Emerging HR Leaders Forum Application • Partnership for Public Service

*Please note, many agencies have specific application guidelines for their employees. Before submitting your application, please make sure that you are following your agency’s internal guidelines and that you have permission from your agency’s leadership to participate in this program.

Emerging HR Leaders

Personal Information

Salutation

First Full Name

Middle Name or Initial(s)

Last Name

Nickname

Job Title

Occupation

State

County or Municipality

Department or Agency

Do not include state, county, or municipality in this field.

Full State/Local Agency Name

Double check that the full agency name above is correct.

Work Phone

Mobile Phone

Home Phone

Preferred Phone Number

Work Email

Personal Email

Preferred Email Address

Address Type

Street

City

State

Zip Code

Country

Address Type

Street

City

State

Zip Code

Country

Professional Experience and Objectives

Are you a (select a single option)

Total years with current agency

Total years of government service

Number of employees you supervise

Describe your current job responsibilities. Limit 300 words

Describe your short- and long-term career objective(s). Why is leadership development important at this point of your career? Limit 300 words.

Why are you interested in participating in the Emerging HR Leaders program? What do you plan to gain from your experience?

The Emerging HR Leaders program is a program built around peer sharing and group learning. What do you hope to bring to your cohort and what will you contribute to your colleagues?

Participants will have the option to attend the EHRL program either in person or virtually. We ask that you make the choice to attend either in-person or virtually so we can create cohorts accordingly and allow you to remain with your group for the duration of the program. Please note that participants will not be permitted to switch between both options during the program.

I would like to attend in person.I would like to attend virtually.

Supervisor Information

Salutation

First Name

Last Name

Job Title

Phone

Street

City

State

Zip Code

Country

Tuition Payment Information

Please make all checks payable to Partnership for Public Service, Inc., and remit to company address. If you wish to pay by credit card or wire transfer, or for any other questions, please call the Partnership Finance Department at 202-996-5288 or email invoice@ourpublicservice.org.

Intended form of payment

ACH Wire TransferCheckPurchase OrderCredit Card

Purchase Order Number (PO#)

Please attach any payment document (e.g., SF182) below:

Check this box if you do not currently know your agency's Payment Point of Contact information

Agency Payment Point of Contact (POC) Information

Payment POC name:

Payment POC email address:

Payment POC phone number:

Letter of Reference

Your supervisor approval form must come from your direct supervisor. You may upload the file here (preferred) or email it directly to Eric Feldman at efeldman@ourpublicservice.org. The file should be no larger than 1MB and no longer than two pages.

Supplemental Information

How did you learn about this training program?

Contact Information

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