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PDF DISADVANTAGED LOCAL WORKER CERTIFICATION FORM I

PDF DISADVANTAGED LOCAL WORKER CERTIFICATION FORM I 2025

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The document is a Disadvantaged Local Worker Certification Form that individuals must complete to declare their eligibility based on specific disadvantaged circumstances, such as homelessness, single parent status, public assistance, lack of education, criminal record, long-term unemployment, foster care emancipation, or veteran status. It requires personal information and proof of residency and eligibility criteria. The form emphasizes the importance of truthful representation under penalty of perjury and includes a checklist for both the applicant and certifying official.

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