29-Doc 00 73 00 - 04 - APPENDIX B PUBLIC WORKS EMPLOYMENT VERIFICATION FORM.pdf
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- Attached to
- Heritage Hills WWTP Discharge Interconnection, Contract No. 6715-11 State and local contract opportunity
- Solicitation number
- Not on record
- Issued by
- Bucks County, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors working on the Upper Makefield Township 2026 Road Program in Pennsylvania. The form documents compliance with the Public Works Employment Verification Act and confirms that contractors utilize the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security to verify employment eligibility. All employees hired after January 1, 2013, must be verified as authorized to work in the United States. Contractors and subcontractors are required to verify employment eligibility for each new hire within five business days of the employee start date and maintain documentation of E-Verify usage throughout the contract duration in case of investigation or audit.
The form requires an authorized representative of the contracting company to attest under penalty of law that all information provided is true and correct. Submission of false or misleading information subjects the contractor to sanctions provided by law. The form must be completed and signed by the authorized representative with the contractor's address, the contracting public body, contract or project number, project description, and project location. This verification form is a mandatory compliance document that demonstrates the contractor's adherence to employment eligibility requirements before work commences on the public works project involving milling, base repair, leveling course, manhole rim adjustments, and wearing course improvements along various roads within Upper Makefield Township.
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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 |
File details come from the government source that posted it. Updated .