Company
Name/Trade Name:
(Name as it should appear in print)
*
Legal
Name of the Company:
(If different than listed above)
Federal
Employer Identification Number (FEIN):
*
Mailing
Address:
*
City:
*
County:
*
State:
Hawaii
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Mexico
New Jersey
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Vermont
Non-USA
Zip
Code:
*
Company
Web Site URL:
*
Industry:
Accounting
Advertising/Public
Relations/Marketing
Architecture
Banking
Construction
Consulting
Distribution
Education
Engineering
Government
Financial
Services - Other
Healthcare
- Insurance/Services
Healthcare
- Provider
Insurance
(non-healthcare)
Legal
Non-Profit
- Health and Human Services
Non-Profit
- Other
Manufacturing
Publishing/Printing
Real Estate
Restaurant
Retail
Services
– Other
Staffing
Technology
Telecommunications
Transportation
Other
– Please list
Select
One
*
Industry
Other:
*
Primary
Contact (This
person will be the main contact for questions
throughout the entire process and the recipient
of all communications (via emails, phone and
letters), employee surveys for distribution,
feedback reports, etc.)
Salutation:
*
First
Name:
*
Last
Name:
*
Title:
*
Mailing
Address:
*
City:
*
State:
Hawaii
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Mexico
New Jersey
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Vermont
Non-USA
Zip
Code:
*
Direct
Dial Phone Number:
*
Fax
Number:
*
Email
Address:
*
Secondary
Contact
(This person will be the contact for questions
if the primary contact is unavailable.)
Salutation:
Name:
Title:
Direct
Dial Phone Number:
Email
Address:
CEO,
President, Manager, Etc. (Highest-ranking
position in the region of the nominated workplace.)
Salutation:
Name:
Title:
Mailing
Address:
City:
State:
Hawaii
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Mexico
New Jersey
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Vermont
Non-USA
Zip
Code:
Direct
Dial Phone Number:
Email
Address:
IT
Contact
(This person will be the contact for any technical
systems questions regarding online surveys -
for all employer questionnaires and online surveys
for employees - regarding filtering, spam content,
white-listing, etc.)
Salutation:
*
Name:
*
Title:
*
Direct
Dial Phone Number:
*
Email
Address:
*
Marketing/PR
Contact (This
person will handle any marketing and/or public
relations questions for your company.)
Salutation:
*
Name:
*
Title:
*
Direct
Dial Phone Number:
*
Fax
Number:
*
Email
Address:
*
*
Additional
Company Information
Total
number of employees in the San Fernando Valley
region (EXCLUDING temporary/seasonal
and per diem employees).
Total
Employees:
Full-time
Employees:
Part-time
Employees:
Total
number of employees in the United States (excluding
temporary/seasonal and per diem employees).
Total US
Employees:
*
Full-time
Employees:
*
Part-time
Employees:
*
* Participation is Free (1)
Please select the survey type
and the corresponding amount of employees
that your company has. For paper surveys,
the primary contact will be invoiced according
to the size of the company for the paper
survey method.
*
Survey Type
Please verify the survey type you
would like to receive.
Free
Online Survey (Electronic)
Paper
Survey (Hard Copy)
There
is a nominal participation fee to cover
the costs associated with the paper surveying
process (printing, processing and shipping
the paper surveys).
Does
your company need alternate
language surveys? *
*
We offer employee surveys in a variety
of languages. Additional languages are
available at $195 per survey translation.
If you need alternate language surveys,
please select this button and you will
receive additional information.
Please
select the language you need
Spanish-Latin
American
Spanish-European
French
Chinese
Japanese
Other (please
describe)
If
Other
Is
your company interested in customizing
the job role and department category demographics
on the employee survey?
Yes, I am interested in receiving more
information.
Special
Offer
Purchase your
Employee Feedback Report Now and
Save 10% off the price.* This report
details the results of your company’s
specific survey results to each
of the 72 survey questions. The
report also includes regional benchmarking
as well as the employee comments
transcribed exactly as submitted
by employees. Similar reports can
cost thousands of dollars if initiated
independently.
Number
of
Employees
Pre-survey
Pricing (10% discount)
Regular
Pricing
Savings
15
- 24
$575
$640
Save
$65
25
- 99
$605
$670
Save
$65
100
- 199
$700
$780
Save
$80
200
- 499
$750
$835
Save
$85
500-2499
$825
$915
Save
$90
2500
+
$865
$960
Save
$95
*After April 23rd the reports go
back to regular pricing.
Questionnaire
How
did you hear about the program?
Select
One
San
Fernando Valley Business Journal - Ad
San
Fernando Valley Business Journal - Email
San
Fernando Valley Business Journal - Phone
Call
Valley
Industry and Commerce Association - Newsletter
Valley
Industry and Commerce Association - Email
Valley
Industry and Commerce Association - Other
Valley
Economic Development Center - Newsletter
Valley
Economic Development Center - Email
Valley
Economic Development Center - Other
United
Chambers of Commerce of the San Fernando
Valley and Region - Newsletter
United
Chambers of Commerce of the San Fernando
Valley and Region - Email
United
Chambers of Commerce of the San Fernando
Valley and Region - Meeting
Professionals
in Human Resources Association - Meeting
Professionals
in Human Resources Association - Email
Professionals
in Human Resources Association - Newsletter
Professionals
in Human Resources Association - Other
Best
Companies Group - Email
Best
Companies Group - Letter
Direct
mail piece
Phone call
Other
- Please describe
If
Other
Did
you participate last year?
Select
One
Yes
No
Name
of person completing this registration form:
Your
Name:
*
Your
Title:
*
Your
Email Address:
*
Are
you authorized to enter your
company into this process:
Select
One
Yes
No
*
Commitment:
*
I
understand that hitting this submit button enters
our company into the "Best Places to Work
in the San Fernando Valley" program. I am
committing to meet all deadlines and complete
both portions of the assessment process. If at
any point we choose to withdraw from the process,
we will notify Alicia Perry at (877) 455-2159
immediately.