(No header. Footer throughout document reads CSCP Application Form.)
Option 1: Complete Section I online then print the entire form. Complete Section II on a separate piece of paper; sign Section III, then give the completed packet to your supervisor to complete Section IV.
Option 2: Print this form and complete Section I by printing the information. Complete Section II by typing essays on a separate piece of paper per the directions; sign Section III, then give the completed packet to your supervisor to complete Section IV.
Only original completed Application Packets will be accepted. Completed Application Packets must be received by the CSCP Application Committee by 3:00 PM Friday, November 30, 2012. Send completed applications to:
CSCP Application Committee
Human Resources Division
1 Ashburton Pl., Room 301
Boston, MA 02108
Employee ID#: __________________________Bargaining Unit: _________________
Job & Functional Title: _____________________________________________________
Number of employee Performance Evaluations such as EPRS or its equivalent you have completed within the last 12 months: ________________________________________
Work Mailing Address: ____________________________________________________
(Building Name) (Street Address) (Floor #)
City: ____________________________ Zip code:__________ Home City:___________________
E-Mail Address: __________________________________________________________
Work Telephone Number: __________________ Cell Phone # (optional): ________________
Supervisor’s Name: _______________________________________________________
SECTION I: Personal and Professional Contact Information (continued)
Supervisor’s Email Address: _________________________________________________
Supervisor’s Work Telephone Number: _____________________________________________
Reasonable Accommodations Requests (please specify) as needed:__________________
Rank Training Location Preference (1-5) with “1” being your first choice through “5” for last choice.
Northeast Region (Tewksbury) Western Region (Holyoke)
Boston (Ashburton Pl.) Central MA (Worcester) Southeast Region (Taunton)
Please attach a copy of your up-to-date resume.
This section of the application form provides an opportunity for you to tell us about your ability and willingness to successfully complete the Commonwealth Supervisor Certificate Program.
Please answer questions 1 – 3. Each response must be typed and contain a minimum of 4 sentences. The response for all 3 questions should be no longer than two single-spaced pages.
1. State and describe your supervisory role and responsibilities within your agency.
2. Describe the types of supervisory skills that you think are important for being an effective supervisor in your current job.
3. What supervisory skills would you like to develop or strengthen by participating in this program?
Please read and agree to the following statement of commitment:
I understand that, if selected, I am taking one of a limited number of available seats in the Commonwealth Supervisor Certificate Program. I agree to participate in the Commonwealth Supervisor Certificate Program to the best of my ability and to attend all scheduled classes. Therefore:
I understand that I am required to enter into and abide by this statement of commitment.
Please review the application, sign below and
1. prepare a letter of support
2. submit completed application packet and letter of support to Agency Head or Designee
3. obtain signature of Agency Head or Designee
Supervisor’s Commitment: I support the participation of __________________________ in the Commonwealth Supervisor Certificate Program.
I will support the applicant as she/he completes all program requirements.
I am supporting the applicant by submitting the attached letter commenting on his/her supervisory qualities, team orientation, problem-solving skills and communication skills.
Supervisor’s Name (PRINT):_______________________________________________
Supervisor’s Signature: _________________________________Date:_____________
Agency Head’s or Designee’s Name (PRINT) __________________________________
Agency Head’s or Designee’s Signature: _______________________________ Date:______________