ACT, Inc. College and Career Readiness Campaign Workplace Success Award Nomination Form Person Making Nomination___________________________________________________________ Title________________________________ LEA__________________________________________ Address_____________________________________ City/State/Zip Code_____________________ Telephone___________________________________ Email________________________________ All employer exemplars will be evaluated based on the following criteria (where applicable): (1) strong partnerships with local community colleges; and (2) use of the NCRC (National Career Readiness Certificate) in the hiring process. While ACT will validate each of these criteria to the extent possible, this form will also provide the National Selection Committee with information about your employer’s background and an evaluation of the unique qualities that make your employer exemplary. If your employer is selected for the national Workplace Success Award, ACT will cover travel expenses to Washington, DC, for one employer representative (and a spouse or partner) to be recognized at our 2013 National Gala on College and Career Readiness to be held on Tuesday, May 21, 2013. EMPLOYER INFORMATION BUSINESS NAME MAILING ADDRESS CITY / STATE / ZIP ACT CODE REPRESENTATIVE’S NAME (First and Last Name) REPRESENTATIVE’S TITLE REPRESENTATIVE’S PHONE NO. USES NCRC? (123-456-7890) (Yes or No) NUMBER OF EMPLOYEES NUMBER OF NCRCCREDENTIALED EMPLOYEES This form must be completed and submitted by Friday, March 15, 2013. Please direct any questions to Sid Baker at 919-807-3478 or [email protected] Thank you. BUSINESS DESCRIPTION Please use the blank space provided below to provide a description of the business (i.e., its purpose, services offered, customers, etc.). (250 words maximum) SPECIAL RECOGNITIONS Please use the blank space provided below to detail the employer’s awards (area, state, or national), memberships, partnerships (local service organizations, schools, etc.), and other notable achievements. (250 words maximum) EMPLOYER EVALUATION Please use the blank space provided below to describe what makes this employer unique, citing specific examples to support your claims. Consider the following questions: Does this employer clearly communicate its skill needs to local colleges and high schools? Does the employer make an effort to create and maintain diversity in its workforce? Do employees have opportunities to gain the new knowledge and skills necessary for career advancement? How do the employer and its employees give back to the community? (500 words maximum) This form must be completed and submitted by Friday, March 15, 2013. Please direct any questions to Sid Baker at 919-807-3478 or [email protected] Thank you.