6-Employment Verification.pdf
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- Attached to
- Walnut Alley Drainage Improvements Project
- Solicitation number
- Not on record
- Issued by
- Lehigh County, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors working on public works projects, including the Walnut Alley Drainage Improvements Project managed by Myerstown Borough. The form serves as an attestation of compliance with the Public Works Employment Verification Act and confirms that contractors utilize the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security to verify employment eligibility. All employees hired after January 1, 2013, must be verified as authorized to work in the United States within five business days of their start date. Contractors and subcontractors are required to maintain documentation of E-Verify usage throughout the duration of the public works contract and submit the completed verification form prior to contract award or during the contract performance period.
The form requires an authorized representative of the contracting business to sign and attest that all information provided is true and accurate, with understanding that submission of false or misleading information subjects the company to sanctions under Pennsylvania law. The verification form must be completed for the specific contract referenced, including the contract number, project description, and project location details. Failure to comply with E-Verify requirements or employment verification standards may result in contract termination or debarment from future public works opportunities with the Commonwealth of Pennsylvania and its municipalities.
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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 |
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