Client Name Dr.MissMr.Mrs.Ms.Prof.Rev. Salutation First Last Known As Company Position Title Number of EmployeesEmail Home PhoneWork PhoneMobile PhoneDate of Birth DD slash MM slash YYYY Skype Name Facebook Linkedin Street Address Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is the postal address same as above? Yes No Postal Address Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Contact Name Emegency Contact PhoneType of CoachingCareerBusiness & EntrepreneurExecutive LeadershipMindset / Metaphysical MasterySub TypeMature ProfessionalsYoung AdultsExecutivesReasons for Metaphysical Mastery Coaching?(Required)Please indicate your current challenges / Why have you decided to seek mastery consultation? I want to create a healthier mindset I want to improve my work/life balance. I want to reduce my stress & anxiety levels I want to improve my wellness levels I want to improve my relationships I want to explore my unlimited potential I want to learn more about mind mastery Reasons for Coaching?(Required)Please indicate your current challenges / Why have you decided to seek career coaching? I want to start my own company/grow my business. How should I go about doing that? My work life balance is currently out of kilter. Can you help me to regain a more satisfying balance? I want a fulfilling career. Can you help me clarify my strengths and weaknesses, so that I will make a wise choice? I have never had the chance to talk over my career aims objectively. Can you help me do this? I feel at a career crossroads. Can you help me decide which way to go? I am interested in so many things. Can you help me focus? I would like to reduce my stress levels & improve my mindset Reasons for Coaching?(Required)Please indicate your current challenges / Why have you decided to seek career coaching? I want to start my own company/grow my business. How should I go about doing that? I want to leave my current job. Should I change careers? Look for another job? My work life balance is currently out of kilter. Can you help me to regain a more satisfying balance? I want a fulfilling career. Can you help me clarify my strengths and weaknesses, so that I will make a wise choice? I have never had the chance to talk over my career aims objectively. Can you help me do this? I want to reduce my stress & anxiety levels I am interested in so many things. Can you help me focus? I want to become more self-confident and/or assertive. Can you help? have recently immigrated to Australia and need help entering the workforce. Just graduated from university and need to clarify my next career moves. I am currently at university and I want help deciding in which sector to work/profession to follow. What are my options? I need help choosing a suitable vocational or tertiary course. I’m looking for my first job, can you help?. ErrorInvalid combination of 'Type of Coaching' ans 'Sub Type' - Please select again! Have you participated in a Metaphysical Mastery program previously?(Required) No Yes Please Specify Please select services of interest:Interests1 Career Concerns/ Direction Resume/CV Networking Skills Audit Stress Work / Life Balance Other Interests2 Starting or Growing Own Business Monday Mindset Negotiations Professional Development Self-esteem Interests3 Workplace Relations Decision Making Assertiveness Sales / Marketing Accountability Please Specify What motivated you to contact The Career College?What is the most important thing you would like to accomplish as a result of attending mastery?On a scale 1-10, how committed are you to making this happen?1 being some what keen and 10 being fully dedicated.Please enter a number from 1 to 10.What kind of barriers could get in the way of meeting your career/business objectives?When you accomplish this, what will be different about your life (be specific in respect to impacts on your time/schedule, quality of life, self-esteem, income, sense of purpose, family relationships)?What is the main thing missing from your current situation (if applicable)?If you could do any job/occupation you wanted, what would it be?Interests & hobbies:E.g. sports, music, travel, languages.Your strengths & areas of improvement:Strongest work skills:Skills you want to develop:Terms and Conditions The completion of this form will be deemed as acceptance by the client of the terms and conditions set out herein. It is by my free will and choice that I attend this session and accept this agreement. I realise that any guidance/information provided by The Career College should not be used or relied upon as the sole determiner for the purposes of my employment or other career or vocational matter or personal matter. I understand that all decisions made regarding my life and career are my own. I take full responsibility for all my decisions. Under no circumstances will The Career College be liable to you for any losses, damages, liabilities, claims or expenses (including legal costs) whether direct, indirect, or consequential howsoever caused (including, without limitation, negligence) suffered or incurred by you arising out of any services offered or made available to you by The Career College. I may not copy, reproduce, distribute, publish, display, perform, modify, create derivative works, transmit, or in any way exploit any content on this form or on www.thecareercollege.com.au I am rest assured that The Career College will treat my personal information as strictly private and confidential. Consent(Required) I agree to the above terms & conditions.Client Signature(Required) Please type your nameDate(Required) DD slash MM slash YYYY Date form completed Δ
