Position Applying For Veterans Local Government Management Fellowship

First Name MI Last Name Current Title

Preferred Phone # ( ) circle one C H W

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Address Alternate Phone # ( ) circle one C H W

Degree(s) and Related Certificates/Licenses Dates Received Email

Please prioritize which local Are you on active duty and
government you would prefer to within 180 days of transition
conduct your fellowship with (separation or retirement) from
during this 16 week fellowship military service?
program. [1] = 1st priority; [2]
= 2nd priority; [3] = 3rd priority
City of Fountain, CO Yes
Are you bilingual? Yes
No City of Colorado Springs,
If yes, what language(s)? CO No
Pueblo West, CO
VLGMF would like for you to honestly evaluate your experience Key: E = Extensive Experience L = Limited Experience
in/with the following job related activities. C = Considerable Experience N = No Experience
Municipal Management ____ Managing Workforce Diversity ____ Economic Development ____

HR & Personnel Administration ____ Facilities Management ____ Policy Analysis and Implementation ____

Equal Opportunity Laws ____ Utilities Administration ____ Organizational Analysis ____

Civil Engineering ____ Community Services/Programs ____ Board/City Council Relations ____

Construction Management ____ Parks and Recreation Administration ____ Community Engagement ____

Staff Development ____ Parks Maintenance ____ Intergovernmental Relations ____

Project Management ____ Public Safety/Emergency Management ____ Public Affairs or Information Ops ____

Strategic Planning ____ Law Enforcement ____ Facilities Maintenance ____

Budgeting ____ Conservation/Environmental Protection ____ Contract/Procurement Administration ____

Financial Management ____ Fire and or Emergency Medical Services ____ Fleet Maintenance ____

Community Development ____ Capital Improvement Projects ____ Information Technology ____
Please answer the following question and please be concise. Which areas of local government management would you most like to gain
experience in and learn more about?

MILITARY EMPLOYMENT HISTORY:

If you have a bachelors degree or higher, please provide 3+ years of supervisory leadership experience. If you have an associates
degree please provide 5+ years of supervisory leadership experience
Dates of Employment Duty Title and Rank Largest annual budget administered
to
Supervisor's Duty Title Organization and Location
and Rank:
Military pay per month: Relevant local government experience:

Total number of staff or Total number of employees in:

personnel supervised:
Organization ______ Department ______
Direct Supv. ______ Indirect Supv. ______
Dates of Employment Duty Title and Rank Largest annual budget administered
to
Supervisor's Duty Title Organization and Location
and Rank:

Military pay per month: Relevant local government experience:

Total number of staff or Total number of employees in:

personnel supervised:
Organization ______ Department ______
Direct Supv. ______ Indirect Supv. ______
Dates of Employment Duty Title and Rank Largest annual budget administered
to
Supervisor's Duty Title Organization and Location
and Rank:

Military pay per month: Relevant local government experience:

Total number of staff or Total number of employees in:

personnel supervised:
Organization ______ Department ______
Direct Supv. ______ Indirect Supv. ______
Dates of Employment Duty Title and Rank Largest annual budget administered
to
Supervisor's Duty Title Organization and Location
and Rank:

Military pay per month: Relevant local government experience:

Total number of staff or Total number of employees in:

personnel supervised:
Organization ______ Department ______
Direct Supv. ______ Indirect Supv. ______
Dates of Employment Duty Title and Rank Largest annual budget administered
to
Supervisor's Duty Title Organization and Location
and Rank:

Military pay per month: Relevant local government experience:

Total number of staff or Total number of employees in:

personnel supervised:
Organization ______ Department ______
Direct Supv. ______ Indirect Supv. ______
I certify that the information on this fellowship application is true to the best of my knowledge and belief.

DATE____________________APPLICANT'S
SIGNATURE________________________________________________