2015 Empire State Pride Agenda Equality@Work Awards
Individual - Nomination Form
Since the passage of the Sexual Orientation Non-Discrimination Act (SONDA) and the extension of the New York City
Human Rights Law to cover transgender employees in 2002 as well as the passage of the Marriage Equality Act in 2011, the
Empire State Pride Agenda has been helping New York businesses meet the legal obligations required by law as well as
educating businesses on the needs of lesbian, gay, bisexual and transgender (LGBT) employees. Through its outreach
initiative, Pride in My Workplace, the Empire State Pride Agenda encourages workplaces throughout New York State to be
free of discrimination and affirm the presence and contributions of their LGBT employees.
Since 2004, the Equality@Work Awards have honored companies and individuals who are working to create an inclusive
work environment that respects, welcomes and supports LGBT professionals and empowers them to perform to their fullest
potential. The award recipients are recognized at our annual Equality@Work Awards Luncheon, where we are joined by
close to 300 guests from the fields of finance, technology, fashion, real estate, media, law and organized labor.
Past Honorees:
Corporate Honorees:
Individual and Employee Group Honorees:
2014
Hilton Worldwide
2014
Moody’s LGBTA Employee Resource Group
Todd Sears of OUT Leadership
2013
Skadden Arps Slate Meagher & Flom
The Chubb Group of Insurance
Companies
2013
The Interbank Roundtable Committee
2012
Morgan Stanley
2012
Emerge at Viacom
Kathryn S. Wylde of the Partnership for NYC
2011
Barclays Capital
Macy’s
2011
LGBT Pride at Con Edison
2010
JPMorgan Chase
KPMG
2010
Lisa Linsky of McDermott Will & Emery LLP
2009
Kramer Levin Naftalis & Frankel LLP
The NYC Bar Association’s Committee
on LGBT Rights
2009
Jeffrey Siminoff of Morgan Stanley
2008
Cleary Gottlieb Steen & Hamilton LLP
Credit Suisse
2008
Kenneth Cole of Kenneth Cole Productions
2007
Lehman Brothers
Xerox Corporation
2007
Richard Bowen of Ernst & Young
2006
Merrill Lynch
Eastman Kodak Company
2006
Kym Ward Gaffney of PricewaterhouseCoopers
2005
American Express Company
The Village Voice
2005
Michael Fishman of Local 32BJ-SEIU
James Berg of Realty Advisory Board of New York
2004
IBM
The Corcoran Group
2004
Patricia Vivado of JPMorgan Chase
Nominating Process
We invite you to recommend businesses, individuals and employee resource and affinity groups who meet the criteria of the
Equality@Work Awards. We have three versions of our nomination form to make it easier for you to fill out the information
needed for your nominee:
1. Company;
2. Employee Resource Group/Industry Committee/LGBT Working Group; and
3. Individual.
Please be sure and submit the appropriate supporting documentation as well as any additional comments in the fields
provided. The forms are also available online at www.prideagenda.org.
Please send completed forms with attachments to the Pride Agenda via email, fax or mail to:
Empire State Pride Agenda
Equality@Work Awards
80 Maiden Lane, Suite 905
New York, NY 10038
Fax: (212) 627-4136
EqualityAtWork@prideagenda.org
Thank you in advance for taking the time to participate in the 2015 Equality@Work Awards.
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Individual Nominee
Name:
Title:
Organization:
Phone:
Email:
Individual Nominee’s Efforts
Corporate Policies
1.
Has the individual worked within the company to secure or implement policies barring employment
discrimination based on sexual orientation and using the words "sexual orientation"?
YES
NO Explain
2.
Has the individual worked within the company to secure or implement policies barring employment
discrimination based on gender identity and expression and using the words "gender identity and
expression"?
YES
NO Explain
3.
Has the individual worked within the company to include same-sex domestic partners, same-sex spouses and
transgender employees in insurance and health coverage policies?
YES
NO Explain
4.
Has the individual worked within the company to develop policies to support transgender employees who are
transitioning on the job?
YES
NO Explain
Diversity Efforts
1.
Has the individual been instrumental in initiating a group within their company, industry or community that
impacts LGBT and ally professionals or employees (e.g., an employee resource group (ERG) or employee
network)?
YES
NO Explain
2.
Is the individual a member of a company or industry-wide diversity council?
YES
NO Explain
3.
