PREVIEW. 1. Contact Information. 2. Telephone Number of Contact

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1 Welcome! CareerSource Polk Business Services Division recognizes companies in Polk County who are taking the lead in developing quality workplaces with the Best Places to Work Award. Award winning companies are the most innovative in the areas of motivating and retaining employees, training and developing initiatives, and implementing workplace practices that promote a healthy work/life balance. Questions apply to Calendar Year Company Information 1. Contact Information Name Company Address 1 Address 2 City State Zip Address 2. Telephone Number of Contact 3. Company Information (List company name as you would like it to appear on award and in print) Company Address 1 Address 2 City State Zip 4. Local Senior Executive in Polk County Name Address 1 Address 2 City State Zip Address 5. Position Title of Local Senior Executive in Polk County

2 . Industry (Choose one) Workforce Demographic/Diversity Information 7. Number of Employees Number of full time permanent employees in U.S. Number of time permanent employees in U.S. Number of full time permanent employees in Polk County Number of time permanent employees in Polk County 8. What percent of your total Polk County workforce is: 0 15% 1 30% 31 45% 4 55% 5 70% 71 85% 8 100% Male Female Caucasian African American Hispanic American Indian and/or Alaskan Native Asian Other than listed above 9. What percent of your total Polk County Executive Team is: 10. Do you employ practices to recruit/retain members of the disabled community? 11. Do you employ practices to recruit/retain employees of varying ethnic and cultural backgrounds? 0 15% 1 30% 31 45% 4 55% 5 70% 71 85% 8 100% Male Female n Caucasian

3 12. Do you employ practices to recruit/retain an aging workforce? Commitment to Work/Life Balance 13. Medical Coverage 14. Prescription Coverage 15. Dental Coverage 1. Vision Coverage 17. Long Term Care Insurance 18. Life Insurance (Employee) 19. Life Insurance (Dependents) 20. Short Term Disability Plan 21. Long Term Disability Plan t offered t offered t offered t offered t offered t offered t offered t offered t offered

4 22. Please describe (in 300 words or less) any unique aspects of your healthcare benefits (health, dental, vision, long term care, and/or disability). 23. When is a new employee eligible to enroll in the organization's healthcare plan? 24. What is the minimum number of hours an employee must work per week to be eligible for health coverage? 25. How many paid holidays does your company offer per year? 2. What is your policy for vacation, sick, etc.? 27. How many PTO days are available after one year of employment (do not include paid holidays)? 28. How many PTO days can be carried over into the next year? 29. How many Personal Days are available after one year of employment? (Do not include paid company holidays) 30. How many vacation days are available after one year of employment? 31. How many vacation days can be accrued? 5 Date of hire 30 Days 90 Days More than 90 Days t Offered Up to 20 hours hours hours t offered 0 5 days 9 days days PTO (one bank of time) Vacation, Sick, Personal (separate banks) Choose One N/A 5 10 days days 1 20 days More than 20 N/A 0 days 1 5 days 10 days days More than 15 N/A 0 1 days 2 3 days 4 5 days More than 5 N/A 0 5 days 10 days days 1 20 days More than 20 N/A 0 5 days 10 days days 1 20 days More than 20

5 32. How many sick days are available after one year of employment? N/A 0 5 days 10 days days 1 20 days More than How many sick days can be accrued? N/A 0 5 days 10 days days 1 20 days More than Does your company pay employees for accrued days after the maximum limit has been reached? 35. Does your company allow time off: For parent conferences and other selected school activities? 3. Does your company offer: 37. Does your company provide: To coach, mentor or tutor? For community service activities/volunteer work? 38. Does your company subsidize childcare costs? 39. Does your company have on site facilities that promote exercise and fitness OR pay all or of employees' costs for health club memberships? Telecommuting options? Job sharing options? Flexible work week options? An Employee Assistance Program? Or support a Wellness Program? (smoking cessation, weight loss, single parent, etc.) Elder care assistance?

6 40. Does your company: Provide cafeteria or meal subsidies, free daily snacks or beverages Provide adoption assistance Offer flexible spending accounts for childcare Offer a bonus or incentive program Offer an employee stock options Offer profit sharing Offer a 401(k) or 403(b) retirement program 41. Does your company Match employee retirement contributions Contribute to the retirement plan independent of the employee's contribution 42. What is the maximum percentage that your company will match? Commitment to an Educated Workforce 43. Does your company require A High School Diploma or GED as an employment requirement 44. Does your company provide flextime for employees who seek to continue their education? Commitment to Training and Development Initiatives 45. What Training and Development initiatives does your company offer? (Please check ALL that apply) Offer tuition reimbursement Job Advancement Supervisory Skills Work/Life Balance Diversity Training Leadership Training N/A Training/Skills Upgrade Training issues Training

7 4. What Training and Development initiatives does your company offer? (Please check ALL that apply) Financial Literacy Motivational Training Teambuilding Training Safety Training (OSHA) Identity Theft Training N/A Training 47. What is the average number of annual training and development hours received per employee? 48. Does your company figure Return on Investment (ROI) on any of your training or formal programs? 49. Does your company have an active safety program/committee? 50. Please check the communications tools your company currently uses (Check all that apply) Suggestion Boxes Commitment to Recruiting Quality Employees 17) 1 5 hours 15 hours 1 20 hours More than 20 hours Corporate Intranet Organization Newsletter 51. What was the average annual salary for exempt employees for 2014? 52. What was your number of new hires for 2014? Opportunities to Employee Survey Open Door Policy meet with Senior N/A Leadership What is your ratio of human resource professionals per employee? (Example: 1 per 5 In the next 3 questions, what level of involvement does each have in your hiring process for an open position?

8 54. Human Resources High Medium Low Screening Interviewing Hiring 55. Immediate Supervisor 5. Co workers 57. In 2014, what percentage of non entry level job openings were filled by internal candidates? 58. Does your company provide an Orientation Program? 59. A new employee spends an average of how many hours in company orientation? 0. Do you offer bonuses to employees who refer new hires? 1. What is the maximum bonus awarded to an employee for a successfully hired referral? High Medium Low Screening Interviewing Hiring High Medium Low Screening Interviewing Hiring 0 5% 10% 11 20% 21 30% 31 40% 41 50% Over 50% 4 hours or less 5 8 hours 9 20 hours hours Over 40 hours $0 $100 $250 More than 250 Commitment to Retaining Quality Employees 2. What was your rate of voluntary turnover for 2014? 10% or less 11% 20% 21% 30% More than 30%

9 3. How does your company determine what retention initiatives are implemented? (Choose all that apply) Conduct employee needs Initiatives are determined by assessment to determine Employee task force propose Management determines our corporate office, at a N/A most effective initiatives for initiatives to management initiatives separate location workforce 4. Does your company have an employee recognition/appreciation program? 5. What is the average length of service for your full time employees?. What is the average length of service for your time employees? 7. Does your company recognize employees for length of service? 8. Do you employ practices for succession planning? 9. Does your company conduct regular employee performance evaluations? 70. Does your company conduct 30 degree Multi Level Assessments? (A tool that provides performance feedback from supervisor and 4 8 peers, coworkers, and/or customers). 0 5 Years 10 Years Years Years More than 25 Years 0 5 Years 10 Years Years More than 15 Years 71. Please describe in 00 words or less what makes your company a great place to work AND what sets your company a from other companies in your efforts to recruit and retain the best employees in Polk County. (This information may be used for publication if your company is selected as a Best Places to Work.) 5