Registration Form

Program Registration

Before completing the registration form on the following page, Best Companies Group (BCG) needs you to agree and commit to the following statements. The form will not submit until all fields are filled out completely and accurately.

*

I have authorization from the executive(s) to enter this organization into the program. You must agree to this statement.

*

The organization I am registering meets the Eligibility criteria. You must agree to this statement.

*

The organization must complete BCG's two part survey process including the Employer Benefits & Policies Questionnaire (EQ) and the Employee Engagement & Satisfaction Survey (EESS) according to the Timeline. You must agree to this statement.

*

The organization must receive a minimum number of responses on the EESS to ensure our data is credible. If not enough responses are received, our ability to be considered for the list or to receive a statistically valid Employee Feedback Report may be impacted. You must agree to this statement.

*

We will be responsible for a $250 administrative fee (in addition to all other fees incurred as part of the survey process), should we withdraw after March 29, 2019. Withdrawing is not continuing the process for any reason. You must agree to this statement.

*

By entering my name below, I agree and commit to all of the above statements and confirm that I am authorized by the executive(s) of this organization. You must agree to this statement.

First Name*

First name needed.

Last Name*

Last name needed.

Title*

Title needed.

Email *

Valid email needed.

Phone*

Valid phone needed.

Phone Extension

Invalid

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

Organization Information Tell us about your organization. Please list the HQ or primary location for your operations in Los Angeles County.

Organization Name*

Response required.

Legal Name

Response required.

FEIN/Business Number

Valid response required.

Mailing Address

Street Address*

Response required.

Address Line 2

Invalid Input

City*

Response required.

State*

Response required.

Organization County*

Response required.

ZIP / Postal Code*

Response required.

Website*

Valid response required.

Twitter Handle

Response required.

Industry*

Response required.

Other Industry

Response required.

Is this the corporate address?*

Response required.

If no, please fill out below.

Street Address*

Response required.

Address Line 2

Invalid Input

City*

Response required.

State*

Response required.

ZIP / Postal Code*

Response required.

Contact Information Tell us about your people.

Primary Contact The Primary Contact will be the main contact for questions throughout the entire process and the recipient of all communications (via emails, phone, website and letters), employee surveys for distribution, feedback reports, etc.

Salutation*

Response required.

First Name*

Response required.

Last Name*

Response required.

Title*

Response required.

Phone*

Valid response required.

Phone Extension

Invalid Input

Email *

Valid response required.

Confirm Email *

Valid response required.

Same as Organization Mailing Address Invalid Input

Street Address*

Response required.

Address Line 2

Invalid Input

City*

Response required.

State*

Response required.

ZIP / Postal Code*

Response required.

Is this contact an employee of the company*

Response required.

Secondary Contact The Secondary Contact will be the contact for questions if the Primary Contact is unavailable.

Salutation

Invalid Input

First Name

Invalid Input

Last Name

Invalid Input

Title

Invalid Input

Email

Invalid Input

Phone

Invalid Input

Phone Extension

Invalid Input

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

Contact Information Tell us about your people.

CEO, President, Manager, Etc. (Highest-ranking position of the nominated workplace.)

Salutation

Invalid Input

First Name

Invalid Input

Last Name

Invalid Input

Title

Invalid Input

Email

Invalid Input

Phone

Invalid Input

Phone Extension

Invalid Input

Same as Organization Mailing Address Invalid Input

Street Address

Invalid Input

Address Line 2

Invalid Input

City

Invalid Input

State

Invalid Input

Zip / Postal Code

Invalid Input

IT Contact The IT Contact 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*

Response required.

First Name*

Response required.

Last Name*

Response required.

Phone*

Valid response required.

Phone Extension

Invalid Input

Email*

Valid response required.

Marketing/PR Contact The Marketing/PR Contact will handle any marketing and/or public relations questions for your organization.

Salutation*

Response required.

First Name*

Response required.

Last Name*

Response required.

