3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 088-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required by the St. Louis Public Schools (SLPS) for the Tornado: Soldan Field House Mitigation and Restoration project in Missouri. The affidavit serves as a compliance document whereby contractors and their authorized representatives certify under oath that their company is enrolled in the E-Verify federal work authorization program and does not knowingly employ unauthorized aliens in connection with services provided to the district. The form requires completion by an individual with firsthand knowledge and authority to execute the affidavit on behalf of the contracting company, along with notarization by a Missouri notary public to authenticate the declaration.
The affidavit includes standard attestation language requiring the affiant to confirm they are at least twenty-one years of age and possess direct knowledge of the company's E-Verify enrollment status and employment practices. The document is a fillable PDF format designed for multiple uses, with sections for the affiant's signature, company name, title, county designation, notary information, and commission expiration date. This form must be submitted as part of bid documentation or contract execution to demonstrate compliance with federal work authorization requirements applicable to public works projects in Missouri.
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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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