Poder25 Applications Due January 3, 2020 Name*FirstLast Email* Phone* Address* Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Company* Current Position* Career Goal* Do you believe you are currently qualified for a F500 GC Placement Opportunity?*YESNO If no, why not? Why do you want to become a F500 GC?* What do you hope to achieve by participating in Poder25?* Highest Degree Obtained* College & Post-Graduate Degrees:* List languages you speak* Team management experience* Experience working with boards of directors?* Interaction with senior management?* Experience working outside of the U.S.? Corporate/M&A experience? Litigation experience? Notable cases or deals in private practice? Notable cases or deals which you spearheaded or had primary supervisory oversight? Top three industries in which you have worked: Do you have a specific practice area now? If no, have you ever specialized in a specific area of the law? Number and titles of direct reports (can group in categories, e.g. "4 attorneys, 3 paralegals, and 1 admin") Annual revenue of current organization or segment that you oversee Other relevant experience Do you currently have an Executive Coach?YESNO Have you ever had an Executive Coach?YESNO Do you currently work with an Executive Recruiting Firm or placement organization?YESNO If yes, who? If your direct reports were to complete a "360" degree" evaluation on you, how would they describe you? What would they likely identify as your areas for opportunity? If your General Counsel (or person to whom you directly report) were to evaluate you, how would they describe you? What would they likely identify as your areas for opportunity?(1) What do you believe are the areas you need to develop in order to be Fortune 500 "GC Ready?" Any other information you would want an Executive Placement Search Firm to know about you? Upload Headshot* Upload Resume/CV* Word VerificationSubmitReset
