1-Public Works Employment Verification Form 01032023.pdf
PDF 125 KB Posted
- Attached to
- Pavement Marking Improvements Project
- Solicitation number
- Not on record
- Issued by
- Bucks County, Pennsylvania
About this file
This is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania, applicable to contractors and subcontractors working on public works projects within the state. The form serves as a compliance document requiring contractors to affirm enrollment in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security and certify that all employees are authorized to work in the United States. Contractors and subcontractors must complete and return this form to the contracting public body prior to contract award. The document establishes ongoing verification requirements, mandating that all new hires be verified through E-Verify within five business days of the employee start date throughout the duration of the public works contract. Documentation confirming E-Verify usage must be maintained and made available for investigations or audits.
The form requires completion by an authorized company representative who must attest under penalty of law that all information provided is true and correct. Required information includes the company's legal name, doing business as name (if applicable), mailing address, contracting public body, contract or project number, project description, project location, and the date of E-Verify enrollment. The authorized representative must provide their printed name, signature, phone number, email address, and the date of signature. False or misleading information submitted on this form subjects the contractor to sanctions provided by law. This verification requirement applies to all public works contracts in Pennsylvania and represents a mandatory compliance measure to ensure legal employment practices on state and local public works projects.
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Text version
Street Address 2
City State Zip Code
Doing Business As:
(if different from Legal Name)
Commonwealth of Pennsylvania Public Works Employment Verification Form
Complete and return the form to the contracting Public Body prior to the award of the contract.
Company Legal Name: ___________________________________________________________
Mailing Address: ______________________________________________________
Check one: Contractor Subcontractor
Contracting Public Body: _________________________________________________________
Contract/Project Number: ________________________________________________________
Project Description: _____________________________________________________________
Project Location: _______________________________________________________________
Date Enrolled in E-Verify (MM/DD/YYYY): ___________________________________________ As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of today’s date, __________________________, our company is in compliance with the Public Works Employment Verification Act (‘the Act’) through utilization of the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. To the best of my/our knowledge, all employees hired are authorized to work in the United States.
It is also agreed to that all public works contractors/subcontractors will utilize the federal EVP to verify the employment eligibility of each new hire within five (5) business days of the employee start date throughout the duration of the public works contract. Documentation confirming the use of the federal EVP upon each new hire shall be maintained in the event of an investigation or audit.
I,____________________________________________, authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by law.
Authorized Representative Signature Date of Signature
Printed Name: _________________________________________________________________
Phone Number: ______________________ Email: ____________________________________
Street Address 1
| Company Legal Name: |
| Doing Business As: |
| Street Address 1: |
| Street Address 2: |
| City: |
| State: |
| Zip Code: |
| Contractor: Off |
| Subcontractor: Off |
| Contracting Public Body: |
| ContractProject Number: |
| Project Description: |
| Project Location: |
| Printed Name: |
| Phone Number: |
| Email: |
| Today's Date: |
| Name of Authorized Representative: |
| MM/DD/YYYY: |
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