Apply: Certified - Good Wages Initiative

Employer Basics

Business/Organization Name(Required)

Please input the business/organization name.

Structure(Required)

Please select the structure of the business/organization.

Industry(Required)

Please select the sector/industry that the business/organization works in.

First Name(Required)

Please input your first name.

Last Name(Required)

Please input your last name.

Title(Required)

Please input your job title.

Phone(Required)

Please input a good contact phone number.

Email(Required)

Please input a good contact email address.

CEO First Name(Required)

Please input the business/organization CEO's first name.

CEO Last Name(Required)

Please input the business/organization CEO's last name.

Marketing Contact First Name(Required)

Please input your marketing/communications lead's first name.

Marketing Contact Last Name(Required)

Please input your marketing/communications lead's last name.

Marketing Contact Email(Required)

Please input your marketing/communications lead's contact email.

Organization Logo (upload high resolution .jpg or .png)

Organization Logo (upload high resolution .jpg or .png)(Required)

Drop files here or

Accepted file types: jpg, jpeg, png, Max. file size: 50 MB.

Your answers to the next two questions do not impact your application, but are helpful for the efforts of the Good Wages Initiative.

Good Wages Discovery

Please describe how you learned about the GWI (Good Wages Initiative) program.

Good Wages Importance

Please explain why a good wages certification is important to your business/organization.

Location(s) & Workforce

Business GWI Certification?(Required)

Yes

No

Does the business seek certification for employees based out of the primary business location? Please select yes or no.

Primary Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Please input the business/organization primary place of business.

Other Location for GWI Certification?(Required)

Yes

No

Is there another business address in Marion County, IN that seeks certification? Please select yes or no.

Other Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Please input the business/organization other place of business.

Other Location for GWI Certification? (2)(Required)

Yes

No

Is there another business address in Marion County, IN that seeks certification? Please select yes or no.

Other Business Address (2)(Required)

Street Address Address Line 2 City State ZIP Code

Please input the business/organization other place of business.

Other Location for GWI Certification? (3)(Required)

Yes

No

Is there another business address in Marion County, IN that seeks certification? Please select yes or no.

Other Business Address (3)(Required)

Street Address Address Line 2 City State ZIP Code

Please input the business/organization other place of business.

Other Location for GWI Certification? (4)(Required)

Yes

No

Is there another business address in Marion County, IN that seeks certification? Please select yes or no.

Other Business Address (4)(Required)

Street Address Address Line 2 City State ZIP Code

Please input the business/organization other place of business.

Other location for GWI Certification? (5)(Required)

Yes

No

Is there another business address in Marion County, IN that seeks certification? Please select yes or no.

Other Business Address (5)(Required)

Street Address Address Line 2 City State ZIP Code

Please input the business/organization other place of business.

For all sites that you wish to certify, what is the total number of…

Full-time Employees(Required)

Please input number of full-time employees (over 30 hours weekly) your business/organization currently employs. Please input a whole number.

Part-time Employees(Required)

Please input number of part-time employees (under 30 hours weekly) your business/organization currently employs. Please input a whole number.

Contract Workers(Required)

Please input number of contract workers your business/organization currently employs. Please input a whole number.

Additional

Additional Information

Is there any additional information you would like to share in this application?

Fees

Organization Type(Required)

Select from our dropdown list of organization types to determine your Application (Certified) fee.

Organization Size(Required)

Select from our dropdown list of organization sizes to determine your Application (Certified) fee.

Total Amount Due

Payment Option(Required)

Credit Card via Paypal Online

Invoice (ACH)

Invoice (check)

Choose from one of the following payment options.

Use Primary Address for Invoice?(Required)

Yes

No

Please select yes or no.

Address for Invoice(Required)

Street Address Address Line 2 City State ZIP Code

Please put in the address for the invoice to be sent to.

Credit Card Information

American Express

Discover

MasterCard

Visa

Card Number Card Number Exp. Date Expiration Date Sec. Code Security Code

Please continue with application submission. Our team will follow up with an invoice for applicable fees.

Submission

To conclude your application, please review the following and add your signature.

On behalf of the organization listed above, I affirm the following:(Required)

Yes

The information provided in this application is true and accurate; information that would impact the consideration of this application is not being withheld.

Employer understands that Good Wages Initiative may ask to interview a sampling of employees and will work with Good Wages Initiative on this request.

This can include but is not limited to full-time employees, part-time employees, interns, apprentices, and employees with special considerations (e.g., tipped, commissioned, bonused, wage increase opt-outs).

Employer understands that Good Wages Initiative will provide employees and job applicants a means to express anonymous concerns about employer's wage floor.

Employer agrees that no retaliatory action will be taken against employees or job applicants who express concerns.

Employer understands that Certified status is contingent upon employer maintaining $18/hr (or salary equivalent) wage floor for full-time employees and offering employer-sponsored health insurance for all full-time employees for the entirety of the two-year certification period.

Employer agrees to notify the Good Wages Initiative if our wages for full-time employees fall below the $18/hour threshold.

Employer agrees to notify the Good Wages Initiative if we no longer offer employer-sponsored health insurance to full-time employees.

If granted certification employer will complete Biannual Employer reporting process, which may include completing reporting forms and interviews and providing requested employer data.

If granted certification employer will share status as a Good Wages Initiative Certified Employer with our employees.

If granted certification employer will share status as a Good Wages Initiative Certified Employer publicly (via social media, blog post, and/or press release).

Employer understands that the good wages threshold of $18/hour may change during the Certified period, which would require adjustments to employer wage floor in order to re-certify.

Employer name and logo may be used by Good Wages Initiative to promote employer’s status and the Good Wages Initiative program.

Employer understands they may use the Good Wages Initiative name, taglines, hashtags, and logo set out in the GWI Toolkit for the purpose of promoting participation in the initiative. Examples of uses by employers may include display on: (a) signage or banners at a job fair or professional networking event; (b) websites, social media, press releases, brochures, or other outreach materials; (c) hiring statements and employee communications; and (d) grant applications, reports, and other fundraising materials.

In order to facilitate consistent Good Wages Initiative branding and messaging across platforms and participants, Employers agree to communicate about the initiative in accordance with the style guide and instructions provided by EmployIndy. The current style guide is included in the GWI Toolkit.

Employer agrees to promote and share marketing assets as directed by EmployIndy. This includes circulation through digital channels (i.e. social media) and physical avenues of engagement, such as the display of certificates in the workplace.

Employer recognizes that participation in Good Wages Initiative is a collaborative effort. Employers are encouraged to elevate any needs, challenges, questions, and/or concerns, marketing or otherwise, as their participation evolves.

Authorized by Employer?(Required)

Yes

No

Are you authorized to complete this application on behalf of the stated employer? Please select yes or no.

Full Name(Required)

Please type your full name.

Your Initials(Required)

Please type your first and last initial.

NOTE: This form contains several required fields. If you submit the form and do not receive a confirmation message, please double-check the entire form for missing field entries (there will be a note indicating missing field entries in red).

Untitled

Apply for Certified Status

Employer Basics

Location(s) & Workforce

Wage & Benefit Analysis

Business Status

Additional

Fees

Submission