2-Employment Verification.pdf
PDF 57 KB Posted
- Solicitation number
- US.251220
- Issued by
- York County, Pennsylvania
About this file
This is a Public Works Employment Verification Form from the Commonwealth of Pennsylvania used in conjunction with the Re-Bid Eisenhower Drive Signalization Upgrade Project administered by Hanover Borough. The form serves as an attestation document that contractors and subcontractors are in compliance with Pennsylvania's Public Works Employment Verification Act. Contractors must verify that all employees hired after January 1, 2013, are authorized to work in the United States through the federal E-Verify Program operated by the Department of Homeland Security. Throughout the duration of the public works contract, all new hires must be verified within five business days of their start date, and documentation of E-Verify usage must be maintained for potential investigations or audits.
An authorized company representative must sign and attest that the information provided is true and correct, understanding that submission of false or misleading information may result in sanctions. The form requires project-specific details including the contractor name, address, contracting public body, contract/project number, project description, and project location. This employment verification requirement is mandatory for the Eisenhower Drive Signalization Upgrade Project, which involves traffic signal improvements and is subject to Pennsylvania Prevailing Wage requirements, OSHA compliance, the Pennsylvania One Call Act, and non-discrimination regulations, with bids due by October 20, 2026, at 2:00 PM.
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Text version
COMMONWEALTH OF PENNSYLVANIA
PUBLIC WORKS EMPLOYMENT VERIFICATION FORM
Date _______________________
Business or Organization Name (Employer)_________________________________________________
Address _____________________________________________________________________________
City _____________________________________ State_____________ Zip Code ________________
Contractor {dzōŎƻƴǘNJŀŎǘƻNJ όŎƘŜŎƪ ƻƴŜύ
Contracting Public Body _______________________________________________________________
Contract/Project No ___________________________________________________________________
Project Description ____________________________________________________________________
Project Location ______________________________________________________________________
As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of the above 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 post
January 1, 2013 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: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Contracting Public Body: |
| ContractProject No: |
| Project Description: |
| Project Location: |
| Name: |
| Business or Organization Name - Employer: |
| Signature: |
| Check Box1: Off |
| Check Box2: Off |
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