Application 2025 Name of Employer 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? Aspiring Silver Gold 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 offer paid sick days for your employees? Yes No 8. Do you offer other paid time off benefits to your employees like vacation and holidays? Yes No 9. Do you offer parental leave benefits for your employees at the time of birth or adoption of a child? Yes No 10. Do you offer health insurance to your employees? Yes No 11. Do you offer disability insurance to your employees? Yes No 12. Do you offer housing assistance to your employees? Yes No 13. Do you offer scholarships or continuing education support to your employees? Yes No 14. Do you offer retirement benefits to your employees? Yes No 15. Are you a second chace employer? Yes No 16. Are your employees covered under a union contract or collective bargaining agreement? Yes No 17. 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
