Executive Management Background Assessment Form
Use this form to assess an executive candidate’s background, leadership experience, strategic fit, and professional references.
Candidate Identification
Candidate Full Name
*
First Name
Middle Name
Last Name
Current Job Title
*
Current Organization/Company
*
Email Address
*
example@example.com
Executive Background Assessment
Years of Executive Leadership Experience
*
Primary Industry Experience
*
Please Select
Technology
Healthcare
Financial Services
Consumer Goods
Manufacturing
Retail
Education
Energy
Government
Nonprofit
Other
Highest Leadership Level Held
*
Director
Vice President
Senior Vice President
C-Level
Board Member
Other
Overall Leadership Effectiveness
*
Needs Improvement
1
2
3
4
5
6
7
8
9
Exceptional
10
1 is Needs Improvement, 10 is Exceptional
Strategic Fit and References
Strategic fit assessment
*
Rows
Strength
Development gap
Strategic thinking
1
2
Decision-making
3
4
People leadership
5
6
Change management
7
8
Governance experience
9
10
Professional references
*
Overall assessment summary / recommendation
*
Submit
Should be Empty: