The Employee Self Certification Form must be completed for all newly hired employees associated with the Community Development Block Grant job creation and job retention programs (e.g., ED and PFED), and can also be used to document section 3 employment. The Employee Self Certification Form documents the family income and demographics of newly hired employees and should be submitted by the prospective employee to the business with the job application. An income level in the first three columns of the table indicates a low-to-moderate income (LMI) status.
Spanish Version
2011 Employee Self Certification Form
2012 Employee Self Certification Form
2013 Employee Self Certificaition Form
2014 Employee Self Certificaition Form
2015 Employee Self Certification Form
2016 Employee Self Certification Form
2017 Employee Self Certification Form
2018 Employee Self Certification Form
2019 Employee Self Certification Form
2020 Employee Self Certification Form
2021 Employee Self Certification Form
2022 Employee Self Certification Form
