Welcome In Application

Welcome In Program Application

Welcome In is a pilot program that recognizes businesses for creating safe and welcoming environments free from discrimination and harassment of customers. The Civil Rights Department (CRD) has established this program pursuant to Civil Code section 51.17.

APPLICATION SECTION 1

Primary Business Contact *

First

Last

Title (e.g. CEO, Owner, Manager) *

Phone *

Email *

Preferred Method of Contact *

Primary Business Information

Legal Name of Business *

Phone *

Website / URL

Hours of Operation *

DBA or any other names used for this business

Secretary of State ID # *

Name of Owner *

First

Last

Business Street Address *

Address Line 1

Address Line 2

City

State

Zip Code

Business Mailing Address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

Are there other business locations you wish to add? *

Yes
No

Other Business Locations

Legal Name of Business

Address

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business

What is your primary business activity? *

Please describe in detail the goods and/or services you provide. *

What is the average number of customers/visitors that your business serves each day? *

How many supervisory employees do you have? *

When was your business established? *

How many non-supervisory employees do you have? *

APPLICATION SECTION 2

Why are you interested in Welcome In? *

(3-5 sentences)

How do you believe this program will contribute to your business and community? *

(3-5 sentences)

Please describe what, if anything, your business is already doing to create a safe and inclusive environment. *

(3-5 sentences)

Please describe any challenges your business has experienced in regard to creating a safe and inclusive environment. *

(3-5 sentences)

Are you aware of any open or closed complaints against your business filed with the Civil Rights Department or another state or federal enforcement agency? *

Yes
No

Having a complaint against your business does not automatically disqualify you from participation in Welcome In.

Please briefly explain.

APPLICATION SECTION 3

How did you hear about this program? *

Other *

Please certify that you agree to the following statements. *

I am authorized to represent the business described in this application and the business is able to participate in the Welcome In program.

Certify Question 2 *

I have reviewed the program requirements and will complete them within one year of acceptance into the program.

Certify Question 3 *

The information provided in this application is true and accurate to the best of my knowledge.

Certify Question 4 *

Participation in Welcome In does not shield the business from liability under California civil rights laws.

Print Name *

Date *