Employee Self Certification Forms

​​​​​​​​​​​​​​​​​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).  The Employee Self Certification Form is for collecting the family income and demographics of newly hired employees.  It is recommended to have job applicants complete the form as part of the application process so their income status is known prior to hire, to help ensure the Business is hiring an adequate number of low- and moderate-income persons for the jobs being retained or created as a result of the CDBG funding assistance.

2011 Employee Self Certification Forms

2012 Employee Self Certification Forms

2013 Employee Self Certificaition Forms

2014 Employee Self Certificaition Forms

2015 Employee Self Certification Forms

2016 Employee Self Certification Forms

2017 Employee Self Certification Forms

2018 Employee Self Certification Forms

2019 Employee Self Certification Forms

2020 Employee Self Certification Forms

2021 Employee Self Certification Forms

2022 Employee Self Certification Forms

2023 Employee Self Certification Forms​​