The Agency for Persons with Disabilities, Vocational Rehabilitation, Blind Services, and other disability organizations are looking to recognize outstanding Florida employers as part of the annual October celebration of Disability Employment Awareness Month.

If you are aware of an employer that has a history of hiring and supporting individuals with disabilities, then complete the following information. Providing detailed information helps the committee in reviewing the nominations. Feel free to elaborate and use as much space as needed.

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* 1. Name of business:

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* 2. Address of business:

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* 3. Business contact person:

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* 4. Email for business contact person:

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* 5. Phone number for business contact person:

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* 6. Nominator name:

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* 7. Nominator phone number:

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* 8. Nominator Email:

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* 9. Business' Facebook profile:

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* 10. Business' X (formerly known as Twitter) profile:

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* 11. Business' Instagram profile:

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* 12. How many individuals with disabilities currently employed by company:

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* 13. How many people with disabilities has the company hired in the past? We need details about their longstanding commitment:

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* 14. What accommodations or assistance, if any, has the business made or provided to the individual/s?

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* 15. What is the total workforce (number of people) that the business employs?

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* 16. Describe why you think this business is an exceptional employer of people with disabilities:

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* 17. Nominator name and contact information (Phone number and email address):

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* 18. Please check this box to confirm that the business knows they are being nominated and that they are willing to participate in the event.

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