SUSTAINABILITY in the AUSTRALIA LATIN AMERICA BUSINESS RELATIONSHIP


AUSTRALIA LATIN AMERICA LEADERSHIP PROGRAM


3 October 2013 - 14 October 2013

APPLICATIONS CLOSE

extended to 18 MARCH 2013

Some boxes on the application form can be expanded. Please note however that any expansion of the complete application form beyond three A4 pages will not be considered.

APPLICATION FORM
Section A: APPLICANT'S PERSONAL INFORMATION
Title: Family name: Given name(s):
Date of Birth:
Residential address: Country:
Work address: Country:
Phone(w): Phone(h): Mobile:
Fax: Email:
FACE TO FACE OR PHONE INTERVIEWS MAY BE CONDUCTED AFTER APPLICATIONS CLOSE. WHERE CAN WE CONTACT YOU IF DIFFERENT FROM ABOVE?
Address:
Phone: Fax:
Email:
EMPLOYER DETAIL [please check ONE only of the following then add the name, email, country and phone]
Name of present employer:
Name of respected community member if you are self-employed:
Email: Country: Phone:

On receipt of your application, we will immediately email your employer/nominated person seeking

documented support of your application for the ALALP.

Section B: EDUCATION AND EMPLOYMENT
Education and Professional Development:
Present Position: Date from:
Responsibilities:
Major Achievements:
PREVIOUS POSITIONS (CHOOSE THE TWO MOST SIGNIFICANT)
Position 1
Date from: to:
Position and Organisation:
Responsibilities:
Major Achievements:
Position 2
Date from: to:
Position and Organisation:
Responsibilities:
Major Achievements:
Section C: COMMUNITY INTERESTS
Please describe your community interests or activities:
Section D: CONFERENCE INTERESTS
Why do you want to apply for the Conference? Please focus on your special interests relating to regional development and the Conference theme and objectives?
Please list any senior level conferences of 2 full days duration or more over the past 3 years that you have attended.
Section E: OTHER INFORMATION
What is your country of residence?
What passport(s) do you hold?
List any current visa(s) you have to enter Australia:
What language's do you speak, write or read?
Please rate your English language verbal skills
where 5=excellent and 1=no comprehension
Please rate your English language written/reading skills
where 5=excellent and 1=no comprehension
 

Your form will be checked and then a copy will be sent to your email address.