Get Eta 9062 Form

The Eta 9062 Form is essential for individuals seeking conditional certification under the Work Opportunity Tax Credit program. This guide will provide clear, step-by-step instructions to help you complete the form online with confidence.

Follow the steps to complete the Eta 9062 Form accurately.

1. Click ‘Get Form’ button to acquire the form and open it in your editor.
2. In Box 1, enter the initiating agency code provided by the responsible agency to indicate where the eligibility determination was made.
3. In Box 2, provide the control number, which helps in tracking the form; ensure to check the box that indicates if the source is a Participating Agency or SWA/DLA.
4. For Box 3, select whether the certification is 'Original' or 'Revalidation' by marking the appropriate box.
5. Complete Box 4 by providing the conviction date, release date, and corrections institution ID number, if applicable, for ex-felon applicants.
6. In Box 5, enter the date when the eligibility determination was completed in the format of month, day, and year.
7. Fill in Box 6 with the name and address of the State Workforce Agency or Designated Local Agency responsible for the certification process.
8. In Box 7, include the signature of the authorized official who is certifying the information provided.
9. Provide a telephone number for the SWA/DLA or participating agency in Box 8.
10. In Part I, Box 9, enter the full name of the individual seeking certification.
11. Fill in Box 10 with the applicant's Social Security number accurately.
12. Check the relevant box in Box 11 to indicate if the individual qualifies as a Disabled Veteran.
13. In Box 12, input the individual's complete home address, including the city, state, and zip code, followed by a phone number.
14. For Box 13, mark the appropriate box that corresponds to the target group the individual belongs to, and provide additional required information.
15. Get the necessary signature from the applicant in Box 14.
16. Box 15 is reserved for the SWA/DLA to indicate the validity period of the conditional certification.
17. In Part II, start with Box 16 by entering the full name of the firm employing the individual.
18. For Box 17, provide the position or job title the employee will hold.
19. Indicate the employment start date in Box 18, using month, day, and year format.
20. In Box 19, input the starting wage the employee will receive per hour.
21. In Box 20, ensure the employer's name and signature are clearly indicated.
22. Lastly, in Box 21, include the date when the employer signed the form.
23. Save any changes to the document. You may download, print, or share the completed form as necessary.

Complete your Eta 9062 Form online today to ensure a smooth application process.