SECTION 3 WORKER CERTIFICATION FORM

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A Section 3 Worker seeking the preference in training and employment provided by this part shall certify or submit evidence to the recipient contractor or subcontractor that the person is a Section 3 Worker, as defined in Section 24 CFR 75.

Targeted Section 3 Employee Name (First, Last) *

Please check at least one option: *

My annual income for the previous year or projected current year is below the HUD Low Income Individual Median Income (80%). I have reviewed the HUD income limits at https://www.huduser.gov/portal/datasets/il.html for the year in which I comply.

I am employed by a Section 3 business concern.

I am a YouthBuild participant.

The status of a Section 3 worker shall not be negatively affected by a prior arrest or conviction. Nothing in this part shall be construed to require the employment of someone who meets this definition of a Section 3 worker. Section 3 workers are not exempt from meeting the qualifications of the position to be filled.

I hereby certify that the information provided by me to be true and correct and understand any falsification of any of the information could subject me to disqualification from participation and punishment under the law.

Signature *

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