3-E Verify affadavit - fillable.pdf
PDF 102 KB Posted
- Attached to
- Tornado: Sumner Mitigation and ROOF
- Solicitation number
- RFP 082-2025
- Issued by
- St. Louis City, Missouri
About this file
This is a Federal Work Authorization Program Affidavit form required by the State of Missouri for the Tornado: Sumner Mitigation and Roof project, applicable to vendors and contractors engaging with Saint Louis Public Schools (SLPS). The affidavit serves as a sworn statement confirming that the employing company is enrolled in and actively participating in the United States E-Verify federal work authorization program for all employees working on services provided to the district. The form requires completion by an authorized company representative who must certify under oath that the company does not knowingly employ any unauthorized aliens in connection with the services being provided, and the affidavit must be notarized by a Missouri notary public with documented commission expiration date.
The document is a fillable PDF template designed for vendor compliance with federal work authorization requirements. Completion requires the affiant to provide personal identification, company name, title, and signature, as well as notarization details including the county, date, and notary information. This affidavit is mandatory for any vendor or contractor bidding on or performing work for the SLPS project and represents a binding legal verification of the company's participation in E-Verify and its compliance with federal employment authorization standards.
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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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