Section_3_-_Individual_Certification_(FY24).pdf
PDF 192 KB Posted
- Solicitation number
- 240130
- Issued by
- Pima County, Arizona
About this file
This document is a Section 3 Individual Certification form from the City of Tucson, designed to capture employee information for a Housing and Community Development (HCD) contract. The form requires detailed personal and employment information, including job title, hire date, contact details, and residential address. It specifically seeks to determine the employee's eligibility based on income level (at or below $45,500/yr or $21.87/hr), local residency status in Tucson or Pima County, and current housing assistance status.
The certification form is part of a workforce tracking and potentially preferential hiring program, with checkboxes for City of Tucson officials to categorize the employee as a "Section 3 Worker" or "Targeted Section 3 Worker". The form requires the employee to certify the accuracy of the provided information under penalty of law, with spaces for signature and date. The form includes an equal opportunity housing logo, indicating its connection to federal housing and employment equity initiatives.
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Text version
CITY OF TUCSON | NS3 IWE 7.01.2023
SECTION 3 INDIVIDUAL CERTIFICATION
Project Info
Project: HCD Contract #:
Contractor: Sub-Contractor: _____________________________
Employee Info
Job Title: Hire Date:
Name: Phone Number: ____________________________
Address: ______
Zip: __________________
Yes No
Yes No
(No P.O. Box Addresses)
City: State:
My current individual income is at or below $45,500/yr or $21.87/hr?
Are you a resident of Tucson, Pima County, Arizona?
I currently receive the following housing assistance; check only one.
No Assistance Public Housing Section 8 Housing
Certification
I hereby certify, under penalty of law, that the information provided above is true and correct.
Employee Name (Print): ______ Date: _____
Employee Signature: ____________
City of Tucson Use Only Section 3 Worker
Targeted Section 3 Worker Date: ______________
Does not qualify (NA) Verified by: ______________
AHollis1 Pencil
| Project: |
| HCD Contract: |
| Contractor: |
| SubContractor: |
| Job Title: |
| Hire Date: |
| Name: |
| Phone Number: |
| City: |
| State: |
| Zip: |
| My current individual annual income is at or below 429502190 phr: Off |
| undefined: Off |
| No Assistance: Off |
| Public Housing: Off |
| Section 8 Housing: Off |
| Section 3 Worker: Off |
| Targeted Section 3 Worker: Off |
| Does not qualify NA: Off |
| Date: |
| Verified by: |
| Date1_es_:signer:date: |
| Name2_es_:signer:fullname: |
| Signature Block4_es_:signer:signatureblock: |
File details come from the government source that posted it. Updated .