Indigenous leadership development program Application Please complete the form below. Step 1 of 3 - PART A: Personal details 33% PART A: Personal detailsGenderGenderFemaleMaleNon-binaryPrefer not to discloseTitleTitleMrMrsMsMissMxFirst Name(Required)Surname(Required)Work PhoneMobile PhoneEmail address(Required) Emergency contactEmergency Contact NameRelationshipEmergency Work PhoneEmergency MobileIdentityAre you Aboriginal and/or Torres Strait Islander origin? Aboriginal Torres Strait Islander Aboriginal and Torres Strait Islander Associated CommunityCommunity / Language Group:Do you speak a First Nation language at home Yes No If yes, please advise the main language spoken at homeDevelopment ParticipationPlease list any previous Leadership Development Training that you have participated in:Dietary or Medical requirements:Please list any medical allergies, dietary requirements that should be considered. PART B: Employment detailsEmployment Status(Required) Full time Trainee/Apprentice Part time Position / Role(Required)Business Unit(Required)How long have you been employed in this role?(Required)Development PlanAs part of Woodside Energy’s commitment to development of staff, have you participated in a development planning session with your Line Leader? Yes No Development Planning proposals:List proposed development opportunities agreed to:Supervisors detailsSupervisor's NameSupervisor's Email Supervisor's PhoneApproval(Required)Participation in this program requires a commitment to attend 3 x 3 day workshops in Perth (plus travel). Applications will only be considered if Line Leaders/Supervisors have agreed. Do you have approval? Yes No PART C: Education and TrainingLeadership Development ReasonPlease indicate your reason to participate in this program Personal Development It was a requirement of my job I wanted to learn new skills for my job For personal interest To explore different career options To be advocate and be a change maker for Indigenous people Recognition within team Do you have a Unique Student Identifier number (USI)?A USI is your individual education number for life. It also gives you an online record of your vocational education and training (VET) undertaken in Australia. Please provide your USI number, if you have one. Yes No Unsure If yes, please provide USI Number.Highest level of education Year 12 Certificate I Certificate II Certificate III Certificate IV Diploma Advanced diploma Graduate certificate Graduate diploma Bachelor’s degree Bachelor Honours Degree Master’s degree Doctoral Degree Select the level of education you have achieved.Qualification Name(Required)Learning SupportDo you believe you may require some assistance to complete any qualifications or workshop activities? Yes No Maybe If yes, please decribe the support or assistance you'll need.Can you think of any social, emotional and wellbeing challenges that could affect your learning? (For example, medical, health, disability, eyesight, hearing).Can you think of any language, and cultural challenges that could affect your learning? (For example, cultural and clan responsibilities, language)Learning DevicesDo you have access to a working and reliable laptop, computer or other device that is connected to the internet, to complete projects, connect, collaborate, co-design and share insights. Yes No
