S3C-1B_Section_3_Worker_Employer_Cert_.pdf
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- Solicitation number
- 2025-IFB-017
- Issued by
- Mohave County, Arizona
About this file
The document is a Section 3 Worker Employer Certification Form (S3C-1B), which is part of the Jerry Ambrose Veterans Council Transitional Housing Rehab - Phase II project in Kingman, Arizona. The form is designed for employers to certify that workers meet Section 3 worker criteria as defined in HUD regulations, specifically relating to income levels and recent hiring within the past five years. Employers must verify that the employee's income is below 80 percent of the median income for their family size, both at the time of hiring and currently.
The certification form is part of a broader Community Development Block Grant project administered by the City of Kingman, which requires contractors to provide documentation demonstrating employment of workers from low-income backgrounds. By completing this form, employers can potentially receive preference in training and employment opportunities associated with the veterans housing rehabilitation project. The form includes provisions for legal accountability, with employers acknowledging that falsifying information could result in disqualification and potential legal punishment.
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Text version
Section 3 Worker Employer Certification Form (S3C-1B)
An employer of a Section 3 Worker seeking preference in training and employment shall certify and maintain evidence the worker is a Section 3 Worker as defined in Section 24 CRF 75.
Name of Employee
I have reviewed the HUD income chart for the current year. The employee named above has an income that is currently below 80 percent of the median income for their family size based on my calculation of what the employee’s wage rate would translate to if annualized on a full-time basis.
The employee was hired within the past five (5) years. I have reviewed the HUD income chart for the year the employee named above was hired. At the time of hire, the employee named above had an income that was below 80 percent of the median income for their family size.
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.
Employer Name
Employer Representative Name
Signature of Employer Representative
Date
Section 3 Worker Employer Certification Form (S3C-1B)
File details come from the government source that posted it. Updated .