*Name of Business

A value is required.

Business contact person

*Name A value is required.

Job position/title

*Email A value is required.Invalid format.

Phone

*City/State located

City A value is required.

State Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Please select an item.

If part of a national corporation, is the corporate office in different city/state?

Yes.  If yes, where?  (City/State)

City

State Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

No.

*Type of industry

Select Accommodation and food services Administrative and support services and waste management and remediation services Agriculture, forestry, fishing and hunting Arts, entertainment and recreation Construction Educational services Finance and insurance Health care and social assistance Information Management of companies and enterprises Manufacturing Mining Personal and laundry services Professional, scientific, and technical services Public administration Real estate and rental and leasing services Religious, grantmaking, civic, professional and similar org Repair and maintenance Retail trade Transportation and warehousing Utilities Wholesale trade

Type of work environment

Office

Non-Office

Both

*Estimated percent of overtime eligible employees

0-30%

Greater than 30% Please make a selection.

* indicates a required field

*Does the business provide space for nursing employees to express milk during the work period?

Yes. 

No

Please make a selection.

If yes, describe.

*Does the business provide nursing employees with break time to express milk during the work period?

Yes. 

No.
Please make a selection.

If yes, describe.

Has the business received an award for providing support for nursing employees?

Yes

No

May we include the name of your business in the public resource?

Yes

No

I am not an employee of the business

Name of person submitting the information
(if different from business contact)

Name

Email

Organization