Advisor Application

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone

Cell Phone

Race

We ask for voluntary demographic information to ensure we reflect the communities we serve.

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Languages Spoken (other than English)

Employment Status*

Please select one (or more) of the choices below that best fits your current employment status.

Employed Full Time
Employed Part Time
Self-Employed Full Time
Self-Employed Part Time
Looking for Full Time
Looking for Part Time
Not Currently Looking for Employment
Retired

Professional Experience*

Please select one (or more) of the choices below that best describes your professional experience.

Other Professional Experience (Please Specify)

Core Competencies*

Please select up to five of the choices below that indicate the areas where you feel you can be most effective as a consultant.

Core Competency Ranking*

Please type in your chosen competencies from the question above and rank them in order of how you feel you can be most effective as a consultant.

#1	#2	#3	#4	#5

Have you had consulting experience?*

Yes
No

If no, are you familiar with the consulting process?

Yes
No

If yes, what type of organizations have you consulted with?

For-Profit
Nonprofit

Consulting Experience

Please press the "+" sign to add an additional line.

Firm/Organization Name	Title	Type of Consulting

Computer Literacy*

Please select any/all of the software with which you are proficient.

MS Access
MS Excel
MS PowerPoint
MS Word
Other

Other Computer Literacy (Please Specify)

Foreign Language Fluency

Please list any languages other than English in which you are fluent and your level of fluency.

Evening/Weekend Availability*

Can you be available some weekdays between 9 a.m.-5 p.m? Are you also available some evenings and/or weekends?

Some Weekdays
Some Evenings
Some Weekends

Monthly Availability*

Please select the months of the year when you are available.

Do you have any other limitations to your availability?*

Yes
No

If yes, please describe those limitations.

Recent Employment History*

Please include your last three positions. Please press the "+" sign to add an additional line.

Employer/Industry	Most Senior Position	Dates

Nonprofit Experience

Please include board membership. Please press the "+" sign to add an additional line.

Organization	Most Senior Position	Dates

What would you like to accomplish by volunteering with ESC?*

Why do you think ESC would be a good fit for you?*

How did you learn about ESC?*

Please select the way you first learned of ESC of the Triangle.

Facebook
Email/Direct Mailing
ESC Website
LinkedIn
Twitter
ESC Board Member or Advisor
Internet
Other

If you selected "Other" above, please provide additional information for our records.

Education

University/College/School	Degree

Other Educational Experience

Please tell us about any other educational experience you may have.