3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 086-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required for the Tornado: Washington Montessori Mitigation and Restoration contract opportunity in Missouri, administered by Saint Louis Public Schools (SLPS). The affidavit serves as a compliance document whereby authorized company representatives attest under oath that their organization is enrolled in the E-Verify federal work authorization program for all employees providing services to the district and that no unauthorized aliens are knowingly employed in connection with the contracted services. The form requires completion by an individual with authority to bind the company, including signature, company name, title, and notarization by a Missouri Notary Public.
The affidavit is a mandatory compliance requirement designed to verify adherence to federal work authorization regulations. Submission of this sworn statement certifies that the bidding company maintains current E-Verify enrollment and employment authorization verification protocols as a condition of contract eligibility with SLPS.
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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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