2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- District Wide School Photography
- Solicitation number
- RFSQ 096-2026
- 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 the District Wide School Photography contract opportunity in Missouri. The affidavit serves as a compliance document confirming that bidders and service providers are enrolled in the E-Verify federal work authorization program and do not knowingly employ unauthorized aliens in connection with services provided to the district. The form is fillable and requires completion by an authorized company representative who must certify under oath that their organization participates in E-Verify to the extent allowed by the program and maintains compliance with federal work authorization requirements.
The affidavit must be notarized by a Missouri notary public and includes standard certification language acknowledging the affiant's legal age, firsthand knowledge of the facts stated, and authority to execute the document on behalf of the company. Execution and notarization requirements are clearly outlined, with designated spaces for the individual signature, company name, title, notary information, and commission expiration date. This document is a prerequisite compliance requirement for vendors seeking to bid on or be awarded the SLPS photography services contract.
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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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