Please answer all questions as accurately as possible.
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PERSONAL INFORMATION
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EDUCATION
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INCOME
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CERTIFICATES/LICENSES
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SKILLS
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PLEASE READ AND SIGN
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I declare under penalty of perjury, under the laws of the State of New York, that the information contained in this application and any accompanying documents are true and correct, with full knowledge that all statements made in this application are subject to investigation and that any false or dishonest answer to any question may be grounds for immediate termination. In addition, I have been informed that a supervised drug test will be required during the Job Readiness Training (JRT) workshop. Failure to take the test and/or failure of that test will be cause for removal from any and all employment and/or training opportunities that are funded through the Buffalo Municipal Housing Authority. At the discretion of the Buffalo Municipal Housing Authority, I may be subject to a random drug test if more than 26 weeks have elapsed from the time of the first drug test and my employment on a BMHA construction project. Finally, I have been informed that the information provided will be discreetly managed and will be used for the administration of this program. To that end, your name, address, and information concerning your training and qualifications may be disclosed to prospective employers and/or training providers. Your signature below authorizes such disclosure. “BMHA is an Equal Opportunity/Affirmative Action Employer”
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DETERMINING ELIGIBILITY
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* indicates required fields.
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