4-Public Works Employment Verification Form.pdf
PDF 125 KB Posted
- Attached to
- Fairmont Plaza Development
- Solicitation number
- Not on record
- Issued by
- Wyoming County, 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. The form applies to the Fairmont Plaza Development project located in Youngsville Borough, Warren County, Pennsylvania, which involves construction of a plaza, stage, pedestrian walkways, and parking area, along with installation of lighting and utilities, ADA access improvements, landscaping, project signage, and related site improvements. Contractors and subcontractors must complete and submit this form to the contracting public body prior to contract award, certifying their enrollment date in the federal E-Verify Program and their compliance with Pennsylvania's Public Works Employment Verification Act.
The form requires contractors and subcontractors to affirm that their company is in compliance with the Public Works Employment Verification Act through participation in the federal E-Verify Program operated by the United States Department of Homeland Security and to certify that all employees hired are authorized to work in the United States. All public works contractors and subcontractors are obligated to utilize E-Verify to verify employment eligibility of each new hire within five business days of the employee start date throughout the contract duration, with documentation of E-Verify usage to be maintained for potential investigation or audit. The authorized representative of the company must sign and attest that all information provided is true and correct, with understanding that submission of false or misleading information is subject to legal sanctions.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Street Address 2
City State Zip Code
Doing Business As:
(if different from Legal Name)
Commonwealth of Pennsylvania Public Works Employment Verification Form
Complete and return the form to the contracting Public Body prior to the award of the contract.
Company Legal Name: ___________________________________________________________
Mailing Address: ______________________________________________________
Check one: Contractor Subcontractor
Contracting Public Body: _________________________________________________________
Contract/Project Number: ________________________________________________________
Project Description: _____________________________________________________________
Project Location: _______________________________________________________________
Date Enrolled in E-Verify (MM/DD/YYYY): ___________________________________________ As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of today’s 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 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 of Signature
Printed Name: _________________________________________________________________
Phone Number: ______________________ Email: ____________________________________
Street Address 1
| Company Legal Name: |
| Doing Business As: |
| Street Address 1: |
| Street Address 2: |
| City: |
| State: |
| Zip Code: |
| Contractor: Off |
| Subcontractor: Off |
| Contracting Public Body: |
| ContractProject Number: |
| Project Description: |
| Project Location: |
| Printed Name: |
| Phone Number: |
| Email: |
| Today's Date: |
| Name of Authorized Representative: |
| MM/DD/YYYY: |
File details come from the government source that posted it. Updated .