Application 2025 Name of Employer Street Address City State Zip Code Phone Website Facebook X (Twitter) Instagram Primary Contact Primary Contact Job Title Primary Contact Email Primary Contact Phone 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 Not Sure a. How many independent contractors do you regularly use? 6. Did you increase wages to any employees to meet our criteria? Yes No Not Sure 7. Do you offer paid sick days for your employees? Yes No Not Sure 8. Do you offer other paid time off benefits to your employees like vacation and holidays? Yes No Not Sure 9. Do you offer parental leave benefits for your employees at the time of birth or adoption of a child? Yes No Not Sure 10. Do you offer health insurance to your employees? Yes No Not Sure 11. Do you offer disability insurance to your employees? Yes No Not Sure 12. Do you offer housing assistance to your employees? Yes No Not Sure 13. Do you offer scholarships or continuing education support to your employees? Yes No Not Sure 14. Do you offer retirement benefits to your employees? Yes No Not Sure 15. Are you a second chace employer? Yes No Not Sure 16. Are your employees covered under a union contract or collective bargaining agreement? Yes No Not Sure 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 First Last Date Submit
