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LARC Application Form

LARC Application Form

The Leading Australian Resilient Communities (LARC) program will be open to people who reside or work in North West Tasmania. We will be aiming to pull together a diverse cohort of applicants from North West Tasmania.

"*" indicates required fields

Step 1 of 8 - Personal Details

12%

PERSONAL DETAILS

Name*
In different from your first name
Date of birth*

Gender

Gender refers to current gender, which may be different to sex recorded at birth and may be different to what is indicated on legal documents.



Hidden

MORE ABOUT YOU


Your cultural background is the cultural/ethnic group(s) to which you feel you belong or identify. This background may be the same as your parents, grandparents, or your heritage, or it may be the country you were born in or have spent a great amount of time in, or you feel more closely tied to.



Please note the definition of disability includes sensory, intellectual, neuro-diverse, physical and mental illness – where the disability is permanent or is likely to be permanent

WHERE DO YOU LIVE


Residential address

*

Postal address

Same as residential address
*

EDUCATION LEVEL

EMPLOYMENT


Current employer

LEADERSHIP HISTORY


Previously completed leadership programs

COMMUNITY AND EMPLOYER INVOLVEMENT

Hold down the control key and select relevant choices

IMPACT

REFEREE

Please provide details for a referee knowledgeable about your leadership performance and potential. The person should be from your industry or organisation, and we ask that you avoid direct family members. Your referee must be willing to answer a number of questions via an online form. This will be sent to them shortly after submission of your application. We encourage you to speak to them prior so they are prepared.

Referee

Name*

COMMITMENT

Commitment*

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