APPLICATION for SCRIPPS HEALTH EMERGING LEADER PROGRAM

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PROGRAM GUIDELINES AND CRITERIA PROGRAM OBJECTIVE: The objective of the Scripps Health Emerging Leader Program is to give non-managerial staff an understanding of the role, challenges and skills required to become a Scripps leader. It provides candidates the opportunity to assess their own area of interest and to practice newly learned skills. ELIGIBILITY CRITERIA: Employed by Scripps full-time or part time for at least one year at the time of application. Performance Evaluation(s) for the preceding 12 months reflecting employee meets expectations on all standards. No formal disciplinary action in progress. PRE-REQUISITE: Effective January 2011: The Career Development Workshop is a pre-requisite for applying to the program. ENTRY REQUIREMENTS: Completed application with endorsement from admin director. TalentMine Career Assessment Manager feedback form. PROGRAM REQUIREMENTS Must complete all required course work within 6 months. APPLICATION PERIOD: Applications will be accepted in October 2014 Applicants will be notified in writing within six (6) weeks from the date that the application was submitted. SELECTION PROCESS: All completed applications are reviewed by the Emerging Leader Program Selection Committee which includes members from executive leadership at Scripps. Applications will be evaluated based on the following areas: Personal statements in application Manager feedback form (manager to submit directly to Human Resources) Performance Evaluation scores TalentMine Career Assessment Employee Must Submit: 1. Completed, typed application with signatures 2. Copy of applicant s current performance appraisal/evaluation. 3. Career Development Workshop Certificate of Completion 4. TalentMine Career Assessment (submit electronically, do not attach to application) To complete the TalentMine Career Assessment please follow the instructions below: a) Use the following URL: http://www.talentminenetwork.com/client/scripps *Note: Be sure the intro screen says Scripps on it before proceeding to step b. b) Click on <Start Now> at the bottom of the screen c) Create a username and password. *Please make note of these as they will be required for subsequent logins. d) If at any time you wish to stop and come back later, you may log in from the upper right hand corner on the home page via the link provided in step a. You will need to supply your username and password. e) If you need technical assistance, please email support@talentmine.com.

EMPLOYEE RESPONSIBILITIES: Complete the Scripps Health Emerging Leader application and all required paperwork, assessment and documentation. Forward to the site Human Resources department to verify eligibility. The deadline to submit the application to the site HR representative is 4:00 PM, Friday, October 24, 2014. If you have questions or need more information, call the Center for Learning & Innovation at (858) 435-7171, tie line 315.7171.

Complete (type) and submit this form, with ALL of the following items, to your Human Resources representative no later than Friday, October 24, 2014, 4:00 PM. 1. A copy of the current performance evaluation/appraisal. 2. Certificate of Completion for Career Development Workshop 3. Manager must submit feedback form directly to Human Resources. Please don t attach to application. I. PERSONAL INFORMATION Applicant s Name: Corporate ID: Home Phone Have you applied to the program before? When: Home Address: Job Title: Work Phone: Department: Business location or site: Mail Drop: Hire Date: Manager s Name: Job Status (Circle One) Full-time Part-time II. EDUCATION: Please indicate the highest level of education you have completed High School Undergraduate Degree Graduate Degree Highest Degree Received and Subject: Professional Licensure or Certification: Are you currently enrolled in an undergraduate, graduate, or professional certification program? If yes, please describe: Expected graduation date: Please list any academic awards or honors you have received: III. LEADERSHIP List recent examples of efforts you have made to develop your professional skills and describe leadership roles held at Scripps, in college or in the community.

IV. GENERAL Please state the reason for your interest in the Emerging Leader Program. State anticipated benefits and what you expect to learn: Describe an improvement you have made in your department. What factors contributed to your success (leadership skills, communication, interpersonal rapport, etc)? In what area or skill could you grow by participating in this program? V. SIGNATURE My signature below acknowledges that I have read the preceding application and program outline. If my application is accepted, I understand the time and professional commitment required to attend courses and complete developmental activities outside of my normal work assignment. It has been determined that this can be accomplished in approximately 80 hours for the entire program (including eight hours for homework and special projects), of which I will be paid regular wages. Participation in the program is not a guarantee for promotion or a leadership position. I understand that the consent and endorsement of my manager and site leadership is required for acceptance into the program. Applicant Signature/Date

SITE ENDORSEMENT OF APPLICANT BY ADMIN DIRECTOR This endorsement supports the continued professional leadership development of Scripps employees who are making a positive contribution to the organization. I, (Name), (Title) acknowledge that the below named individual is interested in participating in the Emerging Leader Program. I believe that this individual is making valuable contributions to Scripps and has the potential to grow into a leadership role within the organization. I agree to support my employees endeavor and understand the time commitment of attending courses and completing developmental activities. The employee s department will accommodate program involvement and pay regular wages when the employee is absent from work due to program sessions and activities. This accommodation is inclusive of eight hours for homework assignments and projects. Additional comments (optional): Applicants Name: Site Leadership Signature Date TO BE SIGNED AND DATED: HUMAN RESOURCES REPRESENTATIVE SIGNATURE/DATE: TO BE COMPLETED BY SITE HUMAN RESOURCES: Has the employee worked for 12 months or more: Does the employee have any formal disciplinary actions in progress? From the employee s last performance appraisal, please input the total points for: BEHAVIORS: DUTIES: CFLI ADMINISTRATIVE USE ONLY: Is the Applicant Accepted or Denied Accepted Denied Was the Applicant Notified? MISCELLANEOUS INFORMATION: