Inked for Success Career Coach
Client Intake Form
SECTION 1— Personal Information
1. Full Name:
2. Preferred Name:
3. Email Address:
example@example.com
4. Phone Number:
Format: (000) 000-0000.
5. City & State:
6. Preferred Contact Method: Phone / Text / Email
7. Best Time to Contact: Morning / Afternoon / Evening
SECTION 2— Career Background
8. Current Employment Status:
9. Current or Most Recent Job Title:
10. Industry/Field:
11. Years of Experience:
12. Upload Resume (optional)
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SECTION 3— Career Goals
13. What type of position are you seeking?
14. Preferred Work Setting: Remote / Hybrid / In-Office / No Preference
15. Desired Salary Range:
16. Short-Term Career Goal (next 6-12 months):
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18. Hours/Shifts You Are Willing to Work:
(Check all that apply)
Hours/Shifts You Are Willing to Work:
Day Shift
Evening Shift
Night Shift
Weekends
Flexible
Other
SECTION 4 — Job Search Support Needed
(Check all that apply)
Job Search Support Needed
Resume Writing
Cover Letter Creation
LinkedIn Optimization
Job Search Assistance/Leads
Interview Coaching
Career Coaching Session
Skills Assessment
Career Path Planning
Other
SECTION 5— Strengths & Barriers
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20. Challenges or barriers:
SECTION 6— Additional Information
21. How did you hear about Inked for Success Career Coach? Facebook / TikTok / Instagram / Referral / Returning Client / Other
22. Anything else you'd like us to know?
SECTION 7 — Agreement
Signature:
Date:
-
Month
-
Day
Year
Date
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