Alamance County Family Friendly Employer
Recognition Program Application
Dear Participants,
We are pleased you are taking the time and effort to complete this application. We
are excited to see Alamance County local businesses receive recognition for their
Family Friendly policies. All businesses are encouraged to participate.
Employers applying for this designation will be considered with similarly-sized
companies or organizations in three categories: small companies or organizations (less
than 100 employees), medium-sized companies or organizations (100 to 500
employees), and large companies or organizations (more than 500 employees).
All applications must be submitted no later than December 14, 2007. They can be
emailed to akalo@alamancechildren.org or mailed to Alamance Partnership for
Children, Attn: Angela Kalo, PO Box 2243, Burlington, NC 27216.
Awards will be presented January 22, 2008 from noon to 2pm at the Cutting Board.
We wish you the best of luck!
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Alamance County Family-Friendly Employer Award
Application
I. Company Information
Company Name: _______________________________________________________________
Address: _____________________________________________________________________
Contact Name: ______________________________ Title: ____________________________
Phone #: ___________________________________ Fax: ____________________________
Email: _____________________________________
Company size: Less than 100 (Small)
100 – 500—(Medium)
More than 500 (Large)
II. Family/Dependent Care (Please check all that apply)
a. Birth Adoption Leave: After the birth or adoption of a child, employer
offers and employee an extended, job-protected leave with or with out pay.
b. Dependent Care Leave: Employer allows employees to take personal leave time
to attend to the needs of their dependents.
c. Gradual Return to Work: After the birth or adoption of a child, employer offers a
work schedule arrangement that allows employees time to transition back to
work.
d. Financial Adoption Assistance: Employer offers financial and/or resource
support to employees for the adoption process.
e. Pretax Dependent Care Spending Account: Employer offers pre-tax
flexible accounts under IRS Code Section 125.
f. Child Care Center at Work Site: An employer provides employee child
care at a company-sponsored site.
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g. Child Care Financial Assistance: Employer provides support based on
family income or a flat rate per week of month that can include financial
assistance to the employee, and/or discounts or reserve slots (based on
agreements between employer and local licensed child care providers).
h. Elder Care Financial Assistance: Employer provides support based on
family income or a flat rate per week of month that can include financial
assistance to the employee, and/or discounts or reserve slots (based on
agreements between employer and local licensed child care providers).
i. Child Care Resource and Referral Services: Employer either directly
provides employees with, or contract out for counseling and information
about available child care resources. This service often includes:
education for parents about quality programs and available funding for
lower-income families, as well as assistance to employers to help them
plan for and meet the child care needs of their employees.
j. Child Care Resource and Referral Services: Employer either directly
provides employees with, or contract out for counseling and information
about available child care resources. This service often includes:
education for parents about quality programs and available funding for
lower-income families, as well as assistance to employers to help them
plan for and meet the child care needs of their employees.
k. Before and After-School Care: Employer supports child care programs for
employees’ children before and during the after-school hours.
l. Summer Care Programs: Employer supports summer programs for
employees’ children.
m. Other: _______________________________________________________
_______________________________________________________
Subtotal for Family/Dependant Care: _____
III. Work Schedule Flexibility (Please check all that apply)
a. Flextime: Employer requires employees to work a standard number of
hours each week, but allows them t choose their own starting and ending
times around a designated ―core time‖ when all employees must be
present.
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b. Telcommuting/Equipment Support: Employer allows employees to work
from home one or more days per week.
c. Job Sharing: Employer offers a flexible work schedule where the
responsibilities of a full-time position are shared between two people.
d. Part-time Schedules/Positions: Employer offers part-day, part-month, or
part-year involving prorated pay and benefits.
e. Leave Sharing/Leave Pool: Employer allows employees to voluntarily
donate their paid time off to coworkers for emergencies, health care, etc.
f. Other: _______________________________________________________
_______________________________________________________
Subtotal for Work Schedule Flexibility: _____
IV. Family Health and Wellness (Please check all that apply)
a. Employee Health Insurance: Employer pays for a portion of or all of
health insurance costs encompassing many categories of policies dedicated
to employees’ health and well-being, including the costs of physicians,
hospital tests and care, medications, and other medical expenses.
b. Dental Insurance: Employer provides employees with insurance that
covers dental services.
c. Life Insurance: In the case employee death, employer provides life
insurance as protection for an employee’s dependents against financial
loss.
d. Health Insurance for Dependents: Employer provides health insurance
coverage for employees’ dependents.
e. Flexible Benefit Plan: Employer provides a benefit plan in which, up to a
designated dollar amount, an employee can choose among an assortment
of fringe benefits, in addition to the universal benefits available to all
employees.
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f. Employee Assistance Programs (EAP): Employer backs programs
intended to provide counseling for health, marital, substance abuse, stress,
or other problems that may affect an employee’s work performance.
g. Family Support Resources and Workshops: Employer provides employees
with information and counseling on (or sponsors service
providers/consultants to present in workshops) available resources
concerning family life, including referrals for parenting workshops, health
care providers, elderly care, and other community resources.
h. Health Screenings/Health Fairs: By sponsoring on-site health fairs or
through health plans, employer provides health-promotion programs that
offer wellness screenings (such as mobile units for mammography)
intended to identify possible medical conditions, including high blood
pressure/cholesterol, and other concerns.
i. Fitness, Recreation and Wellness Programs: Employer provide a number
of initiatives intended to bolster employee health and wellness. Programs
may involve (but are not limited to): on-site exercise facilities (e.g.
walking trail, fitness center, showers), a daily exercise break, and wellness
programs, including exercise/nutrition incentive plans, employee
classes/newsletter, and/or healthy cafeteria and snack machine options.
j. Preventative Insurance Benefits: Employer offers insurance coverage for
counseling programs on current lifestyle behaviors that may inflict future
health problems. These programs may include nutrition and physical
activity assessments, assistance on giving up tobacco products, or other wellness-
related lifestyle habits.
k. On-Site Nurse: Employer provides access to an on-site facility
nurse/physician who has posted hours and is available to all employees
and/or dependents.
l. Employee and Family “Fun Day”: Employer sponsors a company ―fun
day‖ (i.e. a picnic) for employees and their family members.
m. Other: _______________________________________________________
_______________________________________________________
Subtotal for Work Schedule Flexibility: _____
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V. Financial and Educational Assistance (Please check all that apply)
a. 401K/Retirement Program: Employer provides the opportunity for employees it
invest in a company-managed 401K/retirement program
b. Education: Employer sponsors employees who choose to further their
education (i.e. GED or Master’s programs, tuition reimbursement).
c. Scholarships: Employer offers the opportunity to apply for and obtain
company-funded scholarships for employees who desire to further their
education.
d. Banking Services: Employer offers employees access to free
checking/savings accounts through a financial provider, such as a credit
union.
e. Other: _______________________________________________________
_______________________________________________________
Subtotal for Financial and Educational Assistance: _____
VI. Community Involvement (Please check all that apply)
a. Community Service League: Employer allows pain or un-paid leave time
for employees to carry out volunteer work in local areas, agencies, or
programs.
b. Cash/Matching Contributions: Employer may appropriate a fraction of
funds to promote community organizations and/or certain programs, o
pledge to match employee-donated funds to charitable agencies.
c. Literacy Programs: Employer obtains children’s books for book drive,
donations, or sponsors other community children’s literacy programs.
d. Loaned Executives: Employer sponsors an employee (usually upper
management) to collaborate with a charitable group in order to impart
expertise and give back to the community.
Subtotal for Community Involvement: _____
Thank you for taking time to participate. Once a decision is made to determine the
winners, all applicants will be notified of the results.
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