2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- District Whistleblower Hotline Services
- Solicitation number
- RFP 060-2025
- Issued by
- St. Louis County, Missouri
About this file
This document is a Federal Work Authorization Program Affidavit from the City of Saint Louis, Missouri, designed to verify a company's compliance with federal employment authorization requirements. The affidavit requires the company representative to affirm that they are over 21 years old, employed by the company with the authority to submit the document, and that the company is enrolled in the United States E-Verify program. The affiant must also confirm that the company does not knowingly employ unauthorized aliens in connection with services provided to the district.
The document is a standard legal form that requires notarization, with spaces for the individual's signature, company name, title, and official notary public certification. It serves as a formal declaration of the company's commitment to legal workforce practices, specifically focusing on verifying the employment eligibility of workers through the federal E-Verify system. The form is structured to provide legal accountability and ensure compliance with federal immigration employment regulations.
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Text version
FEDERAL WORK AUTHORIZATION PROGRAM AFFIDAVIT
I, __________________________________________, being of legal age and having been duly sworn upon my oath, state the following facts are true:
1. I am more than twenty-one years of age; and have first-hand knowledge of the matters set forth herein.
2. I am employed by ____________________________________ (hereinafter “Company”) and have authority to issue this affidavit on its behalf.
3. Company is enrolled in and participating in the United States E-Verify (formerly known as “Basic Pilot”) federal work authorization program with respect to Company’s employees working in connection with the services Company is providing to, or will provide to, the district, to the extent allowed by E-Verify.
4. Company does not knowingly employ any person who is an unauthorized alien in connection with the services Company is providing to, or will provide to, the district.
FURTHER AFFIANT SAYETH NOT.
By: _________________________________________________ (individual signature)
For: ________________________________________________ (company name)
Title: _______________________________________________
STATE OF MISSOURI)
) ss.
COUNTY OF __________________________)
On this _______ day of ______________, 20____, before me, _______________________, a Notary Public in and for such County and State, personally appeared _______________________________________ of
___________________________________________, known to me to be the person who executed the affidavit on behalf of said ________________________ and acknowledged to me that he or she executed the same for the purposes therein stated. Subscribed and affirmed before me this _______ day of
_________________, 20______.
Notary Public My commission expires on: _________________________
| I: |
| 2 I am employed by: |
| By: |
| For: |
| Title: |
| COUNTY OF: |
| On this: |
| day of: |
| 20: |
| before me: |
| and for such County and State personally appeared: |
| known to me to be the person who executed the: |
| affidavit on behalf of said: |
| same for the purposes therein stated Subscribed and affirmed before me this 1: |
| same for the purposes therein stated Subscribed and affirmed before me this 2: |
| 20_2: |
| Notary Public: |
| My commission expires on: |
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