KLA - APPLICATION

KERN LEADERS ACADEMY APPLICATION
VISION: "A healthy business climate is fundamental to a strong economy. A strong economy is necessary for a vibrant community."

The Kern Leaders Academy was established to further develop and enhance the leadership qualities of individuals who are committed to work with business to solve the region's economic and social problems. The Academy will educate students on the issues facing the region and prepare them to be effective community leaders, with the needed information to run for an elected office. Members from the Academy Admissions Committee will select the candidates for each class.

TO BE ELIGIBLE, AN APPLICANT MUST:
- Be a United States citizen
- Be a Kern County resident for at least one year.
PURPOSE OF SELECTION PROCESS:

To identify the highest quality candidates from Kern County who have the potential to provide the most effective community leadership and are committed to working with the business community to solve the economic and social problems of the region. It is the policy of the Kern Leaders Academy to express a strong preference for candidates who
understand business and the relationship of a healthy business climate to a strong regional economy.

The Board of Directors expects each participant in the Kern Leaders Academy to fulfill the following four commitments:
- To attend all classes, without cell phones, and complete all assignments in
  preparation for classes.
- To assume leadership roles.
- To participate in postgraduate leadership activities.
- To actively assist in the enhancement and perpetuation of a healthy business climate and a vibrant community.
DEADLINE FOR RECEIPT OF APPLICATIONS AND TUITION COST:
- All applications are due the last Friday of July, each year, 5:00 PM, submitted online to info@kernleadersacademy.org at 1401 19th Street, Suite 200, Bakersfield, CA 93301-4400.
- Classes are limited in size to eight to enable the Academy to provide an exceptional experience and opportunity for our students. Applicants, therefore, are encouraged to apply before the deadline.
- The class will be announced August 10, each year.
- The Academy tuition is $1000. The Academy must receive payment no later than September 1st, each year.
Initial below, acknowledging you have read and understand the applcation information above.
Initial here: *
INSTRUCTIONS TO APPLICANTS

Please read the Kern Leaders Academy information carefully, noting both requirements for selection and the time and monetary requisites for participation if selected. Read the entire application before beginning to write, complete all portions of the application completely (the application will be printed and distributed to members of the selection committee). When you submit this application, a copy will automatically send to the email address provided in the Contact Information. If you do not see it in your Inbox, please check your Spam folder. Please keep a duplicate copy of your application for your own file. PLEASE BE SURE YOUR APPLICATION IS COMPLETE AND ALL PAGES INITIALED.

Note the deadline for receipt of application.

You will receive acknowledgment of receipt of your application. The Selection Committee will review all applications and identify candidates to be interviewed based on thoroughness of the application, experience, and background. Applicants will be selected for Academy participation based on this application and if necessary, an oral interview.

All applicants selected as participants in the Academy will be required to attend all classes in order to receive a certificate of graduation. Academy participants who miss one or more classes will be required to make those classes up within the following year at an additional cost of $25 per make-up class in order to graduate.

The Academy defines an absence as:
- not attending a class
- tardiness of thirty minutes or more during any class including before or after a break
- leaving class 30 minutes or more before the class scheduled ending time
Three absences will result in dismissal from the Academy. The Academy attendance policy also requires that students stay in class rather than coming and going, which is disruptive to students and guest instructors. The use of cell phones is not allowed.

Students who are elected officials may have their absences excused when:
- those absences are due to regularly scheduled Council/Board meetings or due to special circumstances relevant to Council/Board meetings and
- they make arrangements in advance with the Academy Chairperson. Absences should be kept to a minimum in order to fully participate in class activities.
APPLICATION INSTRUCTIONS

This application will be submitted electronically
Complete application fully.
This application by must be submitted by the stated deadline.
Initial below, acknowledging you have read and understand the Applcation instructions on this page.
Initial here: *

Educational Background

List all schools attended: High School, College, Business/Trade and/or short courses:

	NAME OF SCHOOL	ATTENDANCE DATES	DATE OF GRADUATION	DIPLOMA / DEGREE	MAJOR / MINOR FIELDS
#1
#2
#3
#4
#5

Other Education:
Initial here: *

Occupational Background
(List all positions held in the past 10 years)
Present Employer:

Business Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Business Phone:

Area Code Phone Number
Fax:

Area Code Phone Number
Type of Business:
Title:
Dates of Employment:
Month/Year to Month/Year
Previous Employer #1:

Business Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Business Phone:

Area Code Phone Number
Fax:

Area Code Phone Number
Type of Business:
Title:
Dates of Employment:
Month/Year to Month/Year
Reason for leaving:
Previous Employer #2:

Business Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Business Phone:

Area Code Phone Number
Fax:

Area Code Phone Number
Type of Business:
Title:
Dates of Employment:
Month/Year to Month/Year
Reason for leaving:
Previous Employer #3:

Business Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Business Phone:

Area Code Phone Number
Fax:

Area Code Phone Number
Type of Business:
Title:
Dates of Employment:
Month/Year to Month/Year
Reason for leaving:
If there is any other previous employment during the past 10 years, please list here.
Initial here: *
Briefly describe your role and responsibilities in your current position: *

50 words or less 0/50
What are your career goals in the next five years? *

50 words or less 0/50

Community Involvement and Leadership Activities

Indicate your past and current community involvement and leadership in organizations, including high school, college, civic, church, governmental, and military or others.

