2-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFSQ 097-2026
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form for use by St. Louis Public Schools in connection with the African American Literature Library Initiative for Gateway MST Middle School. The affidavit requires a company representative over twenty-one years of age to certify, under oath, that the company is enrolled in the United States E-Verify federal work authorization program and that it does not knowingly employ any unauthorized aliens in connection with services provided to the school district. The form requires the affiant to provide their name, company name, title, and signature, and must be notarized in Missouri with the notary public's signature, commission expiration date, county, and date of execution.
The affidavit serves as a compliance document ensuring that vendors participating in the community-based reading services initiative meet federal work authorization requirements. No pricing, set-asides, or contract terms are specified in this form; it is a standardized attestation document that contractors must complete and submit as part of the qualification and contracting process with St. Louis Public Schools.
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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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