WORKER FRIENDLY EMPLOYER APPLICATION FORM

Thank you for your interest in being designated a Worker Friendly Employer! Fill out the following form to determine whether or not your business meets the criteria to be designated "Worker Friendly." If approved, you will receive an email notification and your company will be listed on the Worker Friendly Website and on Worker Friendly promotions. You may post the Worker Friendly logo in your business and on your business Website.

Questions? Send an email to workerfriendly.org

SECTION 1: EMPLOYER INFORMATION

  1. Where is your business/organization located? (To be listed your business/organization must be located in one of these six Georgia counties.)

    Barrow County   Clarke County Jackson County Madison County Oconee County Oglethorpe County
  2. Information to list on the Website if your business/organization meets the criteria:
    Business/Organization Name:
    Unit Name (optional):
          To be listed as a separate unit within a business/organization
           the unit must:
          1) have the authority to hire its own employees and
          2) maintain and track its own personnel budget.
    Business/Organization/Unit Address:
    City
    Zip
    Is your business/organization part of a larger entity? No      Yes
    If yes:
    What is the name of your parent organization?
    Where is your parent organization located?
    City
    State

SECTION II. CONTACT INFORMATION

If we have questions about your responses, whom should we contact?

Name:
Title:
Email Address:
Telephone:
Please provide an alternate phone number in case we
cannot reach the above person:

SECTION III. TYPE OF BUSINESS/ORGANIZATION

What category would you use to describe your business? (e.g., Lodging, Education, Social Services, Restaurant)

SECTION IV. BUDGET AUTHORITY

Does your business/organization (or unit):

Have authority to hire its own employees?
Maintain and track its own personnel budget?

(Employers must answer "yes" to both questions to be listed on this website.)

SECTION V. NUMBER OF EMPLOYEES

Use this procedure to answer the following question:

  1. Pick a payroll that is: 1) typical and 2) from within the last three months.
  2. Enter the total number of regular and temporary employees below
    • A temporary employee is anyone who is hired on an hourly, weekly, or monthly basis for one day or more but is not considered a regular employee. Include on-site contractual, but not off-site contractual.
    • DO NOT include positions held by individuals less than 18 years of age.
    • DO NOT include positions that can ONLY be held by students (e.g., student worker, student interns, graduate assistants)
    • DO include positions that can be filled by BOTH students and non-students, 18 years and older.

How many employees (18 years and older) do you have in the following classifications?

Regular Employees Temporary Employees
# Full Time (35+ hrs/week)
# Part Time (20+ hrs/week)
# Part Time (< 20 hrs/week)

SECTION VI. SALARY INFORMATION

Identify the lowest paid regular OR temporary employee who works 20 or more hours per week. The entry-level salary is the lowest amount you would pay any applicant who applies for this position.

Enter the entry-level salary for this employee in ONE of the sections below:

Annual salary:
Monthly salary:
Bi-weekly salary:
Weekly salary:
Hourly wage:

For how many weeks per year is this employee typically paid (including vacation, holidays, and sick leave)?

How many hours is this person scheduled to work during a typical week?

SECTION VII. EMPLOYEE BENEFITS

Identify your lowest-paid regular employee who works full time.

Is this person eligible to sign up for health insurance
within six months of starting employment? 		Yes        No
What is the total amount per month your company pays toward
employee health insurance for this employee? 		$
Does your organization/business offer a retirement plan for this employee?
(may be defined benefit or defined contribution) 		Yes        No

What percentage of the employee's salary is paid for or matched by the organization/business as a retirement contribution?

Example #1: If your employee makes $1,400 per month and you pay $84 per month into their retirement account, the percentage = 84/1400 = 6%
Example #2: If you contribute 5% to the employee's retirement and the employee is required to also contribute 5%, you would enter 5% below to reflect the employer contribution.
Example #3: If you match UP TO 4% of an employee's retirement contribution, enter 4%. You can list 4% even if the employee has elected to contribute less than this amount.
Enter percent here:

What is the total number of paid holiday, vacation and sick days per year this employee is eligible for one year after they started employment, up to a maximum of 27 days per year, rounded up to nearest 1 day?

Number of days:

Identify your lowest-paid regular employee who works at least 20 hours per week.

Is this person eligible to sign up for health insurance
within six months of starting employment? 		Yes        No
Does your organization/business contribute to their health insurance, pro-rated to be equivalent to the benefit provided to full-time employees? Yes        No
Does your organization/business offer a retirement plan this employee? (may be defined benefit or defined contribution) Yes        No
Does your company contribute to their retirement plan, pro-rated to be equivalent to the benefit provided to full-time employees? Yes        No
Does this employee receive the same number of holidays, vacation, and sick leave days, pro-rated to be equivalent to the days provided to full-time employees? Yes        No