APPLICATION FORM FOR
PROFESSIONAL DEVELOPMENT & MANAGEMENT PROGRAMME
Section I:
There are two sections in this Application Form.
This section is to be completed by the Employer.
The nominee is applying as:

Social Worker / Occupational Therapist / Physiotherapist / Speech Therapist /
Psychologist / Counsellor EIPIC Teacher
INSTRUCTIONS TO EXECUTIVE DIRECTOR / CENTRE HEAD
1.
2.
3.
4.
5.
6.
7.
Nominating agency must be a NCSS member agency or a MSF-funded agency.
If you wish to make several nominations, please submit one application form per nominee.
Applications are open to either Singapore Citizen or Permanent Resident.
Nominee must meet the eligibililty critiera for the programmes listed in:
http://www.ncss.org.sg/VWOcorner/pdmp.asp
If a column is not applicable, please indicate “NA”. Forms that are not fully completed will
not be considered.
The nominee will complete Section II of the application form.
The completed application form (Sections I and II) should be sent to the following address:
The PDMP Secretariat
Sector Manpower
Human Capital Development Group
National Council of Social Service
111 Somerset Road #04-01
TripleOne Somerset
Singapore 238164
*Delete where applicable
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1
NOMINEE
Name
2
Current Designation
Name of Organisation
REASONS TO SUPPORT YOUR NOMINATION

Has
the
nominee
and/or community?
Please elaborate:
organisation
Yes / No*

Has the nominee made significant changes or improvements
which he/she made to your organisation that resulted in
impact beyond his / her immediate level of responsibilities?
Please elaborate:
Yes / No*

Has
the
nominee
introduced
and
implemented
concepts/ideas or new projects in the course of his/her work?
Please elaborate:
Yes / No*
*Delete where applicable
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made
contributions
to
2
CONFIDENTIAL
your
new
3
POTENTIAL
3.1
Potential
(Please indicate an estimation of the highest appointment or level of work the nominee can
potentially handle ultimately.)
Management Track
Specialist Track



Centre Head
Executive Director
Others (please specify) :

3.2
Please provide a copy of the job description at the highest appointment or level of work the
nominee can potentially handle ultimately.
3.3
Career Progression Plan for Nominee to Assume the Position as indicated in question 3.1.
Please tick
accordingly
Years of
Experience



More than 5 years
3 to 4 years
3 to 4 years


2 to 3 years
2 to 3 years
3.4


Master *Social Worker / Therapist /
Counsellor / Psychologist / EIPIC Teacher
Director (Professional Services)
Others (please specify):
Professionals who head a
sizeable professional
practice
Chief
Senior Master
Master
Lead
Mid- or Senior Level
Professional Track
Leaders who manage large
organisations with >100 staff
or TOE >$10 millions
ED (large agency)
Director/Executive Director
Asst Director/Senior Asst
Director
Manager/Senior Manager
Asst Manager/Manager
Organisational Track
How many direct reports is the nominee currently managing?
0

1 to 2

3 to 5

6 to 10

11 to 15

16 to 20

Others:
Please specify: ______________________________________________________________
Note: Please enclose a copy of the organisation chart mapping out the nominee’s route of
advancement from the current position to the highest appointment.
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4.
LEARNING AND DEVELOPMENT PLAN
Please note that Social Workers, Occupational Therapists, Physiotherapists, Speech Therapists,
Psychologists, Counsellors and EIPIC Teachers are eligible for Professional Development and
Management Training. Other staff and staff in administrative or corporate functions are eligible for
Management Training and professional development. The total cost for Professional Development
including supervision Training and Management Training is capped at $30,000.
4.1
Professional Development (Longer-term accredited/certified professional courses - local / overseas)
Course
Institution/Training
Estimated Course Fees
Supervision Training for those who wish to attend training to become supervisors or receive
clinical supervision sessions from external provider.
Supervision Training
(Please
Institution/Training Provider
provide the course outline(s)
(where Supervision Training is applicable).
for
Professional
Development
Estimated Fees
and
Supervision
Training
Management Training
Preference in Level 1 or Level 2 Management Training or both. Please tick the appropriate box
below:

Level 1, Senior Management Programme for Non-Profits, offered by Social Service
Institute (recommended for applicants with 3 – 7 years of experience in the sector).

