Coach in a Box Application Form

Name / Title / Gender
Address
Home phone / Mobile
Email address / Date of Birth/Birth date
Skype address / Native Language (s)
Role applied for: / Associate Coach
How did you hear about Coach in a Box and the role you have applied for?
Reason for attraction to the role
RESOURCE CHECKLIST (Please tick)
Phone / Webcam
Confidential access to PC with email & internet / Quiet working environment
Confidential access to Printer
Rate PC Skills from 1 to 5 (1 = low, 5 = high) / 1 / 2 / 3 / 4 / 5
Email note: Please note that, to work with us, you will be issued with a Coach in a Box email address and, whilst we will provide you with some help to set this up on your computer, it is your responsibility to ensure that you do what is necessary such that you can use this email address as your primary address for the work that you do with us.
COACHING PRACTICE
Do you run your own coaching / counselling business? / Yes/No
Do you have personal indemnity insurance? / Yes/No / If Yes - Value:
Do you receive Supervision? / Yes/No
Please detail the frequency of Supervision:
References – professional and personal
RECENT WORK HISTORY AND/OR EDUCATION (past 10 yrs )
Current Employer
Role – short description
Dates from/to
Coach ina Box aim to deliver the highest standard possible to our Clients. As a business we hold the intention of only recruiting Associates with a Coaching Qualification. The next part of the application will help us understand your qualifications and experience.
Coaching Qualifications:
Please detail year of qualification, number of hours training and the company you trained with.
Coaching Accreditation:
Other Qualifications, Affiliations and Professional Development Activity:
Please detail year of attendance, hours of training, study and name of company / organisation where possible
Skills and experience, specific to role
Coach in a Box does transformational work with our key IP creating deep shifts for those we work with.
Tell us about your personal growth journey. What work have you done? (Including your key transitions.)
Languages spoken fluently to coach in:
IP Property Rights
If you are invited to train to become a coach with Coach in a Box, you will receive some Coach in a Box Intellectual Property and Confidential Information. By sending this application form in, you are confirming agreement to the following:
·  You shall not either during the Training or at any time after this Agreement has terminated, use or disclose to any third party (and shall use your best endeavours to prevent the publication or disclosure of) any Confidential Information. This restriction does not apply to:
o  any use or disclosure authorised by the Company or required by law; or
o  any information which is already in, or comes into, the public domain otherwise than through the Associate's unauthorised disclosure.
·  You undertake not to infringe or exploit for your own benefit any intellectual property rights of the Company including without limitation copying materials, models or processes both during the term of this training and after its termination for whatever reason unless given written permission by a director of the Company.
·  You agree to adhere to the data protection act.
Biography. (Please provide a biography of approx 100 words highlighting your background, your interest in coaching and any snippets about you as a person. This will be displayed to your coachees to paint a picture of who you are)

Coach in a Box Application Form – email version v12 Page 2