2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Professional Development, Performance Evaluation and Absence Management Software Solutions
- Solicitation number
- RFP 095-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required by St. Louis Public Schools (SLPS) for a professional development, performance evaluation, and absence management software solutions contract opportunity in Missouri. The affidavit serves as a compliance document to verify that contractors and their employees are authorized to work in the United States. The form requires the authorized company representative to attest under oath that the company is enrolled in the E-Verify federal work authorization program and does not knowingly employ any unauthorized aliens in connection with services provided to the district. The document must be notarized and includes spaces for the affiant's signature, company name, title, and the notary public's certification and commission expiration date.
The affidavit is a mandatory compliance requirement for bid submission on this SLPS contract opportunity. It does not contain pricing information, set-asides, or other contract-specific terms, but rather functions as a pre-award verification document to ensure contractor compliance with federal employment authorization requirements. All prospective bidders must complete, sign, and have notarized this form as part of their proposal submission to demonstrate their commitment to employing only authorized workers on District-related services.
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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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