Application for Employment

Company is an Equal Opportunity Employer. We do not unlawfully discriminate against any applicant on the basis of race, color, religion, sex, national origin, age, sexual orientation, disability or any other category protected by federal, state or local law.

General Information

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Name
Address:
Have you ever submitted an application to us before?

Employment Experience

Please list the names of your present and previous employers, starting with your present/most recent employment. You should include information about verifiable work performed on a volunteer basis and military service. Be sure to account for all periods of time, including any periods of unemployment. Use additional pages if needed.

Education


Individual Low-Income Person Self-Certification For

(In Compliance with Section 3 of the HUD Act of 1968 Updated 24 CFR Part 75 11/30/2020)

The purpose of this form is to comply with Section 3 of the HUD Act of 1968 self-certification income requirements. To count as a Section 3 individual, any legal resident of the United States annual income must not exceed the HUD income limits for the year before they were hired, or, the individuals current year income annualized for the year you are being confirmed as low-income.

Address
Please check all (more than one if applicable) of the following statements that apply to your Section 3 eligibility:
HUD Individual
Income Limit
$55,800

I hereby certify to the US Department of Housing and Urban Development (HUD) that all the information on this form is true and correct. I attest under penalty of perjury that my total income is as shown above, and that proof of this information may be requested. If found to be inaccurate, I understand that I may be disqualified as an applicant and/or a certified Section 3 individual. Finally, I authorize including my name on a list of Section 3 Residents seeking employment and to include my contact information so that contractors may contact me directly for any employment opportunities.

Clear Signature
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The purpose of this form is to comply with Section 3 of the HUD Act of 1968 self-certification income requirements. To count as a Section 3 individual, any legal resident of the United States annual income must not exceed the HUD income limits for the year before they were hired, or, the individuals current year income annualized for the year you are being confirmed as low-income.


Applicant Data Record

Qualified applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex national origin, age, marital or veteran status. As employers/government contractors, we comply with government regulations and affirmative action responsibilities. Solely, to help us comply with government record keeping, reporting and other legal requirements, please fill out the Data Record. This Data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.
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Affirmative Action Survey Government agencies require periodic reports on the sex, ethnicity, handicapped and veteran status of applicants. This data is for analysis and affirmative action only.

Check one:
Race/Ethic Group:

Resume

Accepted file types: pdf, docx, Max. file size: 2 MB.
Please attach your resume. MS Word and PDF only please.