3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Renovation & Additions for Central VPA & Collegiate Medicine & Bioscience High Schools (2. 0)
- Solicitation number
- RFP 056-2025
- Issued by
- St. Louis City, Missouri
About this file
This document is a Federal Work Authorization Program Affidavit issued by the City of Saint Louis, as indicated by the city seal on the document. The affidavit is a standard form that requires a company representative to attest to their compliance with federal work authorization requirements, specifically the United States E-Verify program. The affiant must confirm they are over 21 years old, have first-hand knowledge of the company's employment practices, and declare that the company is enrolled in the E-Verify program.
The key requirements outlined in the affidavit include the company's commitment to participating in the E-Verify federal work authorization program for employees working on district services, and a sworn statement that the company does not knowingly employ unauthorized aliens. The document provides a formal template for a company representative to sign and have notarized, affirming their compliance with federal employment verification standards. The affidavit is designed to be completed in the State of Missouri and requires signatures from both the company representative and a notary public to be considered valid.
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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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