TARGETED SECTION 3 WORKER CERTIFICATION FORM

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A Targeted 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 Targeted Section 3 Worker, as defined in Section 24 CFR 75.

Targeted Section 3 Employee Name (First, Last) *

Please check at least one option: *

I am employed by a Section 3 business concern.

I am currently a public housing resident or HCV Section 8 resident of MHA or have been within the past 5 years.

I am currently a resident of other housing assisted by MHA or in MHA's management portfolio or I have been within the past 5 years.

I am a YouthBuild participant or have been within the past 5 years.

The status of a Targeted 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 Targeted Section3 worker. Targeted 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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