Whs Form 16 - Whs Aspiring Leader Program Application

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WHS ASPIRING LEADER PROGRAM APPLICATION

PRIVACY ACT STATEMENT

AUTHORITY: DoD Directive 1430.4, Civilian Employee Training; and Administrative Instruction No. 40, Employee Career Development and Training.

PRINCIPAL PURPOSE(S): To manage the WHS-wide Aspiring Leader Program which is intended to develop leadership skills that will benefit participants by

preparing them for more responsible positions in the organization. The program focuses on leadership skills such as critical thinking, decision making, and

communication.

ROUTINE USE(S): Disclosure of records are generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended. Applicable Blanket Routine

Uses are: Law Enforcement Routine Use, Congressional Inquiries, Disclosure to the Department of Justice of Litigation Routine Use, Disclosure of Information to

the National Archives and Records Administration Routine Use, and Data Breach Remediation Purpose Routine Use.

The DoD Blanket Routine Uses set forth at the beginning of the Office of the Secretary of Defense (OSD) compilation of systems of records notices may apply to this

system. The complete list of DoD Blanket Routine Uses can be found online at:

The applicable Privacy Act System of Records Notice is OPM/GOVT-1, General Personal Records found at:

DISCLOSURE: Voluntary; however, failure to provide the requested information may require additional time to process the application or result in denial for

admittance into the WHS Aspiring Leader Program.

SECTION I - NOMINEE INFORMATION

1. NAME

a. PREFIX

b. FIRST NAME

c. MIDDLE INITIAL

d. LAST NAME

e. SUFFIX

(Mr./Ms./Dr.)

(Jr./Sr.)

2. PREFERRED NAME FOR GRADUATION CERTIFICATE (e.g., Jane E. Doe; Jane E. Doe, PhD; Jane E. Doe, COL)

3. ORGANIZATION

4. POSITION TITLE

5. OCCUPATIONAL SERIES

(4-digit code)

6. PAY PLAN/PAY SCHEDULE

7. GS GRADE LEVEL

8. DATE OF LAST PROMOTION

(Month/Year)

10. OFFICE TELEPHONE NUMBER

11. DSN PREFIX

9. OFFICE EMAIL ADDRESS

(Include Area Code)

(If applicable)

12. ALTERNATE EMAIL ADDRESS

13. ALTERNATE TELEPHONE NUMBER

(Include Area Code)

14. COMPLETE ORGANIZATIONAL MAILING ADDRESS

a. NUMBER

b. STREET

c. SUITE

d. CITY

e. STATE

f. ZIP CODE

15. NOMINEE SIGNATURE

16. DATE SIGNED

SECTION II - RESUME SAMPLE

Please be sure to include all of the following items when you attach your resume to the application package.

Contact Information:

Name.

Work: Address, Telephone number, Fax, and Email (required).

Education:

School(s) (name and location).

Degree earned, graduation date.

Major field of study for each undergraduate and graduate degree.

Non-degree studies: School, location, major field of study, undergraduate/graduate credit hours earned.

Experience/Work History:

Dates, title, grade, agency/company, location, responsibilities/achievements. Focus on results. Be sure to highlight position(s) involving formal supervisory

experience. Also, include grade/rank for each position.

Defense/Government Sponsored Training (to include any previous leadership training):

School and course title, date (include sponsoring institution, e.g., Defense Systems Management College/NDU, OPM FEI or Management Development

Centers).

Skills/Accomplishments:

Skills, e.g., computer; languages; publications; certifications; licensure; clearances.

Activities and Honors:

Community Service, awards, professional memberships, hobbies.

WHS FORM 16, MAY 2016

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