E-Verify Registration Waiver Affidavit.pdf

SCS-E-Verify Registration Waiver Affidavit v.9.00 rev 4/26/2024

STATE COURTS SYSTEM

CONTRACTOR’S E-VERIFY REGISTRATION WAIVER AFFIDAVIT

I, , am the owner or authorized representative of the business entity shown below. I hereby acknowledge on behalf of my business or business entity that I am aware of the requirement in section 448.095(2)(a), Florida Statutes, that every public employer, contractor, and subcontractor shall register with and use the E-Verify system to verify the work authorization status of all newly hired employees.

Business or Business Entity Legal Name:

Business or Business Entity Legal Address:

Business or Business Entity Taxpayer Identification Number:

I hereby certify that my business:

Is not engaged as an “employer” who hires individuals as an “employee” to perform labor or services in exchange for a salary, wages or other renumeration requiring the completion and submission of the U.S. Citizenship and Immigration Services Form I-9, “Employment Eligibility Verification”, does not pay employee salaries or wages, does not collect federal withholding taxes from any salaries or wages and submit them to the Internal Revenue Service, has no power to dictate or control an individual’s work duties and obligations, and does not supervise employees of subcontractors.

Is organized outside the United States and its territories and does not have any physical locations within the United States, and is not considered an “employer”, as described in the paragraph above.

Does not have more than five (5) employees at any given time and does not hire more than five

(5) employees in a calendar year.

For the reasons stated above, my business or business entity is not eligible to register with and cannot use the Department of Homeland Security E-Verify System.

SCS-E-Verify Registration Waiver Affidavit v.9.00 rev 4/26/2024

By signing this affidavit, I agree not to hire employees who are not authorized to be employed in the United States pursuant to 8 U.S.C. s. 1324a(h)(3) at the time of employment or at any time throughout the term of the employment. I further acknowledge that I will notify the Contract Manager within ten (10) calendar days of any change in the business entity status as an employer or if any employees are hired.

I further acknowledge that the failure to make the appropriate notifications will result in the immediate termination of my contract.

I HEREBY AFFIRM AND VERIFY THAT THE FOREGOING IS TRUE AND CORRECT.

Sole Proprietor/Authorized Representative

Printed Name

STATE OF

COUNTY OF

Sworn to (or Affirmed) and Subscribed Before Me By Means of Physical Presence or Online Notarization this day of , 202 , by , Who

Is Personally Known to Me or Produced Identification.

Type of Identification Produced:

Signature of Notary Public

Printed Name of Notary Public Administering Oath Pursuant to §117.03, Florida Statutes