Not Working Form

Date

I certify that I am not currently working. I understand that if I do obtain employment in the future, I must report the change to my case worker at the Cliffside Park Housing Authority within ten days of employment.

It is further understood that if it is subsequently discovered that I have withheld or provided false or misleading information that it may result in the termination of my participation in the Housing Choice Voucher Program.

Signature of Head of Household

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.