Application for Participation in Work-Life Consultancy Clinic
Application for Participation in Work-Life Consultancy Clinic
Application for Participation in Work-Life Consultancy Clinic
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<strong>Application</strong> <strong>for</strong> <strong>Participation</strong> <strong>in</strong> <strong>Work</strong><strong>Life</strong> <strong>Consultancy</strong> Cl<strong>in</strong>ic<br />
1 PARTICULARS OF ORGANISATION<br />
Registered Name of Organisation (with RCB or ACRA):<br />
Contact Details of Applicant Organisation:<br />
Address<br />
Contact Person<br />
Designation<br />
Tel Fax Email<br />
Employment Details:<br />
Total number of employees Total number of men Total number of women<br />
Bus<strong>in</strong>ess Activity:<br />
* Industry: Trad<strong>in</strong>g & Retail / Hospitality / F<strong>in</strong>ancial / Medical and Social Services / Professional<br />
Services / Others (specify)<br />
What are the key areas of focus <strong>in</strong> your organisation <strong>for</strong> the next two years? Eg Regional<br />
Expansion, New Markets, Employee Development<br />
1
2 INFORMATION FOR CONSULTANCY PROGRAMME<br />
2a Preferred month <strong>for</strong> consultancy programme (Please Indicate preference 1,2,3)<br />
( ) April ( ) May ( ) June<br />
2b<br />
Proposed Participants <strong>for</strong> the cl<strong>in</strong>ic: Eg CEO/HR Manager/Adm<strong>in</strong> Manager:<br />
1<br />
Name<br />
Designation<br />
2<br />
3<br />
4<br />
5<br />
Has anyone <strong>in</strong> your organisation attended a <strong>Work</strong>-<strong>Life</strong> brief<strong>in</strong>g conducted by MOM or EA:<br />
Yes No<br />
3 INFORMATION ON WORK-LIFE NEEDS<br />
3a<br />
What do you consider as the current <strong>Work</strong>-<strong>Life</strong> practices with<strong>in</strong> your organisation.<br />
Eg Telecommut<strong>in</strong>g, Part Time, Flexi Time, Eldercare Leave<br />
2
3b<br />
What do you th<strong>in</strong>k are the <strong>Work</strong>-<strong>Life</strong> needs of your organisation and staff?<br />
Eg new mothers, elderly worker, young parents<br />
3c<br />
What do you want to achieve with the <strong>Work</strong>-<strong>Life</strong> <strong>Consultancy</strong> Cl<strong>in</strong>ic?<br />
4 CONFIRMATION OF REQUEST<br />
Applicant’s Confirmation<br />
Signature & Company Stamp<br />
Name<br />
Designation<br />
Note: <strong>Application</strong> must be submitted by <strong>Work</strong>-<strong>Life</strong><br />
coord<strong>in</strong>ator or Project Leader and supported by<br />
management<br />
Date<br />
3
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