Business or Organization Name
*
Business or Industry
*
Behavioral Health/Social Services
Construction/Contracting/Mining/Utilities
Education, health and related occupations
Entertainers, sports, media and communications
Executive/administrative/managerial/financial
Farming, fishing, forestry occupations
Food & Hospitality
Hospital/Health Services
Installation, maintenance and repair workers
Office and administrative support workers
Production, machinery setters, operators, tenders
Professional or Scientific Services
Protective Service occupations
Sales Occupations
Service occupations, except protective
Technicians and related support occupations
Transportation and material moving workers
Manufacturing
Wholesale Trade
Retail Trade
Organization Type
*
Number of Workplace Locations
*
Total Number of Employees
Organization website
Organization Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Contact Name
*
First Name
Last Name
Contact Email
*
Phone
(###)
###
####
Message
Do you currently employ individuals in recovery at your organization?
Yes
No
We don't know
Do you currently employ individuals with justice system involvement at your organization?
Yes
No
We don't know
Do you currently offer an employee assistance program that includes behavioral health benefits at your organization?
Yes
No
We don't know
Do you currently have organizational policies that provide workplace protection for employees in recovery?
Yes
No
We don't know
Referral Source (How did you learn about this initiative? e.g., presentation, colleague, social media, RFW organization? Please be specific if possible.)
What are you most interested in from the RFW initiative (select all that apply)?
I agree that by submitting this application, I am authorized to submit this form on behalf of the organization named and that we agree to be contacted by a RFW staff person to receive more information about the Recovery Friendly Workplace initiative.