Does the individual hold a leadership position in the company, ERG, industry, industry-wide diversity council
or community?
YES
NO Explain
Community Volunteerism
1.
In addition to working for LGBT issues within the company, has the individual been involved with any LGBT
issue related advocacy work with the public or elected officials at the federal, state or local level?
YES
NO Explain
2.
Has the individual volunteered or collaborated with the Pride in My Workplace Program?
YES
NO Explain
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General
1.
If chosen, will the individual be able to accept the award at the Equality@Work Luncheon?
YES
NO Comments:
2.
How has the individual demonstrated leadership in promoting an inclusive work environment that respects,
welcomes and supports LGBT employees? (250 words or less)
3.
How do the individual's achievements stand out from others? How can the nominee’s achievements serve as
a model for others? (250 words or less)
4.
Please explain the impact that the individual's accomplishments have had on their company, industry and/or
community. (250 words or less)
Corporate / Employer Policies
Please attach a copy of the EEO policy
1.
Does the company have a written policy barring employment discrimination based on sexual orientation and
using the words "sexual orientation”?
YES
NO Explain
2.
Does the company have a written policy barring employment discrimination based on gender identity and
expression and using the words "gender identity and expression”?
YES
NO Explain
3.
If the company has an anti-harassment policy, does it explicitly include sexual orientation as a protected
characteristic?
YES
NO Explain
4.
If the company has an anti-harassment policy, does it explicitly include gender identity and gender expression
as protected characteristics?
YES
NO Explain
5.
Does the company have guidelines to assist transgender employees who transition on the job? If so, please
attach guidelines.
YES
NO Explain
Benefits
Please attach a copy of Domestic Partner Policy and Affirmation form
1.
Does the company offer health insurance coverage to employees' same-sex domestic partners?
YES
NO Explain
2.
In order to obtain domestic partner benefits, does the company require domestic partners to attest on an
affirmation form that they are financially interdependent and/or have lived together for a certain length of time?
YES
NO
If yes, are married employees required to attest to those criteria before their spouses receive benefits?
NO
3.
YES
Will the company accept a Domestic Partner registration certificate in lieu of an affidavit or affirmation form?
YES
NO If no, explain why
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4.
In order to obtain spousal benefits, are married employees required to provide a copy of their marriage license
or other certificate verifying their marriage?
YES
NO
5.
Does the company offer spousal equivalency benefits to domestic partners in any of the following areas:
adoption assistance, bereavement leave, family medical leave, COBRA benefits continuation, relocation
assistance, employee family discounts and survivor pension benefits?
YES
NO
Please list and explain
6.
Does the company treat same-sex marriages performed in New York or other jurisdictions equally as other
marriages (e.g., accepting marriage certificate, providing equal benefits, etc)? For example, does it: 1. accept
marriage certificate as sole required proof for domestic partner health benefits; 2. list the husband/wife as
spouse, rather than as domestic partner in personnel records; 3. provide spousal benefits including those that
may not be available to domestic partners?
YES
NO
Please list and explain
7.
Does the company provide any financial assistance (for example, “grossing up”) to offset the cost of imputed
income for employees who receive health insurance benefits for a same-sex domestic partner or spouse who
does not qualify as a tax dependent?
YES
NO
Explain
8.
Does the company’s health insurance policy include transgender health benefits, including mental health
counseling, hormone treatment, medical visits, surgical procedures (including sex reassignment surgery) and
short-term disability leave?
YES
NO
Explain
1.
Are there any openly LGBT members of the company’s board of directors, executive committee, governing
body or senior management?
YES
NO Explain
2.
Does your company have a major New York State presence?
YES
NO Explain
3.
Has the company or its CEO publicly supported marriage equality in New York or elsewhere?
YES
NO Explain
4.
Has the company or its CEO publicly supported transgender civil rights in New York or elsewhere?
YES
NO Explain
General
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Awardee Contact Information:
Does the nominee consent to the nomination and to be present at the Equality @ Work Awards luncheon to accept the
award?
What is the best way to reach the nominee?
An officer at the company or organization must verify this nomination.
By checking the box below, you are indicating that this nomination has been verified and approved by the person whose
name appears below.
I support this nomination and verify its accuracy.
Name:
Title:
Phone:
Nominator/Point of Contact:
Name:
Title:
Organization:
Address, line 1:
Address, line 2:
City, State, Zip:
Cell Phone:
Work Phone:
Fax:
Email:
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