"Best Workplaces in Canada" List 2011 Nomination Form

The fields in yellow are required:

ORGANIZATION CONTACT INFORMATION:
Nomination Information:
Name of person submitting
the nomination:		  
e-mail of person
submitting the nomination:		  
(You will receive an auto-reply email upon submission of this form)
Organization Name  
Organization Headquarters
City		  
Organization Headquarters
Province/Territory
Industry
Organization Web Site  
Primary Contact:
If selected to participate, will be the main contact for questions throughout the entire process and the recipient of all communications, distribution of employee surveys, coordination of management questionnaire completion, etc.
Primary Contact First Name  
Primary Contact Last Name  
Primary Contact Title  
Primary Contact Telephone  format : 123-456-8790
Primary Contact Extension  
Fax Number  format : 123-456-8790
Primary Contact e-mail  
Primary Contact Street
Address		  No P.O. Boxes
City  
Province/Territory
Postal Code  
ELIGIBILITY INFORMATION:
How many regular, full-time employees do you currently have working in Canada (EXCLUDING temporary and seasonal employees)?  Numbers only
How many regular, part-time employees do you currently have working in Canada (EXCLUDING temporary and seasonal employees)?  Numbers only
Comments on
full-time/part-time
employee numbers
(optional)		  
What year was your
organization founded?		  4 digits.
Note: if this year is later than 2006, an additional series of questions will appear.
ADDITIONAL INFORMATION
Has your organization participated in the "Best Workplaces" selection process in past years?
Yes    No   
If your organization is selected to participate, we offer three options:
Option 1) 100% of your randomly selected employees will take the web-based survey
Option 2) Your randomly selected employees will take either the paper survey or the web-based survey
Option 3) 100% of your randomly selected employees will take the paper-based survey

Please answer the following questions to determine which survey method your organization will be eligible to use.
Do 100 % of your employees have internet access?
Yes    No   
Do 100 % of your employees have an individual email address?
Yes    No   
If you answered 'yes' to BOTH of the above two questions, you are eligible for options 1, 2 & 3.
If you answered 'no' to EITHER of the above two questions, you are eligible for options 2 & 3.
How would you prefer to have your employees take the survey if your organization is selected to participate? Please select one of the options below:
Your survey method:
Option 1: 100% web    
Option 2: A mix of web and paper   
Option 3: 100% paper    
  Note: if you select 'Option 2' here, an additional question will appear.
If your organization is selected to participate, we also offer the employee survey in French. Please estimate the percentage of your total Canadian population of full- and part-time employees that would prefer to take the survey in French. (If your organization would not need any French surveys, please enter "0".)
Percentage of surveys in French  % (Number only - for example 5% should be entered as "5")
How did you hear about the "Best Workplaces in Canada" List selection process?  
After clicking on "Verify" below, your information will be checked (there will be error messages at the top of the form prompting you to fill in any fields you may have accidentally missed) and then you will see a summary of the information that you have provided for verification.
Click to verify your
information:		  

Additional information

For additional details or questions, please contact:

Great Place to Work® Institute Canada
Phone: 1.866.712.0630
Email : bestworkplaces@greatplacetowork.ca