Organizational Award Application Form

Organizational Award Application Form
Please fill the Organization Profile below: Large Employer Category
Organization Name*
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
CEO
Award Application Coordinator's Name
First NameLast Name
Coordinator's Fax Number
Area CodePhone Number
Coordinator's Email Address

SECTION I. WORKFORCE DIVERSITY AND INCLUSION
1- EMPLOYEE DEMOGRAPHICS. Please complete the information below. All data reported should be based on regular full-time and part-time employees in our organization excluding temporary and seasonal employees.
Our Organization Area Employees
Total # of All Employees
2012
2010 (if available)
Female Employees
Total # of All Employees % of workforce that is Female*
2012
2010 (if available)
*To calculate percentage, divide total number of female employees by the total number of employees.
Minority Employees
Total # of All Employees % of workforce that is Minority*
2012
2010 (if available)
*To calculate percentage, divide total number of minority employees by the total number of employees.

	Total # of All Employees
2012
2010 (if available)

Officials/Managers/Supervisors

	2012	2010 (if available)
Total # of All Officials/Managers/Supervisors
% of All Employees that are Officials/Managers/Supervisors*
Total # of Female Officials/Managers/Supervisors
% of Females that are Officials/Managers/Supervisors*
Total # of Minority Officials/Managers/Supervisors
% of Minorities that are Officials/Managers/Supervisors*

*To calculate percentage, divide the total number of perspective category of employees by the total number of employees.
Attach any necessary documents
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2- RECRUITMENT RESULTS. Please complete the information below. All data reported should be based on regular full-time and part-time employees in our greater Organization area excluding temporary and seasonal employees.
Employees Hired
Total # of All Terminations
2012
2010 (if available)
Female Employees Hired
Total # of Females Hired % of total employees hired that were Female*
2012
2010 (if available)
*To calculate percentage, divide total number of female hired employees by the total number of employees hired.
Minority Employees
Total # of Minorities Hired % of total employees hired that were Minority*
2012
2010 (if available)
*To calculate percentage, divide total number of minority hires employees by the total number of employees hired.
A- What recruitment efforts does your organization use to attract diverse candidates?
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	Total # of All Terminations
2012
2010 (if available)

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3- RETENTION INITIATIVES. Please complete the information below. All data reported should be based on regular full-time and part-time employees in our greater Organization area excluding temporary and seasonal employees.
Total Employee Terminations (voluntary and involuntary)
Total # of Terminations
2012
2010 (if available)
Female Terminations (voluntary and involuntary)
Total # of Female Terminations % of total employee terminations that were Female*
2012
2010 (if available)
*To calculate percentage, divide total number of female employee terminations by the total number of employee terminations.
Minority Employee Terminations (voluntary and involuntary)
Total # of Minority Terminations % of total employee terminations that were Minority*
2012
2010 (if available)
*To calculate percentage, divide total number of minority employees by the total number of employee terminations.
A- What retention efforts does your organization use to retain diverse employees?
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	Total # of Terminations
2012
2010 (if available)

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4- EMPLOYEE TRAINING AND DEVELOPMENT.
A. Is diversity and inclusion training required for all employees?
YesNo
If yes, briefly describe the training and how frequently it is provided.
B. Is diversity and inclusion training required for all leaders?
YesNo
If yes, briefly describe the training and how frequently it is provided.
C. Is harassment prevention training required?
YesNo
If yes, briefly describe the training and how frequently it is provided.
D. Does your organization have a succession-planning program?
YesNo
If yes, please describe how this program tracks and provides development opportunities for diverse employees.
E. Describe how your organization creates, promotes, and sustains a positive inclusive environment.
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SECTION III. COMMUNITY IMPACT AND OUTREACH
Please describe the organization’s philosophy, strategies, and/or programs related to the following three areas.
1. Community Sponsored Programs.
2. Employee Community Volunteer Hours.
3. Corporate Match Programs.
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SECTION IV. DIVERSITY and INCLUSION SUCCESSES and STRATEGIES
A. What are the top 3 accomplishments that your organization has achieved as it relates to your diversity and inclusion initiatives?
B. Describe how Officials/Managers/Supervisors are held accountable through recruitment, retention, training, and development in relation to diversity and inclusion?
C1. What is unique about your organization overall as related to diversity and inclusion?
C2. What is unique about your organization in comparison to your industry as related to diversity and inclusion?
D. What does your organization do to attract and better serve diverse customers?
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SECTION I. WORKFORCE DIVERSITY AND INCLUSION