensure you submit your completed application form to Le Vano later than 5pm Friday 16th December 2014

personal details:

Surname:Title:

Given Name:

Preferred Name:

Address:

Contact Phone:Mobile:

Email:

Gender: Male Female [Please tick relevant box]

Ethnicity:Date of Birth:

Country of Birth:NZ Pacific Island Other Please specify

Personal Considerations:Please note any medical condition/s or dietary requirements, as well as any access requirements such as wheelchair access, support for vision/ hearing impairment etc:

If you have participated in any other management and/or leadership programmes, please list here:

employment details:

What is the name of your organisation?

What is your role within the organisation?

How long have you been in this particular role?

What type of service does the organisation provide?

Mental Health Disability Public Health Addictions Other Please specify

Postal Address:

Physical Address:

Employer status: NGO DHB PHO Other Please specify

Health/ Disability work experience

Please specify how years of experience you have had working in the health sector?

Mental Health Sector Number of Years:

Addictions SectorNumber of Years:

Public Health Sector Number of Years:

Disability Health sectorNumber of Years:

Other Number of Years: Please specify

Have you held managementrole(s) during this time? YES NO

If yes, please specify these roles?

Have you carried out leadership roles in your journey? YES NO (This question is not limited to your time in health, this may in the community, family, sports settings etc)

If yes, please specify these roles?

Leadership

Please provide the reason why you wish to participate in this programme?

(The selection panel will consider this information for suitability of the applicant and group dynamics of the cohort.)

What health or disability sector role do you see yourself in 5 years time? What kind of support would you like to have to help you achieve your aspired role in the health and disability sector?

Supporting Documents

Please attachthe following documents with this application:

  • Arecent resume (CV)including work experience and academic history
  • Evidence of Support from your employer

(This maybe an email letter supporting study leave to participate in Le Tautua programme)

  • Reference letter from one other person who supports your application

declaration

I declare that the information set out in this application is accurate and true.

I have discussed this commitment with my manager/supervisor who understands and supports my application, and to this end I attach a letter of support.

I agree to notify Le Va immediately of any changes to my contact details, or changes that may occur that prevent me from attending the full programme. I give authorisation to Le Va to release application information to my employer.

Agree: Yes No

Email address:

Date:

Employer/ Manager to complete:

I confirm that I have read and agree to support the applicant and make available the necessary resources to support him/her throughout the programme. A letter confirming my support is attached.

Agree: Yes No

Name of Manager/ Supervisor (print):

Email address of Manager/ Supervisor:

(Letter from Employer will support this)

Date:

checklist

Documents / Check
C.V
Support letter from Employer
Support letter from one other referee

send application

Please ensure we received your completed application and attached documents no later than 5pm Friday 16th December 2013 via email: or post:

Le Tautua Emerging Leaders

PO Box 76536

Manukau City

2241