Application for Participation in Work-Life Consultancy Clinic (Form B)

Application for Participation in Work-Life Consultancy Clinic (Form B)1 PARTICULARS OF ORGANISATIONRegistered Name of Organisation (with RCB or ACRA):Contact Details of Applicant Organisation:AddressContact PersonDesignationTel Fax EmailEmployment Details:Total number of employees Total number of men Total number of womenBusiness Activity:* Industry: Trading & Retail / Hospitality / F&B/ Financial / Medical and Social Services /Professional Services / Manufacturing/ Others (specify)What are the key areas of focus in your organisation for the next two years? For e.g. regionalexpansion, new markets, employee development, etc.Page 1 of 3

2 INFORMATION FOR CONSULTANCY PROGRAMME2aPreferred month for consultancy programme20122bProposed list of Managers attending the presentation:The Manager oversees the department’s/company’s daily operations and processes and leads a team.Note: There can be more than one manager from each department.Department Designation No. of staffmanaged by themEg. 1. Marketing Marketing Manager 6 staff3 INFORMATION ON WORK-LIFE NEEDS3aWhat do you want to achieve with the Work-Life Consultancy Clinic? Please provideobjectives and/or areas of focus. For e.g. general overview of Work-Life Strategies vsparticular focus on specific Work-Life programmes, industry etc. This information isrequired for the consultant to prepare the session content accordingly.Page 2 of 3

3bWhat do you consider as the current Work-Life practices within your organization (for e.g.telecommuting, part-time work, flexi-time, eldercare leave, etc) and what is the next stagethat your organization would like to achieve in terms of Work-Life Integration?3cWhat do you think are the Work-Life needs of your organisation and staff?For e.g. new mothers, elderly worker, young parents, etc.Sharing of relevant information gained from communication channels such as employeeengagement surveys, focus group discussions, etc would be useful. Please indicate source ofinformation when doing so.4 CONFIRMATION OF REQUESTApplicant’s ConfirmationSignature & Company StampNameDesignationNote: Application must be submitted by Work-Lifecoordinator or Project Leader and supported bymanagementDatePage 3 of 3