Section 3 Business Employee List printable pdf download

Section 3 Business Employee List

Greater Dayton Premier Management

400 Wayne Ave.

P.O. Box 8750

Dayton, Ohio

45401-8750

Telephone (937) 910-7500

Fax

(937) 910-7689

Section 3 Business Employee List (To be submitted with bid/offer)

Form sec3-001b

COMPANY NAME: _________________________________________________________________________________

ADDRESS: _______________________________________________________________________________________

TELEPHONE NUMBER: ____________________________________ FAX: ___________________________________

Instructions: Please complete (type or legibly print) information for all employees of the company (only office/branch

that works with GDPM). For Section 3 employees,* attach form sec3-002a, Section 3 Resident Preference Claim Form

AND form sec3-002b, Section 3 Resident or Employee Household Income Certification (contact GDPM for these

forms). USE ADDITIONAL PAGES OF THIS FORM WHERE NECESSARY AND NUMBER EACH PAGE.

Sec. 3 Employee

Employee Name

Address

Work Classification

Date of Hire

FT or PT

(Yes or No)

Legend: FT = Full Time

PT = Part time

Sec. 3 = Section 3 Resident

TOTAL NUMBER OF EMPLOYEES: ______________

SIGNATURE: ____________________________________________________________ DATE: _________________

TITLE:__________________________________________________________________

Section 3 person is an individual who is a public housing resident, or who resides in the metropolitan area where the Section 3 assistance is being expended AND who is low or

very low income,** or a person seeking the training and/or employment preference provided by Section 3 program, or a person receiving unemployment benefits, or a returning

veteran, or a recent college or vocational school graduate or a woman in non-traditional career.

Income Level Determination**

# IN HOUSEHOLD

1 PERSON

2 PERSONS

3 PERSONS

4 PERSONS

5 PERSONS

6 PERSONS

7 PERSONS

8 PERSONS

VERY LOW-INCOME