3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Tornado: Bryan Hill ROOF (Slate and PVC)
- Solicitation number
- RFP 090-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required for a roofing project (Slate and PVC) at Bryan Hill in Springfield-Greene County Public Schools (SLPS), Missouri. The affidavit serves as a compliance document confirming that the contracting company is enrolled in the E-Verify federal work authorization program and does not knowingly employ unauthorized aliens in connection with the services provided to the district. The form requires the authorized company representative to affirm under oath that the company is participating in E-Verify to the extent allowed by the program and maintains compliance with federal work authorization requirements for all employees working on the project.
The document is a notarized, fillable form that must be completed by an individual with firsthand knowledge and authority to execute the affidavit on behalf of the contracting company. The affiant must be at least twenty-one years of age and sign the document before a notary public in Missouri, with all required fields including the notary's commission expiration date. This affidavit is a standard prerequisite compliance requirement for contractors bidding on SLPS projects and demonstrates the contractor's commitment to maintaining a lawfully authorized workforce in accordance with federal regulations.
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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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