Application- Certified Living Wage Congregation

Name of Congregation *

Street Address *

City *

State *

Zip Code *

Phone *

Website *

Facebook

Please add your Facebook handle/page

Twitter

Please add your Twitter handle/page

Instagram

Please add your Instagram handle/page

Primary Contact *

First

Last

Primary Contact Job Title *

Primary Contact Email *

1. Which Tier are you applying for? *

Please refer to the website for guidance on the different tiers.

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) *

To qualify as a living wage congregation, your lowest paid employee must be paid the corresponding Tier 1 or Tier 2 wage for your location. Please see the website for guidance on rates.

5. Do you hire independent contractors whom you pay on an hourly basis? *

a. How many independent contractors do you regularly use? *

6. Did you increase wages to any employees to meet our criteria?

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? *

Please upload your organization's logo | min size: 150px x 150px *

Click or drag a file to this area to upload.

If your organization does not qualify to be certified, the logo will not be used.

Signed *

First

Last

Title *

Date *

Phone