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Leadership CORE Application Form

To be considered for participation in the Regional Chamber's Leadership CORE program, please complete the following application form. This must be received by Aug 1 at 5:00pm. Once submitted, your application will be reviewed by our Selection Committee. Our class will be finalized and all candidates will be notified of their status by Aug 5.
1.First Name:(Required.)
2.Last Name:(Required.)
3.Employer (company name):(Required.)
4.Your Direct Supervisor:(Required.)
5.Your phone number:(Required.)
6.Your work email address:(Required.)
7.Your Title:(Required.)
8.How long have you been in this role?(Required.)
9.How long have you been employed by this company?(Required.)
10.Please summarize your current job responsibilities.(Required.)
11.How do you feel you are performing in the following areas:(Required.)
Excellent
Average
Needs Significant Improvement
Unsure
Communication
Supervising
Coaching
Accountability
Conflict Resolution
Team Building
Workplace Leadership
Strategy/Goal Setting
12.Within your current company, what is your ideal role or area of responsibility? What is your ultimate career goal and how do you plan to get there? Please explain. If you're not sure of your goals/plans, please share that here with some detail - it's OK to not know!(Required.)
13.Consider specific skills that are important in reaching your career goals. Would it be helpful to have access to resources/training in any of those areas? Please mark all that apply below:(Required.)
14.Please share the name of an individual who you feel is an effective leader and explain why. Do you feel that you have any particular management or leadership skills in common with that person?(Required.)
15.Have you ever taken the StrengthsFinder Assessment?(Required.)