Allied Executives

Please complete the following application. Your answers will be kept confidential. This information will allow Allied Executives to evaluate the extent that you will benefit from becoming a member and allow us to determine the best fit when assigning you to a peer group. An Allied Executives representative will contact you to review the results.

First Name:	Last Name:
Company:
Title:
Address:
City:	State: Postal Code:
Email:
Phone:

1.	Which part of your business are you "MOST" comfortable or "MOST" proficient?
	Sales & Marketing Production & Operations Finance & Accounting
2.	Which part of your business are you "LEAST" comfortable or "LEAST" proficient?
	Sales & Marketing Production & Operations Finance & Accounting
3.	Rate how competent you are as a leader.
	1-Low 2 3 4 5-High
4.	Rate how thorough you are with communication to key people and employees.
	1-Low 2 3 4 5-High
5.	Rate how effective you are at managing employee accountability.
	1-Low 2 3 4 5-High
6.	Rate how well you handle conflict and conflict resolution.
	1-Low 2 3 4 5-High
7.	Rate where you are currently with stress and anxiety.
	1-Low 2 3 4 5-High
8.	Rate how effective you are with time management and your personal workload.
	1-Low 2 3 4 5-High
9.	Rate how you measure the quality of your life, the balance between work and home.
	1-Low 2 3 4 5-High
10.	Rate how satisfied you are with your business sales growth.
	1-Low 2 3 4 5-High
11.	Rate how satisfied you are with your business profit.
	1-Low 2 3 4 5-High
12.	Rate how satisfied you are with your company cashflow.
	1-Low 2 3 4 5-High
13.	Rate how satisfied you are with your company debt load.
	1-Low 2 3 4 5-High
14.	Rate how satisfied you are with the overall performance of your management team.
	1-Low 2 3 4 5-High
15.	Rate how satisfied you are with the overall performance of your company.
	1-Low 2 3 4 5-High
16.	What would you like to change most about yourself?

17.	What would you like to change most about your business?

18.	What is your website address?

19.	What industry are you in?

20.	Please give a description of your business.

21.	What range is your company annual sales volume in millions $?
	$0 to $5 M $5 M to $20 M $20 M to $50 M $50 M to $100 M Over $100 M
22.	How many employees in your company?

23.	How many years have you been with your company?

24.	Describe your past work experience.

25.	What is your family status?
	Single Married Married w/ children single w/ children
26.	What is your birthdate?

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