Please submit this application with the following applicable documents: Unemployment wage transcript, last paystub received, copy of child support order, and copy of social security documents.
I certify that the information I have provided to determine my eligibility for assistance through the City of Jacksonville’s Neighborhood Improvement Services is true and complete to the best of my knowledge. I understand that if the City discovers new information that indicates that I am not eligible for the program; my participation in the program could be canceled prior to program assistance approval. For the purpose of verification of information required by this application, I give my consent to the City of Jacksonville’s Neighborhood Improvement Services its agents and contractors to examine my confidential information given herein. I further grant permission, and authorize any bank, employer, credit bureau, or other public or private agency to disclose information deemed necessary to complete this application.
I certify and attest that the information is complete and accurate to the best of my knowledge. I certify that I have not received funding for utility assistance from another source. I understand that failure to provide complete and accurate information may be the basis for rejection of my application. My signature below attests that all information provided is accurate to the best of my knowledge.