4-Doc 00 73 00 4 - Appendix B - Public Works Employment Verification Form.pdf
PDF 63 KB Posted
- Attached to
- 2026 Bristol Borough CDBG Curb Ramp Program
- Solicitation number
- Not on record
- Issued by
- Bucks County, Brodheadsville CDP, Pennsylvania
About this file
This is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for use by contractors and subcontractors on public works projects, including the 2026 Bristol Borough CDBG Curb Ramp Program in Bucks County, Pennsylvania. The form serves as an attestation of compliance with the Public Works Employment Verification Act and requires all contractors and subcontractors to verify employment eligibility through the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. Contractors must confirm that all employees hired after January 1, 2013, are authorized to work in the United States and commit to utilizing the federal EVP to verify employment eligibility of each new hire within five business days of the employee start date throughout the duration of the public works contract. Documentation confirming use of the federal EVP for each new hire must be maintained for investigation or audit purposes.
The form requires completion and submission by an authorized representative of the contractor or subcontractor, who must attest under penalty of law that all information provided is true and correct. The submission of false or misleading information subjects the contractor to sanctions provided by law. This verification requirement applies to all public works projects, including infrastructure improvements funded through Community Development Block Grant (CDBG) programs such as the Bristol Borough curb ramp project, ensuring federal labor standards compliance and verification of worker authorization across the entire contractor and subcontractor team.
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Text version
COMMONWEALTH OF PENNSYLVANIA
PUBLIC WORKS EMPLOYMENT VERIFICATION FORM
Date _______________________
Business or Organization Name (Employer)_________________________________________________
Address _____________________________________________________________________________
City _____________________________________ State_____________ Zip Code ________________
Contractor {dzōŎƻƴǘNJŀŎǘƻNJ όŎƘŜŎƪ ƻƴŜύ
Contracting Public Body _______________________________________________________________
Contract/Project No ___________________________________________________________________
Project Description ____________________________________________________________________
Project Location ______________________________________________________________________
As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of the above date, our company is in compliance with the Public Works Employment Verification Act
(‘the Act’) through utilization of the federal E‐Verify Program (EVP) operated by the United States
Department of Homeland Security. To the best of my/our knowledge, all employees hired post
January 1, 2013 are authorized to work in the United States.
It is also agreed to that all public works contractors/subcontractors will utilize the federal EVP to verify the employment eligibility of each new hire within five (5) business days of the employee start date throughout the duration of the public works contract. Documentation confirming the use of the federal EVP upon each new hire shall be maintained in the event of an investigation or audit.
I, _________________________, authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by law.
Authorized Representative Signature
| Date: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Contracting Public Body: |
| ContractProject No: |
| Project Description: |
| Project Location: |
| Name: |
| Business or Organization Name - Employer: |
| Signature: |
| Check Box1: Off |
| Check Box2: Off |
File details come from the government source that posted it. Updated .