	ORGANIZATION	DATES OF MEMBERSHIP	POSITIONS HELD	AVERAGE VOLUNTEER HOURS/MONTH
#1
#2
#3
#4
#5
#6

Of the community organizations listed above, cite one specific program wherein you personally initiated, developed and played a major leadership role in the completion of a project.

100 words or less 0/100
Initial here: *

List Awards and Honors You Have Received

	ORGANIZATION OR GRANTOR	AWARD OR HONORS
#1
#2
#3
#4
#5

References
List four references (two businesses and two personal) whom we may contact to assess your leadership potential.
1. *

Personal Business
Name: *

Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Company:
Position:
Phone: *

Area Code Phone Number
2. *

Personal Business
Name: *

Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Company:
Position:
Phone: *

Area Code Phone Number
3. *

Personal Business
Name: *

Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Company:
Position:
Phone: *

Area Code Phone Number
4. *

Personal Business
Name: *

Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Company:
Position:
Phone: *

Area Code Phone Number
I understand my commitment for participation in the Kern Leaders Academy and give my permission for you to contact the references listed. I hereby certify that all statements made in this application are true and complete. I agree and understand that any misrepresentation or omission of material facts herein will cause disqualification of my application. I understand that selection of applicants is the sole responsibility of the Board of Directors of the Kern Leaders Academy.
SIGNATURE: *
Type your full name on the line above as your signature
DATE:

Month Day Year Date Picker Icon
INITIALS: *

Participant Commitment
KERN LEADERS ACADEMY
PARTICIPANT COMMITMENT

Upon acceptance by the Board of Directors as a participant in the Academy, I understand that I am expected to attend all class sessions. Knowing that emergencies can arise, I am allowed three absences (for any reason) before being removed from the Academy. I know that an absence includes a) missing a full session, b) tardiness of thirty minutes or more during any class including before or after a break; and/or leaving class 30 minutes or more before the class ending time. I understand that I will not graduate from the Academy until I make up those classes within the next year at an additional $25 per make-up session.

Students who are elected officials may have their absences excused when a) those absences are due to regularly scheduled Council/Board meetings or due to special circumstances relevant to Council/Board meetings and b) they make arrangements in advance with the Academy Chairperson. Absences should be kept to a minimum in order to fully participate in class activities.

I understand my commitment includes a $1000 registration fee. Other costs will be covered by the Academy. Once the Academy starts and I have attended the orientation or first class, there will be no refunds of the participant fee.

Upon graduation from the Academy, I understand that I am expected to utilize my training to be an active leader on behalf of business and my community. If I run for political office, or am involved in a political campaign, my training in the Academy encourages me to focus on issues, views, beliefs, experiences and record, and the differences between them and those of my opponents. My campaign will be committed to the principles of honesty, fairness, respect for my opponent and the voters.
SIGNATURE: *
Type your full name on the line above as your signature
DATE:

Month Day Year
Date

Release of All Claims
RELEASE OF ALL CLAIMS
Release made this *
Today's Date #
day of *
Current Year
By *

First Name Last Name
In consideration of permission granted me by the Kern Leaders Academy Board of Directors, to participate in the Kern Leaders Academy, I hereby release and discharge the Kern Leaders Academy and its agents, employees, officers and Board from all claims, demands, actions, judgments and executions which the undersigned ever had, or now has, or may have, or which the undersigned's heirs, executors, administrators, or assigns may have, or claim to have, against the above-mentioned entity and persons, or their successors or assigns, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by, or resulting from, my participation in the Kern Leaders Academy.

I, the undersigned, have read this release in its entirety and understand all its terms. I execute it voluntarily and with complete knowledge of its significance.
In witness whereof, I have executed this release at *
your City
California, on the day and year first above written.
SIGNATURE: *
Type your full name on the line above as your signature
INITIALS: *

Participant Authorization and Application Completion
KERN LEADERS ACADEMY
PARTICIPANT AUTHORIZATION

If selected as a participant in the Kern Leaders Academy, I hereby authorize the Academy to:
- Publish or give out my name as a student of the Academy.
- Print or publish my picture in any publications.
- Provide a personal quote for the Academy to publish either during or after completion of the Academy.
I understand that participation in the Academy requires open discussions, presentations, debates, writings, and videotapes. While the Academy will not publish or distribute any of those materials (writings, videos) produced or discussed during class without my express permission, it cannot guarantee confidentiality of what is said and presented in class.

The Academy does not permit individual audio or videotaping of classes. Academy staff or Board will handle all videotaping as part of classroom activities. All videotapes are property of the Academy.
SIGNATURE: *
Type your full name on the line above as your signature
DATE:

Month Day Year
Date Date Picker Icon
KERN LEADERS ACADEMY
1401 19th Street, Suite 200
Bakersfield, CA 93301-4400
www.kernleadersacademy.org
INITIALS: *
Should be Empty: