Application Name of Congregation Street Address City State Zip Code Phone Website Facebook Twitter Instagram Primary Contact Primary Contact Job Title Primary Contact Email 1. Which Tier are you applying for? 2. How many employees do you have? 3. How many of the employees listed above are apprentices or interns? a. How many are minors? b. How many are temporary or project-based employees? c. Other (please describe) 4. What are the lowest wages you pay your employees? (excluding those in Question 3) 5. Do you hire independent contractors whom you pay on an hourly basis? Yes No a. How many independent contractors do you regularly use? 6. Did you increase wages to any employees to meet our criteria? Yes No 7. Do you certify that the information above is true and accurate to the best of your knowledge and that you have the authority to sign this application? Yes No Please upload your organization's logo | min size: 150px x 150px Signed First Last Date Submit
