Executive Client

Name*

First Last

Age*

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouse Name (if applicable)

Kids’ names and ages (if applicable)

List areas of professional expertise (e.g. – Entrepreneurship, Operations, Sales & Marketing, Strategic Planning, Process Improvement, etc.)

List of organizations you are associated with (e.g. - Board member, advisory team, volunteer, etc.)

Personal Mission Statement (if desired)

Resume

Professional Experience Blurb – This is a great place to talk about how long have you been a business and community leader. Describe your experiences and roles in business and community settings. What is driving you to be coached by another man? In other words, why are you willing to make this investment?

What is your current job and when did you start it?

Do you have any other professional experience? If yes, describe and provide dates of service

Where did you go to college, what degree did you get, and when?

Are there any other professional achievements which you would like included in the resume portion of your profile?

Personal Blurb – please provide a brief personal blurb about yourself and your life.

Rate the following areas of your life on a scale of 1-5 (1 = in crisis, 2 = needs attention, 3 = room for improvement & accountability, 4 = consistent & productive, 5= rockin’ and rollin’)

Faith

Family

Friends

Finances

Fitness

Please provide any commentary that may be helpful in the explanation of your above assessment

Briefly describe your relationship with God

Why do you want to be an executive client?

Please explain your biggest weakness and strengths (personally and professionally)

List any hobbies or interests

Please submit a headshot and logos for each organization you would like represented on your profile to jeff@menofiron.org

Executive Client Application

Resume