SECTION 3 PERMANENT WORKFORCE FORM
This form is used to determine the Section 3 Workers already employed by the contractor and may be compared to Davis-Bacon Payrolls for cross referencing purposes.

NOTE: If you have more than 5 current Section 3 workers you will need to complete multiple forms to account for ALL of your current workers who meet the 'Section 3' criteria.
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Enter project name, contractor, and full address *
Name of Employee #1 (First, Last) and job title
Is employee #1 a certified Section 3 Worker?
Clear selection
What is the monthly salary for employee #1?
Is the salary for employee #1 below 80% of the median income?
Clear selection
Name of Employee #2 (First, Last) and job title
Is employee #2 a certified Section 3 Worker?
Clear selection
What is the monthly salary for employee #2?
Is the salary for employee #2 below 80% of the median income?
Clear selection
Name of Employee #3 (First, Last) and job title
Is employee #3 a certified Section 3 Worker?
Clear selection
What is the monthly salary for employee #3?
Is the salary for employee #3 below 80% of the median income?
Clear selection
Name of Employee #4 (First, Last) and job title
Is employee #4 a certified Section 3 Worker?
Clear selection
What is the monthly salary for employee #4?
Is the salary for employee #4 below 80% of the median income?
Clear selection
Name of Employee #5 (First, Last) and job title
Is employee #5 a certified Section 3 Worker?
Clear selection
What is the monthly salary for employee #5?
Is the salary for employee #5 below 80% of the median income?
Clear selection
I certify the above employees are permanent employees of the company referenced above. I certify the above employees are on our regular monthly payroll and have their W-2 tax forms for our records. These records will be available to MHA for the above referenced project for verification purposes. I understand that falsifying information is perjury and subject to legal ramifications.
Please include below, the name and title of the person completing this form. *
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This form was created inside of Montgomery Housing Authority.

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