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Services
Advisors
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Contact
Founder
Studio
Film/Photo Shoots
Booking Inquiries
Event Calendar
MEETINGS
CENTURY HOUSE
Advisors
About
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Advisors
CHA Contact
Info
Contact
Founder
Please complete this survey in its entirety.
Personal Information
Name
*
First Name
Last Name
Email Address
*
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Mailing Address, if different
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone
Country
(###)
###
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Mobile 1
Country
(###)
###
####
Mobile 2
Country
(###)
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Skype
Facebook
LinkedIn
Business Website
http://
Twitter
@
Age
*
Height (cm or ft/in)
*
Weight (kg or lbs)
*
Health Status
*
Poor
Below Average
Average
Above Average
Excellent
Physical Status
*
Out of shape
A little overweight
A few extra kilos (pounds)
Average
Naturally Fit
Lean Machine
Personal Mental State
*
Highly Stressed
Managing Stress
Super Intense
Mixed Emotions
Singularly Focused
Almost on track
Adrift and Lost at Sea
Out of Control
Completely Calm
Happy
Educational History
First Degree
University
Major/Specialization
Graduation Year
Second Degree
University
Major/Specialization
Graduation Year
Additional Education
Additional Professional Skills and/or Certification
Skills/Certification 1
Skills/Certification 2
Skills/Certification 3
Employment History
First Employer
*
First Job Title
*
Current Employer
*
Current Position/Title
*
Years in Position
*
Other Positions/Titles
Years with Employer
Most Important Skill Developed
Previous Employer
Position/Title
Years in Position
Other Positions/Titles
Years with Employer
Most Important Skill Developed
Previous Employer
Position/Title
Years in Position
Other Positions/Titles
Years with Employer
Most Important Skill Developed
Family Information
Spouse/Partner's Name
Spouse/Partner's Highest School Level
Spouse/Partner's Profession
Spouse/Partner's Position/Title
Child's Name 1
Child's Age 1
Child's School Level or Profession 1
Child's Name 2
Child's Age 2
Child's School Level or Profession 2
Child's Name 3
Child's Age 3
Child's School Level or Profession 3
Child's Name 4
Child's Age 4
Child's School Level or Profession 4
Mother's Name
Mother's Age (or Deceased)
Mother's Highest School Level
Mother's Profession
Mother's Expectations for You
Father's Name
Father's Age
Father's Highest School Level
Father's Profession
Father's Expectations for You
Other Close Relative's Name(s)
Other Close Relative's Profession
Other Close Relative's Expectations for You
Interests
Check items in which you have a keen personal interest:
Games
Arts
Politics
Music
Wealth
Beauty
Government
Nature
Humour
Preventive Health
Collecting
Sports
History
Fashion
Gadgets & Electronics
Books
Magazines
Networks
Animals
Reading
Shopping
Fitness
Select your skill level below
Negotiation
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Presentations
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Finance
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Accounting
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Economics
*
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Mathematics
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Operations
Option One
Option Two
Marketing
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Leadership
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Engineering
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Programming
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Art
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Design
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Writing
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Managing People
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Understanding People
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Verbal Communication
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
Interpreting Non-Verbal Communication
Rare Talent
Expert
High Proficiency
Proficiency
Deficiency
aspirations
Ultimate Job Title
Preferred Industry
Preferred Company
Preferred Organization
Preferred Employment Status
Self-Employed
Chief Executive, Non-Owner
Senior Executive
Executive Director, Non-Profit
Senior Director, Non-Profit
Executive Director, Government Agency
Senior Director, Government Agency
Partner, Private Firm
Principal, Private Agency
Professor, Academic Institution
List Desired Skills
List Desired Life Qualities
Describe Desired Life Balance
Thank you!
