| Name |
|
| Date of Birth |
|
| Place of Birth |
|
Parents
|
| Mothers Name |
|
| Mothers DOB |
|
| Fathers Name |
|
| Fathers DOB |
|
| What was your mother like as a person? |
|
| What was your father like as a person |
|
| Describe your parents' relationship - how did they
relate to each other |
|
| Objectively, whose behavioural traits do you have
most of - your Mother's or Father's? |
|
| DId your parents get divorced? |
|
| Describe your relationship with your mother at the
moment. |
|
| Describe your relationship with your father at the
moment. |
|
Mentors
|
| Describe any important people in your formative
years. Note that the experiences with these people don't
necessarilly have to have been positive. |
|
Environment
|
| Did you move home as a child? How often? |
|
| Give Details
of moves and your age at the time |
|
| How did you feel about moving ? |
|
Education - Primary & High School
|
| How old were you when you first attended Creche or Nursery School? |
|
| Do you remember anything about those years? If so, please Comment |
|
| Give details of school attended and how you felt about school
this should include schoolwork, playground activities, extra murals
and sport |
|
| Please
give details of schools attended and how you felt about school.
This
should include schoolwork, playground activities, extra murals
and sport. Please give details as above including Subjects chosen for final
years ("A" levels, Matric etc.) |
|
| Did you have a nickname at school and if so, what
was it? |
|
|
Were school years the best years of your life? Give reasons. |
|
| Were you given recognition at school for academics / cultural
activities?
|
|
| Which sports did you participate in at school. Did you enjoy
them? |
|
| Do
you participate in any sport now? |
|
Education - Tertiary
|
|
Please give details of Universities or colleges attended, courses taken and qualifiecations achieved |
|
| Please
state any adult-study courses or ongoing education programmes
that you may be or have been involved in |
|
| Detail interests you had or are currently involved in |
|
| Position held now |
| Are you happy in your chosen career? |
|
| Do you have future career goals? |
|
| How do you intend to reach your future career
goals? |
|
Beliefs / Philosophy
|
| Who do you admire most and why? This can be any
person, living or dead. |
|
| Do you believe in God? |
|
| Do you believe in an afterlife? |
|
| Does life hold meaning for you? |
|
Medical History
|
|
| Please detail any illnesses or injuries which you
may have had. |
|
| Are you taking any drugs at the moment -
Perscription or otherwise. Please detail. |
|
Marriage / Relationships
|
| Marriage / Relationship status |
|
| For how long have you been in this relationship? |
|
| Have you ever had an affair and have you ever
spoken to your partner about this affair? |
|
| Please describe your partner. |
|
| What does the relationship feel like? |
|
| What do you fight about and how often? |
|
| Are there secrets between you? |
|
| How does the relationship differ from your
expectations? |
|
| Please give details of previous marriages or
close / committed relationships. How long did they last, also
detail the reasons why they did not last |
|
| Do you fantasise about having relationships with
others? Are there recurring fantasies involving particular
people? |
|
Feelings
|
| Do you feel alone from time to time? |
|
| Do you experience depression? |
|
| Do you get angry and, if so, under what
circumstances? |
|
| What makes you laugh? |
|
| Do you feel different? How? |
|
| What makes you cry? |
|
| Are you safe and secure? |
|
| Do you have fears? Of what? |
|
| Are you affectionate? |
|
Perceptions
|
| Do people seek out your company? |
|
| Do others see you as being safe and secure? |
|
| Do you have the power to change things? |
|
| Do you get your own way most of the time? |
|
| How do people see you? |
|
| What strategies do you have for getting your own
way? |
|
| How would you describe yourself? |
|
| How would your partner / Wife / Husband describe
you? |
|
| How would your best friend describe you? |
|
| How would your worst enemy describe you? |
|
Organisational Experiences
|
|
What made you feel fulfilled and happy in the jobs you have held
previously?
|
|
|
What made you feel frustrated in the jobs you have held
previously?
|
|
|
What experiences have you had which you can share with others in
your organisation?
|
|
|
Describe your ideal job - what woiuld you be doing if you worked
at your ideal job?
|
|
|
If money were no object, what would you be doing now?
|
|
Goals and Dreams
|
| What did you want to be when you were small? |
|
| What do you want to be now? |
|
| Do you make things happen or do you wait for
things to happen? |
|
| If you could do anything right now, what would you
be doing? |
|
| Are you in control most of the time? What happens
when you are not? |
|
| Are you living in your power right now? |
|
| Have you answered all questions honestly here? |
|
