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2024 Employer Certification Application

The application must be completed by the employer's designated person with the authority to represent the business or organization.

All applications will be reviewed by the Orange County Living Wage Certification Committee, which is empowered to make all final decisions on certification.

Application data is considered confidential and privileged information.

Employers must reapply for Living Wage certification every two years.

Business / Organization Information

Application Type:*
Contact Person*
Physical Address of Business or Organization*
Mailing Address (if different than above)

Employees & Wages

Note: You should count the following categories of employees in your answer BUT they need not be paid a living wage if they meet certain conditions: interns, apprentices, temporary or project-based employees working less than 90 days a year, minors working part-time, new hires in a probationary period not to exceed 90 days. For details, refer to our definitions: orangecountylivingwage.org/definitions/
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How many employees fall into the following special categories?

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Note: For tipped, commissioned, and variable-pay employees, total compensation must equal at least $17.65/hour (or at least $16.15/hour with health insurance.)
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Raises & Benefits Increase


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Employer Attestation and Agreements

Diversity

We are increasingly asked about the overall demographics of employees who are benefiting from a living wage. Please answer the following questions to the best of your ability.



Please tell us, to the best of your ability, the number of employees that fall into each of these gender categories.

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Please tell us, to the best of your ability, the number of employees that fall into each of these race or ethnicity categories.

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Are you a minority, worker or women-owned business?*
Check all that apply. If you are a not-for-profit business governed by a rotating board of directors, check none.

Application Fees

Starting April 1, 2024, Orange County Living Wage will implement a new application fee to support the staff and infrastructure necessary to maintain and expand our programming. The fee structure: Employers with 0-9 employees: $50 Employers with 10-49 employees: $100 Employers with 50 or more employees: $200
Choose your payment method
You have two choices to pay, you can use Venmo by scanning the QR code or you can use a bank account, credit card, Apply Pay or Google Pay by using Zeffy.
If you're already on your mobile device, click HERE to get to Venmo.
Who from Orange County Living Wage assisted you in applying for living wage certification?*
Check all that apply.

Post Office Box 1502
Carrboro, NC 27510

info@orangecountylivingwage.org

Orange County Living Wage is a 501(c)3 charitable organization,
EIN 47-4595087.
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