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Get Dol Eta 9061 2013

Of a felony or released from prison after a felony conviction during the year before you were hired? If YES, enter date of conviction ________________ and date of release _________________. Was this a Federal ____ or a State conviction_____? (Check one) Yes___ No___ Yes___ No___ Yes___No___ Yes___No___ Yes___No___ 18. Do you live in a Rural Renewal County or Empowerment Zone? Yes__ No __ 19. Do you live in an Empowerment Zone and are at least age 16, but not yet 18, on your hiring date? Ye.

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