Public Sector Management Program by tcu11291


									 Public Sector Management Program
        Northern Territory Application Form

        •      Applicant to complete sections A and B
        •      Sponsor and line manager to complete section C
        •      Forward completed application to your agency representative (refer
               to website) who will then contact you if you have been short listed
        •      Agency representative will forward application onto Chief Executive
               Officer for approval
        •      It may be necessary for you to also enter your details onto a
               national database. If this is required the PSM Program office will
               notify you

Additional Application Requirements

For further information refer to the Northern Territory PSM Program website

Send Application to

Applications will not be accepted by the Office of the Commissioner for Public Employment Office without prior
approval and a covering letter from your agency representative.

                 Application close off with OCPE is one month prior to the Orientation Day.

Privacy Statement

The Office of the Commissioner for Public Employment respects your privacy and is committed to protecting your
personal information. We collect your personal information to provide and improve our services. For these
purposes we may disclose your personal information to organisations to which we outsource functions such as
the accrediting universities and course facilitators. We will assume that we have your permission to do so unless
you tell us otherwise.

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Public Sector Management Program
        Northern Territory Application Form
                     Preferred Program
                                   Please complete ALL details.


Applicant Details
AGS Number                                                          Title    Mr           Ms             Miss           Mrs         Dr
Family Name                                                        Given Name/s
Preferred Name                                                     Date of Birth
                                                                   Gender                            Male                  Female

Education                   5 years middle management experience
                            Vet qualification
                            Undergraduate degree
                            Postgraduate degree or qualification

Home Address
                             State / Territory                                               Postcode
                            Home Telephone                                                   Mobile
                            Home Email
Preferred Email Address     Home                                                     Work
Preferred Postal Address    Home                                                     Work
Individual Needs
(eg physical/diet)

EEO Group                   You do not have to fill out this section, however the information will only be used for statistical purposes
                           Women                                                     Do you have a disability?
                           Aboriginal or Torres Strait                               From a Non English Speaking
                           Islander Background                                       Background

Work Details
Tier of Government          Commonwealth                              State                              Local
Designation                 (AO6 to AO8 or equivalent)
Position Title
Agency / Department
Postal/Delivery Address
                           State / Territory                                                 Postcode
                           Work Telephone                                                    Fax
                           Work Mobile
                           Work Email

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SECTION A – continued
Education and Qualifications
Please list your qualifications and educational background

    Course / Qualification            Institution where course / qualification was      Date of completion

Please list any other education or professional development activities you have undertaken, which
support your application.

Work History
Please list previous positions held from 2002 onwards.

        Dates                              Job Titles                           Organisation / Business

        Marketing Source (please indicate where you first heard about the PSM Program):
                  Advertisement (Sectorwide etc)                        HRM/staff development
                  Agency newsletter/email                               Information session
                  Work colleague/graduate                            Other:

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SECTION A – continued

Participants Agreement
I agree to
       Commit to this program
       Actively participate in the program
       Apply the learning to my workplace
       I am able and prepared to commit the necessary time and energy to
         successfully engage in all aspects of this Program
       Submitting my assignments before the close off time of 10pm on the due date
       Attend all scheduled days of the program

I understand that
      I must complete the program in sequential order
      I must defer to another program if I am unable to attend any of the scheduled
        program days (e.g. Residential, face to face units, library training,
        presentations etc)
      In doing so there will be a $1500 fee incurred
      If I defer / withdrawal I must have my CEO and Sponsor’s approval in writing
      My PSM registration period is valid for two years
      Assessment penalties may apply for late submission of assignments

I understand that the PSM Program involves
      Enhancing my existing skills and experience
      Action learning
      Research
      Reading
      Assignment writing
      Sharing my learning with colleagues

I agree to participate in the PSM Program as outlined in the prospectus and to commit to the
requirements in the form of attendance, active participation and completion of the assessment
component. I am aware that penalties may apply for missing assessment due dates. I
confirm that I have read and understood all Program Administration, Policy details and agree
to the above.

Participants Signature                                           Date

       ** Participants must sign.

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Selection Criteria
Having undertaken some research into the content of the PSM Program, how would you rate yourself
currently against the 12 key skills areas which you will develop during the program?

                                                         Low              Medium              High
Business ethics
Knowledge of public sector context
Decision making
Political Management
Strategic thinking
Policy skills
Managing Relationships
Interpersonal skills
Communication skills
Delivering Results
Managing people and performance
Problem solving

What learning needs do you have that this Program will address?

Please describe how you expect to contribute to improving organisational outcomes in your workplace
through your involvement in this Program (both during and after the Program).

Please write a 500 word essay (approximately 2 x A4 pages in length) justifying why your agency should
sponsor your application to participate in this personal development opportunity. You should make
reference to your skills gaps, development objectives, future career aspirations and give details of
initiatives that you have introduced etc.

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Sponsor to Complete

Title               Mr           Ms           Miss        Mrs
Family Name                                                    Given Name
Position Title
Postal Address
State / Territory                                               Postcode
Work Telephone                                                  Work Fax

Sponsor’s Agreement

I endorse this nomination and agree to support the applicant’s participation in the Public Sector Management
Program, in particular through:
        Ensuring time release from the workplace for the applicant to attend course work;
        Acting as a mentor/coach for the participant; and
       Assisting in the definition of the work based project and providing support to the participant in completing
        the project;
        I understand that there is no refund if this applicant needs to withdraw or defer from the program
        I agree to commit to attend the short presentation at unit 4 for the work base project

Sponsor’s Endorsement
Please give specific reasons for your support of this candidate

Sponsor’s Signature                                                                       Date

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Line Manager’s Endorsement
(Please complete even if the line manager is also your sponsor)
Please indicate how you will support your staff member throughout the duration of the PSM Program?

Line Manager’s Signature                                                                            Date

Line Manager’s Name

Chief Executive Officer Signature                                                                  Date

Chief Executive Officer Name

Program Fee                                                   ($6,500)
Participants not based in Darwin please note that your agency will be required to cover any additional costs (travel,
                                             accommodation, TA etc)

Authority to Pay
All Northern Territory Government Agencies are to fill in Part A & B; this will allow us to receive your payment via LTF
** Please note the payment for this Program will be deducted automatically via LTF once you supply your expense / cost code.
    (Invoice will not be issued).

If you are not part of the Northern Territory Government or you are a GBD, please fill in part B only and a Tax Invoice will be
forwarded to you.

Part A
Cost Code:                                                Standard Classification

Line Manager’s
                                                                            Date                           /     /

Part B
Family Name                                                          Given Name
Position Title
Postal Address
State / Territory                                                      Postcode
Work Telephone                                                         Work Fax
Email (accounts section)

For GST Purposes                     Non GBD                                    GBD

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