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- 5 Week Gut-Brain Reboot
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Application for Influential Women in Transition

Full Name

Email *

Phone *

Time Zone *

Eastern

Mountain

Central

Pacific

Other Please Specify Below

Other Specified Time Zone

Describe your current professional responsibilities? *

Other responsibilities (parenting, caring for aging parent, community, volunteer, etc.) *

Time with current or last employer:

Best thing about the above position (check all that apply)

Hours work with my personal life needs

Monthly/Regular Base Income

Bonuses

Income Growth Potential

Personal Growth Potential

Products/Services produced by company

Company Core Values

Beneﬁts and Perks (insurance and beneﬁts package, stock options, etc.)

Compatible with Healthy Lifestyle (challenging but not high stress, time for exercise and movement through the day, sit-stand desk options, nutritional meals and snacks readily available, Time oﬀ for person-al renewal time)

Colleagues

Customers/clients

Alignment with personal goals, skills, drive, ambition

Familiarity/comfort zone

Something else

Worst thing about the position (check all that apply)

Unending stress and health consequences - stomach issues, immune system, sleep disruption, undesired weight gain or loss, etc.

My boss

My boss's boss

Lack of power to resolve client issues.

Declining quality of product or service

Budget cuts, layoﬀs - who's next - and those who stay get to carry that load with full expectation of equal performance with no compensation

Dread waking up on Monday

The coworkers

Company politics

Management blindness

The economy

Employer's place in the market is unstable - lots of red ﬂags

Something else

If you checked “something else” on either question 8 or 9, describe the best or worst thing you experience about your current or most recent position.