2-4. Supporting Documents 4 Public Works Employment Verification Form.pdf
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- Solicitation number
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- Delaware County, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors bidding on public works projects in the City of Chester, Pennsylvania. The form must be completed and submitted to the contracting public body prior to contract award. Bidders are required to verify compliance with the Public Works Employment Verification Act through enrollment and utilization of the federal E-Verify Program operated by the United States Department of Homeland Security. The form captures essential contractor information including company legal name, mailing address, contractor or subcontractor status, contract/project number, project description, and project location. Contractors must certify their E-Verify enrollment date and affirm that all employees are authorized to work in the United States as of the form submission date.
As a condition of contract award, contractors and subcontractors commit to utilizing the federal E-Verify Program to verify employment eligibility for each new hire within five business days of the employee start date throughout the duration of the public works contract. Contractors must maintain documentation confirming E-Verify usage for all new hires in preparation for potential investigations or audits. An authorized company representative must sign and date the form, certifying under penalty of law that all information provided is true and accurate. False or misleading information submitted in connection with this verification is subject to sanctions provided by law. The form requires contact information including phone number and email address for the authorized representative completing the certification.
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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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