S3C-1C_Targeted_Section_3_Worker_Self_Cert.pdf
PDF 72 KB Posted
- Solicitation number
- 2025-IFB-017
- Issued by
- Mohave County, Arizona
About this file
The document is a Targeted Section 3 Worker Self-Certification Form (S3C-1C) related to the Jerry Ambrose Veterans Council Transitional Housing Rehab - Phase II project in Kingman, Arizona. The form is designed for workers seeking preference in training and employment, specifically for YouthBuild participants who were hired within the past five years while participating in the YouthBuild program.
The self-certification form requires the worker to verify their status as a YouthBuild participant and certifies that the information provided is true and correct. The form includes a warning that falsification of information could result in disqualification and potential legal punishment. This document appears to be part of the City of Kingman's efforts to ensure employment opportunities for targeted workforce groups in conjunction with the Community Development Block Grant from the Arizona Department of Housing.
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Text version
Targeted Section 3 Worker Self-Certification Form (S3C-1C)
A Section 3 Worker seeking the preference in training and employment shall certify or submit evidence to the recipient, contractor, or subcontractor that the person is a Section 3 Worker, as defined in Section 24 CRF 75.
Name of Worker
I am a YouthBuild participant.
I was hired within the past five years and at the time of my hire was a YouthBuild participant.
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 Date
Targeted Section 3 Worker Self-Certification Form (S3C-1C)
File details come from the government source that posted it. Updated .