Level 2, Capstone Programme offered by Social Service Institute (recommended for
applicants with more than 7 years of experience in the sector).
*CNPL – Centre for Non-Profit Leadership
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4.2
Please describe why the above learning and development plan is proposed. (e.g. the benefits of
the proposed learning and development programmes to the organisation and nominee.)
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NOMINATING ORGANISATION
Name of Organisation:
_________________________________________________
Email Address:
_________________________________________________
Contact Number:
_________________________________________________
Nominated by:
_______________________________
_________________
Name of Executive Director/Centre Head
Signature
_____________
Date
Supported By:
_______________________________
_________________
Name of Chairman
Signature
Organisation Stamp:
FOR OFFICIAL USE ONLY
Shortlisted for interview:
□ Selected
□ KIV
□ Rejected
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_____________
Date
Section II
There are two sections in this Application Form.
This Section is to be completed by the Nominee.
INSTRUCTIONS TO NOMINEE
1.
2.
3.
4.
Applications are open to either Singapore Citizen or Permanent Resident.
Nominee must meet the eligibililty critiera for the programmes listed in:
http://www.ncss.org.sg/VWOcorner/pdmp.asp
The nominee will complete Section II of the nomination form. All the sections are to be
completed unless otherwise stated. If a column is not applicable, please indicate “NA”.
Forms that are not fully completed will not be considered.
The completed application form (both Section I and II), together with the supporting
documents, should be sent to the following address before the closing date to:
The PDMP Secretariat
Sector Manpower
Human Capital Development Group
National Council of Social Service
111 Somerset Road #04-01
TripleOne Somerset
Singapore 238164
Application Checklist
Please tick () if the following Supporting Documents are enclosed:
a.
One passport sized photograph
b.
A copy of the NRIC (front and back)
c.
Tertiary education certificates, transcripts, testimonials, etc./Other Professional certificates
d.
Certificate of Accreditation by the respective professional body (for Social Workers and
Therapists)
e.
Log sheet showing the number of client contact hours and supervised practice hours to date
(for Psychologists and Counsellors)
f.
Write-up on Career Aspirations
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PERSONAL PARTICULARS
Name (As in NRIC/ Passport, please underline
surname)
*(Dr/ Mr/ Mdm/ Miss)
Aliases (if any)
Address
*NRIC No./Passport No.
Please paste your
photograph here.
Residence Status
*Singaporean/PR
Email Address
Contact No
Home:
Office
Mobile
Date of Birth
Age
Gender
*Male / Female
Race/Dialect
Nationality
Accreditation Status:
 *Registered Social Worker / Therapist / Psychologist / Counsellor / Not applicable
EDUCATIONAL QUALIFICATIONS (Please attach copies of all educational certificates, transcripts,
testimonials, etc.)
Period
Highest Qualification
Obtained
Name of
From
To
(Please indicate your Honours
Course of Study
School/Institution/Country
(MM/ (MM/
classification and overall
YY)
YY)
CAP/GPA score if applicable.)
SCHOLARSHIP/ TRAINING AWARDS
Date of Award
Name of Scholarship/
Training
Name of
Organisation
which awarded the
scholarship
* Delete where applicable
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Course of
Study
Period of
Bond
(MM/YY)
PROFESSIONAL MEMBERSHIPS
From
(MM/YY)
To
(MM/YY)
Association/Society/Company
HISTORY (Please give details of
social service sector beginning with the most recent
provide the information on a separate sheet of paper.)
EMPLOYMENT
From
(MM/YY)
To
(MM/YY)
Name of Organisation
your employment history including nonemployer. If space is insufficient, please
Last Position
Held
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Position Held
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Job Roles and
Responsibilities
CAREER ASPIRATIONS
What are your career goals in the next 5 years? How would you like the programme to support you
in meeting your career aspirations?
(Please attach separate sheet and limit to no more than 300 words.)
OTHER INFORMATION
1.
Are you serving any bond with your present employer ?
Yes / No*
2.
Do you have a criminal record in Singapore? This refers to a criminal record under
the Registration of Criminal Acts.
If yes, please specify ___________________________________________________
Yes / No*
3.
Have you ever been convicted in a court of law in any other country (excluding
parking offences or criminal records disclosed above)?
If yes, please specify ________ ___________________________________________
Yes / No*
DECLARATION
I give my consent to the National Council of Social Service to obtain and verify from or with any
source, as you deem appropriate for the assessment of my application for Professional Development
and Management Programme.
I declare that the particulars stated in this application and the attached documents are true to the
best of my knowledge and belief, and that I have not wilfully suppressed or falsified any
information.
____________________
_______________________________________
Date
Signature
* Delete where applicable
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