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
*
If
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 New York
City - Manhattan, Bronx, Brooklyn,
Staten Island and Queens boroughs
only (EXCLUDING
temporary/seasonal and per diem
employees).
Total
Employees:
Full-time
Employees:
Part-time
Employees:
Total
Worldwide 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? (There
is a fee for customizations)
Yes,
I am interested in receiving
more information. There is a
fee to customize.
What
is this?
Special
Offer
Purchase
your Employee Feedback
Report Now and Save.*
This report details
the results of your
company’s specific
survey results to each
of the 72 survey questions.
The report also includes
city 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 (discount)*
Regular
Pricing
Savings
25
- 99
$640
$710
Save
$70
100
- 199
$780
$870
Save
$90
200
- 499
$830
$925
Save
$95
500-2499
$995
$1,105
Save
$110
2500
+
$1,035
$1,150
Save
$115
*After July 16th the
reports go back to regular
pricing.
Questionnaire
How
did you hear about the program?
Select
One
Crain's
New York Business - Ad
Crain's
New York Business - Phone
call
Crain's
New York Business - Email
www.crainsnewyork.com
Human
Resources Association of New
York- Phone call
Human
Resources Association of New
York- Email
Human
Resources Association of New
York- Meeting
Best
Companies Group - Phone call
Best
Companies Group - Email
Direct
mail piece
Other
- Please describe
If
Other
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 by clicking this submit
button, our company is entered into
the "Best Places to Work in New
York City" 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 a
representative of Best Companies Group
at 1-877-455-2159 immediately. Companies
withdrawing after July 16, 2010 will
incur a $250 withdrawal fee in addition
to the total fees incurred for any
special requests (customization orders,
language translations, paper survey
processing, etc.)