Please demonstrate how conducive your organization’s culture and work environment are to supporting the needs of working parents.  All applications are evaluated by business leaders who have implemented effective employee work/life programs and services in their companies.   

 1)  Total number of employees in the nine-county region:
       Number of Male:      Number of Female:      Average Age:

2)  FLEXIBLE WORK ARRANGEMENTS 

• Type in the percentage of employees who participate in each program that are available at your company:

Flextime      Job Sharing       Part-time        Telecommuting 
Occasional work at home   Compressed Work Weeks 
Other (please explain in space provided)

• Are alternative work programs available to all employees?  Yes No
  If no, please explain: 
  

3)      EARLY CARE AND EDUCATION SUPPORT

• Does your company have an on-site early care center?  Yes No
  If yes, does your company subsidize the cost of the center or is the center an independent operation?  Subsidized Independent
• Does your company support a near-site early care center?  Yes No
• Total number of employees' children who use these programs  ________
• Is the program accredited by the National Association for Education Young Children? Yes No
• Does you company offer financial contributions to centers?  Yes No      
• Does your company offer direct subsidies to employees to help pay for early care programs? Yes No
• Does your company offer any of the following benefits?  Please check the appropriate box.  (note:  if services are offered through a resource and referral vendor, and not directly by the company, please indicate)

• Does your company participate in a program to increase the quality and/or quantity of early care programs in communities where your business is located?  Yes No

  If yes, please explain:

4)      FAMILY/MEDICAL LEAVE

• Can employees at your company take more than the 12 weeks of unpaid leave under the Family and Medical Leave Act and still be guaranteed their jobs or comparable jobs? Yes No

  If yes, how many weeks can they take in addition to the FMLA leave? 

  If yes, how many weeks are taken with pay (please indicate how much pay is provided by insurance and how much pay is provided by company?

• What family and medical leave benefits do you provide your employees? 
  
  

• Check the programs that are available:

  Paid parental leave  Adoption leave Unpaid parental leave  
  Extended parental leave Other (please explain)
  

5)      OTHER FAMILY SUPPORTIVE BENEFITS

• Can employees use sick time to care for dependents?  Yes No
• Does your company have a work/life manager?  Yes No
• Does your company survey your employees on work/life topics?  Yes No
• How do you communicate your family supportive programs? 

• Does your company offer any of the following benefits?  Please check the appropriate box.

  Employee Assistance Program
  Resource and Referral Eldercare
  Gym or fitness resources
  On-site medical leave
  Concierge services
  Other (Dscription: )

6)      BUSINESS CULTURE

Please provide description of why your organization should win this award; include information on mission and values of your organization, programs, and activities. We also encourage you to describe your company's most stellar work/life benefit.  The value of this answer is 10 percent of the final score. If available, please enclose an annual report, recruiting materials, company publications, and employee benefits information.