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Qualification Questionnaire
General Business
Information
Please provide your information below.
Legal Name of Business:
Business Website:
Business Street Address:
Address Line 2:
City
State / Province / Region
ZIP / Postal Code
Country
USA
Primary Contact/ First Title:
Primary Contact/ Last Title:
Email Address:
Phone Number:
Business Entity Ownership:
Number of Locations:
Operating Hours for Business:
company representation –
Corporate Structure
What % of full time employees are women?
What % of women employees are in leadership positions?
What % of the company's board of directors are women?
What % of Senior Level Positions are held by women?
What % of your workforce is comprised of “Diverse” Employees?
(“Diverse” – ethnic minority, LGBTQ, disabled)
What % of “Diverse” employees work in managerial / leadership roles?
company benefits –
Work Life Balance
Does your company offer flexible schedules to employees?
Yes
No
Is telecommuting available?
Yes
No
Do you offer onsite childcare?
Yes
No
Is subsidized childcare available to employees?
Yes
No
company benefits –
Development Opportunities:
Do you have a new hire training program?
Yes
No
Are there career mentorship programs?
Yes
No
Does your company have onsite training courses to enhance job-related skills?
Yes
No
Do you offer tuition reimbursement?
Yes
No
Do you provide paid memberships to professional associations?
Yes
No
Do you conduct annual performance reviews with employees?
Yes
No
company benefits –
Time Off:
Does your facility have a ....
facility
Does your company offer separate sick days apart from PTO days?
Yes
No
Does your company offer Paid Time Off apart from vacation?
Yes
No
Does your company have Paid Leave for new parents?
Yes
No
Are employees able to accrue more vacation time per year?
Yes
No
Is there Bereavement Leave at your company?
Yes
No
Does your company offer paid time off for community service?
Yes
No
company benefits –
Wellness Benefits:
Does your company have an on-site medical facility?
Yes
No
Does your company offer Paid Time Off apart from vacation?
Yes
No
Does your company have an on-site gym?
Yes
No
Do you offer healthy snacks in your break room?
Yes
No
Does the company provide discounts to health support services
(weight loss programs; stop smoking programs, etc.)
Yes
No
company benefits –
Perks:
Are stock options available to employees?
Yes
No
Does the company offer financial bonuses?
Yes
No
Does your company offer 401K matching (≥3%)?
Yes
No
Does your company have a pension plan?
Yes
No
Do you have monthly celebrations?
Yes
No
Is there a lactation room on site?
Yes
No
Does the company offer any fertility assistance?
Yes
No
Does your company provide routine catered lunches?
Yes
No
Does your company provide any type of entertainment discounts (movie tickets, theme parks)?
Yes
No
Are there any employee recognition programs to celebrate an employee’s service (1, 3, 5 and ten-year mark)?
Yes
No
Does the company offer any type of social event apart from an annual Christmas gathering?
Yes
No
Submit
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