Attachment F, Employment Verification form.pdf
PDF 77 KB Posted
- Attached to
- Replace Siding & Roofing Materials
- Solicitation number
- 6100036846
- Issued by
- Berks County, Troxelville CDP, Pennsylvania
About this file
This document is the Commonwealth of Pennsylvania Public Works Employment Verification Form. It is required for contractors and subcontractors on public works projects in Pennsylvania. The form affirms the contractor's compliance with the Public Works Employment Verification Act through the use of the federal E-Verify program to verify the employment eligibility of new hires. Contractors and subcontractors must utilize E-Verify to verify each new hire within five business days of the employee start date for the duration of the public works contract. The form must be signed by an authorized representative of the contracting company.
The document outlines the specific contract or project details, including the contract/project number, project description, and project location. It requires the contractor to provide information such as the business or organization name, address, and the contracting public body. The form serves as documentation of the contractor's compliance with the verification requirements and must be maintained in the event of an investigation or audit.
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
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
Attachment F, Employment Verification form
| 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 .