PLA 2023 Application Page | Honolulu-Pacific Federal Executive Board

PLA Application Submission

Applicants or Agency Coordinators Can Use this Form to Generate PLA 2023 Applications For Signature. You can download the fillable .pdf file at any point in the process, or save and continue later. The form can be digitally signed after download. Applications are due by August 5, 2022.

Please Select Your Department*

Please Select Sponsoring HPFEB Agency*

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Agency Internal Suspense Date

Unless your agency has set an internal suspense date for PLA 2023 applications, this date will be the deadline for submission to the HPFEB.

PLA Track*

PLA 2023 Senior Leader

PLA 2023 Emerging Leader

Name*

Prefix First Middle Initial Last Suffix

Job Title/Position*

Grade or Rank*

APPLICANT AGENCY

Same as HPFEB Nominating Agency

AGENCY (Spell Out...e.g. Joint Base Pearl Harbor...)*

Applicant Work Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Format

Use International Phone Format

APPLICANT'S OFFICE PHONE*

APPLICANT'S MOBILE PHONE (Emergency Use)*

APPLICANT'S OFFICE PHONE*

APPLICANT'S MOBILE PHONE (Emergency Use)*

APPLICANT'S WORK EMAIL*

APPLICANT'S ALTERNATE EMAIL

Name of Person Certifying Funding (Authorized Agency Official Must Sign to Certify Funding)*

Invoice Required?

YES

Credit Card Holder

Card Holder Email

SPECIAL REQUIREMENTS: e.g. sign interpreter, accommodations, etc.

Preferred Nickname for Badges/Name Tags

Number of Years in Your Present Department*

Number Of Years in Federal Service*

Number of People You Manage*

Number of Years in Management Position*

Briefly Describe Your Duties*

What Are Your Goals and/or Objectives in Attending the Pacific Leadership Academy?*

What do you Consider Your Highest Responsibility, Skill or Career Achievement to Date?*

Please List Your Employment History and Principal Positions Over Last 5 Years, Beginning with Current*

Agency or Organization

Type of Organization

Job Title

Highest Degree or Academic Grade Completed*

List Previous Management/Leadership Courses Taken in Last 5-10 Years*

Applicant's Supervisor Full Name*

Applicant's Supervisor's Work Email*

Applicant's Supervisor's Work Phone*

(Optional) Email Copy of Application to Applicant's Supervisor?

YES

(Optional) Email Copy of Application to Agency PLA Coordinator (PLA Coordinator Email Address)?

YES