COSE SMALL BUSINESS DIVISION | 1-100 EMPLOYEES
APPLICATION FORM
Describe your organization’s position on Working For Health:
YES NO
Describe your organization’s position on Working For The Community:
Do you offer volunteer service project opportunities?
Do you offer time off for volunteering?
Do you have programs for charitable contributions/donations?
Do you provide information on community resources? (volunteer opportunities, social activities,
education, etc.)
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❑
❑
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❑
❑
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Please describe how you are Working For The Community, including specifics on the questions answered above:
Describe your organization’s position on Working For An Improved Standard Of Living:
$___________
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Please describe how you are Working For An Improved Standard Of Living, including specifics on the questions answered above:
If you answered yes to any of the above, please complete the following:
Initiative/
Program
Description
of
participants
engaged
How many
successfully
completed it?
Date of
Inception
Length of
Program
What did you do to
make it effective?
Why was it a success?
Outcomes:
What is the average number of days of unscheduled absences (days taken without prior notice) for employees last year? _____ days
What percentage of your workforce had an extended absence last year? (sick leave, salary continuance, short term disability, etc.) _____%
What was your company’s voluntary turnover rate last year? (voluntary terminations only) _____%
Please include supplemental materials to provide evidence of assessment of needs, implemented programs, dissemination of
programs and the evaluation and success of programs. The entire application and supplemental materials may not exceed 20 pages.
Anything after 20 pages will be automatically removed.
Within one business week you will receive a confirmation email informing you that we have received your application.
If not, please follow up with a phone call and/or email to John Roman, Marketing & Events Associate at 216.231.4600 ext. 3369
or jroman@cmnh.org.
