7-00 45 46 Public Works Employment Verification Form.pdf
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- Solicitation number
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- Northampton County, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors on public works projects. The form is associated with the River Road Water Main Replacement Project (Contract 2026-01) administered by the Lower Mahanoy Township Municipal Authority in Northumberland County, Pennsylvania. The form must be completed and submitted to the contracting public body prior to contract award. Contractors and subcontractors are required to verify enrollment in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security and must document the date of enrollment on the form. The form serves as the contractor's affirmation of compliance with Pennsylvania's Public Works Employment Verification Act, confirming that all employees are authorized to work in the United States.
The form requires that all public works contractors and subcontractors utilize the federal E-Verify Program to verify employment eligibility for each new hire within five business days of the employee's start date throughout the duration of the public works contract. Contractors must maintain documentation confirming the use of E-Verify for each new hire in the event of investigation or audit. An authorized company representative must sign and attest that all information contained in the verification form is true and correct, acknowledging that submission of false or misleading information is subject to legal sanctions.
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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 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 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
Herbert, Rowland & Grubic, Inc. 00 45 46 - 1 001787.0480 drarig Rectangle drarig Typewriter 003207.0440
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