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Section 3 Resident Application

  1. Gender

  2. BMHA Resident Only

  3. Ethnicity

  4. Race

  5. Are you a U.S. Citizen?

  6. If no, are you authorized to work in the U.S.?

  7. Do you have a Driver’s License?

  8. Do you have access to a vehicle?

  9. Are you presently employed?

  10. Do you have any vocational, technical, academic certificates or licenses?

    If you are applying for a construction position, OSHA safety training is mandatory.

  11. Check up to 3 areas that you have experience in

  12. I attest that the information stated above is true and accurate, and understand that the information, if misrepresented or incomplete, may be grounds for immediate termination.

    In addition, 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.

  13. Contact Linda Gleason at 716-855-7580, ext. 304 to schedule an appointment for eligibility determination.
    Contact David Granville at 716-855-7580, ext. 305 to schedule the 10 hour OSHA General Construction class.

  14. View the Documentation Used for Determining Eligibility (PDF). Please bring at least one type of documentation from each category pertaining to your household situation. Section 3 certification is valid for 3 years from the date of certification.

  15. Leave This Blank:

  16. This field is not part of the form submission.