S3C-1D_Targeted_Section_3_Worker_Employer_Cert_.pdf
PDF 74 KB Posted
- Solicitation number
- 2025-IFB-017
- Issued by
- Mohave County, Arizona
About this file
The document is a Targeted Section 3 Worker Employer Certification Form (S3C-1D) related to the Jerry Ambrose Veterans Council Transitional Housing Rehab - Phase II project in Kingman, Arizona. This form is designed for employers to certify that a worker meets Section 3 worker qualifications as defined in Section 24 CFR 75, which involves providing training and employment preferences to local residents. The form requires employers to verify that the employee resides within the project area, was hired within the past five years, and is part of the business's permanent workforce.
The certification form is part of a Community Development Block Grant (CDBG) project funded by the State of Arizona Department of Housing. Employers must complete this form to demonstrate compliance with Section 3 worker requirements, which aim to support local hiring and economic opportunities for residents in the project area. The form includes a legal declaration that the information provided is true and correct, with potential consequences for falsification, including disqualification from participation and potential legal punishment.
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Text version
Targeted Section 3 Worker Employer Certification Form (S3C-1D)
An employer of a Section 3 Worker seeking the 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
The employee named above resides within the project area as defined in the bid documents.
The employee named above was hired within the past five years. At the time of hire, the employee resided within the project area as defined in the bid documents.
I have certified this business as a Section 3 business and the employee is part of the business’s permanent workforce.
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
Targeted Section 3 Worker Employer Certification Form (S3C-1D)
File details come from the government source that posted it. Updated .