**U. S. DEPARTMENT OF ENERGY**

# Albuquerque Operations Office

**2001 EXECUTIVE POTENTIAL PROGRAM**

**APPLICATION PACKAGE (AP)**

**COVER SHEET**

**TO:** ­ **FROM:**

Training Officer EPP Applicant

***Attached is my application package for the 2001 Executive Potential
Program. I have obtained supervisory reviews and other recommendations,
and have coordinated the review of this application as required within
my organization.***

**Departmental Forms Required:**

> **AP #1\-- Personal Information**
>
> **AP #2\-- Supervisors Information**
>
> **AP #3\-- Purpose for Applying**
>
> **AP #4\-- Developmental Accomplishments**
>
> **AP #5\-- Formal Training / Awards (include copies)**
>
> **AP #6\-- Evaluation of Performance**
>
> **AP #7\-- Assessment of Potential**
>
> **AP #8\-- Supervisor Sponsorship Form**

**Attach: Application for Federal Employment (SF-171, or OF-612, or
detailed resume with a current home address)**

####### SIGNATURE DATE 

> **TITLE SERIES/GRADE**

\*All application materials must be submitted to the Training and
Administration Branch, HRTD (Attn: Gloria Chavez) and must be
accompanied by a SF- 612, 171 or resume and an approved training form
such as a SF-182, 1556 or 350. Letters of recommendation will also be
accepted.

**Application Package**

**for the**

**2001 Executive Potential Program**

*(To be completed by the Applicant)*

Name

Home Address **[(Kept confidential upon request)]{.underline}**

Work Address

Work Phone Work Fax

E-Mail

Title Series Grade

Social Security Number Education: \_\_\_HS \_\_\_AA \_\_\_BA/BS
\_\_\_Masters \_\_\_Ph.D.

Years of Government Service Years of Supervisory Experience

###  

### Application Package 

**for the**

**2001 Executive Potential Program**

(*To be completed by the Applicant)*

Immediate Supervisor's Name

Supervisor's Title Telephone Number

#### Supervisor's Mailing Address 

Agency Nominating Official Name:

Title: Telephone Number:

Agency Mailing Address:

**Application Package**

**for the**

**2001 Executive Potential Program**

***Purpose for Applying***

*(To be completed by the Applicant)*

Applicant's Name

**Part A:**

Please state your purpose for applying, how will your participation in
the Executive Potential Program support your career goals over the next
3-5 years.

**Part B:**

How will your participation in the Executive Potential Program support
the accomplishment of your agency's mission upon completion of the
program.

**Application Package**

**for the**

**2001 Executive Potential Program**

***Developmental Accomplishments***

*(To be completed by the Applicant)*

Applicant's Name

Describe three career or personal developmental accomplishments that you
have had within the past 5 years and under each accomplishment list the
self-study, on-the-job training, formal training courses, developmental
assignments or other learning activities that you undertook to achieve
each one. Finally explain how the accomplishment contributed to a
developmental objective.

**Accomplishment #1:**

**Accomplishment #2**

**Accomplishment #3**

### Application Package 

**for the**

**2001 Executive Potential Program**

***Formal Training*** / **Awards**

*(To be completed by the Applicant)*

Applicant's Name

**PART A:**

Please list all formal training courses (programs) you have completed in
the last five years that relate to your leadership, supervisory or
managerial development.

**PART B:**

Please list awards and recognition you have received both on and off the
job.

**Application Package for the**

**2001 Executive Potential Program**

##### Evaluation of Performance

*(To be completed by the Supervisor)*

Applicant's Name

**Narrative Evaluation of the Applicants Performance**

Please provide a written narrative of the applicant's current
performance.

###### Supervisor's Signature 

Supervisor's Title

###### Telephone Number 

**Application Package**

**for the**

**2001 Executive Potential Program**

***Assessment of Potential***

*(To be completed by the Supervisor)*

Applicant's Name

This assessment should focus on indicators of potential such as
educational pursuits, self-study, formal training, developmental work
assignments, membership and leadership on teams, special assignments,
and involvement in voluntary civic/community activities demonstrating
leadership qualities.

Supervisor's Signature

###### Supervisor's Title 

###### Telephone Number 

**2001 Executive Potential Program**

### SUPERVISOR SPONSORSHIP

### FORM

*(To be completed by Supervisor)*

**I HEREBY AGREE,** to sponsor (name of applicant)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

in the
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
and at the onset of the Program, I will help to set goals and objectives
for the program and work with participant to develop an Individual
Development Plan (IDP). I will provide support, supervision, oversight,
as well as feedback and guidance. Subsequent to completion of the
Program, I will ensure and authorize utilization of their acquired
skills by providing meaningful work assignments, involvement in
challenging developmental opportunities and participation on challenging
work details.

#### Supervisor\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature

Title

Work Phone

Period of Time You Supervised Applicant

**[Rating of Potential:]{.underline}** Please provide a written
assessment below of the applicant\'s potential, focusing on indicators
such as educational pursuits, self-study, formal training, leadership
skills, work assignments, etc.: