Other Multi Racial. For reporting individual responses that are not included in any of the other categories listed above. Household Size. Enter the appropriate number of persons in the household: 1, 2, 3, 4, 5, 6, 7, or 8 (for households of more than 8, enter
Other Multi Racial. Category used for reporting individual responses that are not included in any of the categories listed above. Please select one. Ethnic Category
Other Multi Racial. For reporting individual responses that are not included in any of the other categories listed above Prior Employment Status: Unemployed Employed New Job Category: Officials and Managers Professional Technicians Sales Office and Clerical Craft Workers (skilled) Operatives (semi-skilled) Laborers (unskilled) Service Workers Insurance: Does your employer provide health care benefits? Yes No CERTIFICATION: "To the best of my knowledge, the above information is true and can be verified if requested by proper officials of the Grantee, City of Joplin and The U.S. Department of Housing and Urban Development." Print Name Date Sign Name EXHIBIT D If you need assistance completing this form, please check with the Grantee for assistance. For Grantee Use Only Name of Grantee: EXHIBIT D Proposed Job Creation Titles Quality Control (2) Maintenance Manager Maintenance Mechanic (2) Sanitation Lead Sanitation Workers (2) Warehouse Manager Material Handler (2) Purchasing Manager Plant Accountant/ Office Manager Office/ Warehouse Clerk Shift Supervisor (2) Dough Mixer (8) Oven Operator (4)
