Career Advancement Programme

Application Form

You should allow about 15-30 minutes to complete this application  As well as your needs and ambitions for the programme, you will also need to record the contact details (including any payment reference or code) of the person to whom the invoice for the programme should be sent.  Please make sure you have these at hand. All information you supply will be treated in confidence.

Background Information

Your Full Name

Job Title

Organisation

Mobile:

Preferred Contact Points (where we should send information and feedback about the Programme)

Address:

Postcode:

Email:

Landline:

2.	How did you first hear about this Programme?
	--Click Here--previous participant in the programmeline managercolleaguee mail communicationwebsitearticlejournal advertother

3.	Which of the following career development experiences have you been engaged in during the last five years?
	Career Coaching		Assessment Centre		Other  (please specify below)
	Other Coaching (please outline below)		Leadership Development Programme
	Career Seminar/Tutorial		Mentoring

	Please outline the development opportunities below e.g. name, organisation, content and  your learning

4.	Briefly describe the series of events that led to your decision to apply for this Programme?

Needs Assessment

5.	How important are the following career priorities to you?
		Very important		important		quite important		not at all important		don't know /perhaps
	I need to know where I should go next in my career
	I want to change jobs
	I want to add new dimension to my career e.g. managerial, clinical, technical
	I need to move out of the sector I currently work in
	I want to advance in my current career further
	I want to change career direction
	I want to reach an executive position
	I want to prepare for my retirement
	I want to change sectors
	I need to secure a new role within our organisation's new structure
	My job is at risk and need to pln my next move
	I need to secure a higher salary

	What other priorities you have for your career?

6.	By the end of the programme, how important is it that you ...
		very important		important		quite important		Not important at all
	have reviewed your career direction and choices?
	know how to recognise new career opportunities?
	have a plan to achieve your career goals?
	have fresh material for applications and interviews?
	are more able to manage the application process?
	have an up-to-date Curriculum Vitae?
	are more able to write applications for employment?
	are more able to tackle selection processes?
	are more confident and/or proficient at interviews?
	are more informed about the requirements of assessment centres?
	have a better life-work balance?
	are more motivated and engaged at work?

	List here anything else that is important for you to have achieved:

7.	What is your overall goal for this programme?

8.	What are your expectations of the career consultant who will work with you during the programme?

Access

9.	Which of the following is your preferred learning style (tick up to two)?
	Activitist		Reflector		Theorist		Pragmatist		Do not know

10.	How do you best learn?  How true are these phrases describe you?
		Very true		True		Partly true		Untrue
	I like new experiences and  are enthusiastic about new ideas. You tend to act first and consider the consequences later
	I like to look at situations from different perspectives.  You like to collect and consider information and data before drawing your conclusions.
	I like to adapt observations and apply theories. You are very systematic and logical when thinking through problems.
	I like to try things out.  You tend towards impatience, being keen to get to the conclusions.

11.	How much do you enjoy and learn through ...
		lots		quite a lot		a little		not at all
	reading
	doing internet searches
	writing out your ideas
	listening to speakers or lectures
	watching DVDs
	trying our techniques
	watching others at work
	working alone
	completing 'on line' exercises

12.

Would you like us to request on-site car-parking for your sessions?

Yes

No

Not sure

	Our premises are fully accessible for people with physical disabilities.  However, should you have any other access requirements that we should be aware of (e.g. visual, audio or learning needs), please state them below.

	What other issues should we be aware of in order to ensure your achieve your programme goal successfully?

Prerequisites for Admission

13.	What information do you have available to send to Accomplice alongside your application
		I have submitted this to Accomplice		I will submit this to Accomplice on request		not available
	Most recent CV
	Current job description (and organisational structure)
	Most recent appraisal
	Personal Development Plan
	References
	360 Analysis e.g Leadership Qualities Feedback

	If known, what was your MBTI (Myers Briggs) type?

	If known, what are your main Belbin Team Role preferences?

	What other supporting information would you like to submit with your application?

14.	Outside the formal (one hour) sessions, how much time will you devote to career study each week?
	--Click Here--less than an houran hour1-2 hours

Fees

15.	To whom should the invoice for the fee be sent?
	--Click Here--YourselfYour ManagerOther

	Full Name

	Email address

	Address (if different from contact information given earlier)

	Postcode

	Telephone

	Other reference information

Equal Opportunities Monitoring

16.

To ensure we serve a full range of individuals and communities, would you be prepared to provide the following personal information which will be kept in confidence.

Yes, I am happy to provide personal data

No, I do not want to provide any personal data

16.a

Are you?

male

female

16.b	What is your marital status?
	married		single		divorced		widowed		civil partnership		co-habiting

16.c	What age group do you fall into?
	Under 16		18 - 19		25 - 29		45 - 49		60 - 64
	16 - 17		20 - 24		30 - 44		50 - 59

16.d

Which postcode do you live in?

16.e	Are you:
	A British (United Kingdom) Citizen		An EU national		A refugee		An asylum seeker		a foreign student		other

16.f	Which ethnic group do you belong to?
	White British		Mixed Race: White and Asian		Other Asian or Asian British		Gypsy/Traveller
	White Irish		Other Mixed Race		Caribbean		Other (please specify below)
	White (other)		Indian		African
	Mixed Race: White & Black Caribbean		Pakistani		Any other Black or Black British
	Mixed race: White and Black African		Bangladeshi		Chinese

	Please specify your ethnic group here:-

16.h

Is English your first language?

yes

no

16.i	What is your religion?
	Buddist		Hindu		Muslim		No religion
	Christian		Jewish		Sikh		other (please specify below)

	Please specify your religion here:

16.k	Please indicate if you would consider that you have a :-
	physical impairment such as a wheel chair to get around, difficulty using your arms or legs
	sensory impairment such as being blind or having a serious visual or hearing impairment?
	mental health condition such as depression, dementia, schizophrenia)
	learning disability such as Downs syndrome or dyslexia; or cognitive impairment such as autism or head-injury
	long-standing condition such as cancer, HIV, diabetes, chronic heart disease, epilepsy
	drug or alcohol dependency

16.l

What is your sexual orientation?

Heterosexual ('straight')

Homosexual ('gay' man; 'gay' woman or lesbian)

Bisexual

Feedback on this Activity

17.	Completion of the Activity
	How easy was it to complete this activity?	Easy		Quite Easy		Quite difficult		Difficult

18.	Duration of the Activity
	How long did it take to complete this activity?	0-30min		30-45min		45-1hr		1-2 hr

	Provide any other  Comments, Feedback and Advice below

On completion of this exercise, you are advised to print a copy for your records (Main Menu: File & Print).

Then, press 'submit' to send a copy to Accomplice.

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