Become a Coach Tell us about yourself. We will use this information to match you with potential coaching clients. Contact Information NAME * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country PHONE * (###) ### #### EMAIL * Coaching Experience & Background Which functional area(s) do you have experience in? * Administration Finance Clinical/Medical Human Resources Information Technology Marketing Operations Sales Strategy Engineering Research & Development Customer Service Business Development Logistic/Procurement Which industry(s) do you have experience in? * Aerospace Agriculture Chemical Commerce Construction Education Energy Entertainment Forestry Food Government Healthcare Hospitality Manufacturing Media Mining Music Pharmaceutical Professional Services Shipping Technology Telecommunications Textiles Tourism Transport Utilities What are the coaching topics you have experience coaching on? * Strategy and strategic thinking Influence and leadership presence Building effective teams Communication skills Conflict management Decision making, working with uncertainty and ambiguity Delegation and empowerment Developing others, mentoring, succession planning Interpersonal relationships, listening skills and empathy Leading during times of change Motivation and engagement, leading with vision and purpose Organization, resource management and task completion Self-awareness Time and energy management; organization Are there other coaching topics not listed that you have experience in? What interpersonal attributes best describe you? * Building trust Collaborating and working well together with others Comforting people when they need it Clear communication skills Conflict management and resolution skills Constructive feedback (ways people can improve) Diplomacy (handling affairs without hostility) Caring about other people Driven; results oriented Empathy for others Encouraging and inspiring people to do their best Flexibility in thinking and operating style Humor and lightheartedness Inspiring and motivating Listening well Networking and building relationships; Socializing skills Patience when dealing with others Public speaking and presentation skills Self-awareness Sensitivity toward the preferences and wishes of others Tolerance and respect for others Are there interpersonal attributes not listed above you want to include? What is your highest job level achieved? Executive (i.e. VP, CFO, CEO, COO, CIO, etc.) Mid-level Management (Sr. Manager, Director, etc.) First-level Management (Supervisor, Manager, Department Manager, etc.) Intermediate/Experienced (Individual contributors with 5+ years of experience) Entry-level (Individual contributor with less than 5 years of experience) How much coaching experience do you have? * 1-5 years 6-10 years 11-15 years 15+ years What is the highest degree or level of education you have completed? * Some High School High School Bachelor's Degree Master's Degree Ph.D. or higher Trade School Which Languages are you capable of speaking fluently? * Check all that apply. English Spanish Portuguese French Mandarin Arabic Other If you selected other, please add languages here. Please feel free to share your pronoun. (Optional) Please specify your ethnicity. (Optional) White African-American Latino or Hispanic Asian Native-American Native Hawaiian or Pacific Islander Two or More Other/Unknown Prefer not to say What coaching credential do you have? * Associate Certified Coach (ACC) (ICF) Professional Certified Coach (PCC) (ICF) Master Certified Coach (MCC) (ICF) None Other If you chose other, please share credential here: Please share details on your programs, packages and pricing. It is okay to copy from your website or share a link to this information. * Describe your ideal clients, including types of roles you have coached. * What is your main motivation for wanting to work with Empower (besides being aligned with the mission!) * Thank you for your interest in becoming a coach with Empower Leadership Coaching. Someone from our team will contact you soon.
