Section 3 - New Hire Status Report

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CAPITAL CONSTRUCTION DEPARTMENT
INFORMATIONAL FORM – A. 6.5
SECTION 3 – NEW HIRE STATUS REPORT
(1) COMPANY NAME:
(2) CONTACT PERSON AND PHONE NO:
(3) REPORTING PERIOD:
(4) PROJECT/PROGRAM NAME & NO:
(5) CONTRACT AWARD DATE:
(6) POSITION DESCRIPTION/NAME OF PERSON
(7)
(8)
(9)
(10)
(11)
(12)
Report new hires only.
A new hire is a full time
SECTION
RACE/
employee filling a permanent, temporary or seasonal
SECTION
DATE
3 HIRE
SECTION 3
ETHNICITY
employment who is not on the company's payroll at
3 HIRE?
OF
CODE
GENDER
TRAINEE?
(SEE #2
the time of receipt of Section 3 covered assistance.
Y/N
HIRE
(SEE #1
Y/N
BELOW)
BELOW)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
1.
SECTION 3 PREFERENCE CODE: 1=Resident of development(s) for which covered assistance is expended; 2=Resident of other KCHA
Public Housing; 3=HUD Youthbuild participant; 4=Puget Sound Area resident.
ETHNICITY CATEGORIES: A: White/not Hispanic; B: Black/not Hispanic; C: Hispanic; D: Asian or Pacific Islander; E: American
2.
Indian or Alaskan Native.
I certify that the information in this report is true and correct to the best of my knowledge :
Name & Title
Signature
Date
(To be completed by KCHA staff)
Received By :
Name & Title
Signature
Date
Submit this report as required by the project/contract manager.
S3- Employment Tracking Form
Page 1 of 1
KCHA/CCD / 6506-A.6.5 / 03-03-14 Rev

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