Phone*

Valid response required.

Phone Extension

Invalid Input

Email*

Valid response required.

Human Resources Contact Human Resources Contact will handle any human resources related questions for your organization.

Salutation*

Response required.

First Name*

Response required.

Last Name*

Response required.

Title*

Response required.

Email*

Valid response required.

Phone*

Valid response required.

Phone Extension

Invalid Input

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

Number of Employees Tell us how many employees you have working in Los Angeles County.

If you employ more than 250 people, we will survey a random sample of your employees. Please enter the total number of employees (See Eligibility) working at this organization. Please do not include temporary, seasonal or per diem employees, PRN, 1099 employees/independent contractors, volunteers, interns, outside consultants or staffing employees placed by other organizations. (See Eligibility)

Full-time Employees in Los Angeles County*

Valid numbers needed.

Part-time Employees in Los Angeles County*

Valid numbers needed.

Total Employees in Los Angeles County*

Valid numbers needed.

You must have a total of at least 15 employees to continue.

Participation Fees

Your level of participation depends on how many employees you have at your organization and whether you choose the online or the paper employee survey process. See Online vs. Paper for more information. Please see the chart below to determine the survey selection, as well as the fees regarding organization size and survey method if applicable. You will receive an invoice at a later date or you can choose to pay online at the end of this form.

Number of Los Angeles County Eligible
Employees

Number of Los Angeles County Eligible
Employees Surveyed

Online Fee*

Paper Fee*

15 – 24**

All

$0

$250

25 – 99

All

$0

$395

100 – 199

All

$0

$525

200 – 499

All (up to 250)***

$0

$605

500 – 2499

All (up to 350)***

$0

$705

2500 +

All (up to 400)***

$0

$860

*Fees are non-refundable. **To ensure the credibility of the information, companies with 15-24 employees must have an 80% (or better) response rate on the employee survey to be considered for the list. ***Employees are randomly selected. Best Companies Group offers the option to survey more employees than the random sample calculated in the above chart, and/or include additional employees in the survey process who work in locations outside of the program area. Please contact Best Companies Group for details and pricing at 717-323-5278.

While we recommend online surveys in most cases, sometimes paper is a better option. If more than 30% of your employees do not have their own email address, please select "paper" below.

*

Please select.

Number of eligible employees in Los Angeles County as indicated above.*

Response required.

Number of eligible employees in Los Angeles County as indicated above.*

Response required.

Survey Additional Employees? For employee populations over 250 we survey a random selection or, would you like to survey additional employees?

Yes, I'm interested Invalid Input

Please tell us about your United States employees. Please do not include temporary, seasonal or per diem employees, PRN, 1099 employees/independent contractors, volunteers, interns, outside consultants or staffing employees placed by other organizations.

Full-time Employees in the United States*

Valid numbers needed.

Part-time Employees in the United States*

Valid numbers needed.

Total Employees in the United States*

Valid numbers needed.

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

Submit Your Registration You're almost done! (All fees are non refundable)

Total Fee

$0.00 USD

Payment Options

Billing Contact Even if you have selected the Free Registration, you will still need to complete the Billing information request, except for the credit card request.

First Name*

First name needed.

Last Name*

Last name needed.

Phone*

Valid phone needed.

Phone Extension

Invalid

Email for credit card receipt, if applicable*

Valid email needed.

Fax

Valid phone needed.

Billing Address

Same as Organization Mailing Address Invalid Input

Street Address*

Response required.

Address Line 2*

Invalid Input

City*

Response required.

State*

Response required.

ZIP / Postal Code*

Response required.

Credit Card Information If applicable

Credit Card Number

Invalid Input

Card Security Code (CSC)

Invalid Input

Card Expiry Month

Invalid Input

Card Expiry Year

Invalid Input

If the form does not submit, please review your information throughout the form to see what is missing or what needs corrected.

Prove that you're human*

Response required.

Proudly Presented By

Connect With Us: