Common use of AFFIDAVIT OF WORK AUTHORIZATION Clause in Contracts

AFFIDAVIT OF WORK AUTHORIZATION. The Employer who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now (Name of Business Entity Authorized Representative) as (Position/Title), first being duly sworn on my oath, affirm 285.530 RSMo. I also affirm that (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the agreed services provided under the agreement(s) for the duration of the agreement(s), if awarded. Authorized Business Entity Authorized Business Entity Representative's Name (Please Print) Representative's Signature Position/Title (Please Print) Date Email Address (Please Print) E-verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a Notary Public within the County of , State of , and my commission expires on (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, DO NOT complete Box B.) I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525 RSMo, pertaining to section 285.530 RSMo, and has enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to agreements(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency, Missouri Job Center, Local Workforce Development Board, or or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following: The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Employer's name and the MOU signature page completed and signed by the Employer and the U.S. Department of Homeland Security—Verification Division. A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, or Public University* to which previous E-Verify Documentation was submitted:

AFFIDAVIT OF WORK AUTHORIZATION. The Employer bidder/contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now _ (Name of Business Entity Authorized Representative) as (Position/Title), ) first being duly sworn on my oath, affirm 285.530 (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that _ (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the agreed contracted services provided under the agreement(scontract(s) for the duration of the agreement(scontract(s), if awarded. Authorized Business Entity Authorized Business Entity Representative's ’s Signature Printed Name (Please Print) Representative's Signature Position/Title (Please Print) Date Email Address (Please Print) E-verify Mail Address E-Verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a Notary Public notary public within the County of , State of , and my commission expires on (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) . Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, DO NOT complete Box B.) I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525 285.525, RSMo, pertaining to section 285.530 285.530, RSMo, and has have enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to agreements(scontract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency, Missouri Job Center, Local Workforce Development Board, or agency or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following: .  The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Employer's bidder’s/contractor’s name and the MOU signature page completed and signed by the Employer bidder/contractor and the U.S. Department of Homeland Security—Security – Verification Division. Division  A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with within the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, Agency or Public University* to which previous Which Previous E-Verify Documentation was submitted:Submitted: *Public University includes the following five schools under chapter 34, RSMo: Xxxxxx-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Name (Please Print) Authorized Business Entity Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date Documentation Verification Completed By: Buyer Date This certification is required by 2 CFR Part 180.

AFFIDAVIT OF WORK AUTHORIZATION. The Employer contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now (Name of Business Entity Authorized Representative) as (Position/Title), ) first being duly sworn on my oath, affirm 285.530 (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the agreed contracted services provided under the agreement(scontract(s) for the duration of the agreement(scontract(s), if awarded. Authorized Business Entity Authorized Business Entity Representative's Name (Please Print) Representative's Signature Position/Title (Please Print) Date Email Address (Please Print) E-verify Mail Address E-Verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a Notary Public notary public commissioned as a notary public within the County of , State of , and my commission expires on (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) Signature of Notary Date and my commission expires on . Exhibit # 1: (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, DO NOT complete Box B.continued) I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525 285.525, RSMo, pertaining to section 285.530 285.530, RSMo, and has have enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to agreements(scontract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency, Missouri Job Center, Local Workforce Development Board, or agency or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following: . ✓ The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Employer's contractor’s name and the MOU signature page completed and signed by the Employer contractor and the U.S. Department of Homeland Security—Security – Verification Division. Division ✓ A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with within the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, Agency or Public University* to which previous Which Previous E-Verify Documentation was submitted:Submitted: *Public University includes the following five schools under chapter 34, RSMo: Xxxxxx-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Authorized Business Entity Name (Please Print) Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date Documentation Verification Completed By: Buyer Date This certification is required by 2 CFR Part 180.

AFFIDAVIT OF WORK AUTHORIZATION. The Employer bidder/contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now (Name of Business Entity Authorized Representative) as (Position/Title), ) first being duly sworn on my oath, affirm 285.530 (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the agreed contracted services provided under the agreement(scontract(s) for the duration of the agreement(scontract(s), if awarded. Authorized Business Entity Authorized Business Entity Representative's ’s Signature Printed Name (Please Print) Representative's Signature Position/Title (Please Print) Date Email Address (Please Print) E-verify Mail Address E-Verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a Notary Public notary public within the County of , State of , and my commission expires on (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) and my commission expires on . Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current BOX C – Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, DO NOT complete Box B.) File - Current Business Entity Status I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525 285.525, RSMo, pertaining to section 285.530 285.530, RSMo, and has have enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to agreements(scontract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency, Missouri Job Center, Local Workforce Development Board, or agency or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following: .  The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Employer's bidder’s/contractor’s name and the MOU signature page completed and signed by the Employer bidder/contractor and the U.S. Department of Homeland Security—Security – Verification Division. Division  A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with within the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, Agency or Public University* to which previous Which Previous E-Verify Documentation was submitted:Submitted: *Public University includes the following five schools under chapter 34, RSMo: Xxxxxx-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Name (Please Print) Authorized Business Entity Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date Documentation Verification Completed By: Buyer Date This certification is required by 2 CFR Part 180.

AFFIDAVIT OF WORK AUTHORIZATION. The Employer who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now (Name of Business Entity Authorized Representative) as (Position/Title), first being duly sworn on my oath, affirm 285.530 RSMo. I also affirm that (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the agreed services provided under the agreement(s) for the duration of the agreement(s), if awarded. Authorized Business Entity Authorized Business Entity Representative's Name (Please Print) Representative's Signature Position/Title (Please Print) Date Email Address (Please Print) E-verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a Notary Public within the County of , State of , and my commission expires on (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, DO NOT complete Box B.) I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525 RSMo, pertaining to section 285.530 RSMo, and has enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to agreements(scontract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency, Missouri Job Center, Local Workforce Development Board, or or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following: The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Employer's name and the MOU signature page completed and signed by the Employer and the U.S. Department of Homeland Security—Verification Division. A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, or Public University* to which previous E-Verify Documentation was submitted:

AFFIDAVIT OF WORK AUTHORIZATION. The Employer bidder/contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now _ (Name of Business Entity Authorized Representative) as (Position/Title), ) first being duly sworn on my oath, affirm 285.530 (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the agreed contracted services provided under the agreement(scontract(s) for the duration of the agreement(scontract(s), if awarded. Authorized Business Entity Authorized Business Entity Representative's ’s Signature Printed Name (Please Print) Representative's Signature Position/Title (Please Print) Date Email Address (Please Print) E-verify Mail Address E-Verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a Notary Public notary public within the County of , State of , and my commission expires on (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) . Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current BOX C – Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, DO NOT complete Box B.) File - Current Business Entity Status I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525 285.525, RSMo, pertaining to section 285.530 285.530, RSMo, and has have enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to agreements(scontract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency, Missouri Job Center, Local Workforce Development Board, or agency or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following: .  The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Employer's bidder’s/contractor’s name and the MOU signature page completed and signed by the Employer bidder/contractor and the U.S. Department of Homeland Security—Security – Verification Division. Division  A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with within the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, Agency or Public University* to which previous Which Previous E-Verify Documentation was submitted:Submitted: *Public University includes the following five schools under chapter 34, RSMo: Xxxxxx-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Name (Please Print) Authorized Business Entity Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date Documentation Verification Completed By: Buyer Date This certification is required by 2 CFR Part 180.

AFFIDAVIT OF WORK AUTHORIZATION. The Employer bidder/contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization. Comes now _ (Name of Business Entity Authorized Representative) as (Position/Title), ) first being duly sworn on my oath, affirm 285.530 (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that _ (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the agreed contracted services provided under the agreement(scontract(s) for the duration of the agreement(scontract(s), if awarded. Authorized Business Entity Authorized Business Entity Representative's ’s Signature Printed Name (Please Print) Representative's Signature Position/Title (Please Print) Date Email Address (Please Print) E-verify Mail Address E-Verify Company ID Number Subscribed and sworn to before me this of . I am commissioned as a Notary Public notary (DAY) (MONTH, YEAR) public within the County of , State of , and my commission expires on (DATE OF EXPIRATION) (NAME OF COUNTY) (NAME OF STATE) and my commission expires on . Signature of Notary Date (Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, DO NOT complete Box B.) I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525 285.525, RSMo, pertaining to section 285.530 285.530, RSMo, and has have enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to agreements(scontract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency, Missouri Job Center, Local Workforce Development Board, or agency or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following: . ✓ The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Employer's bidder’s/contractor’s name and the MOU signature page completed and signed by the Employer bidder/contractor and the U.S. Department of Homeland Security—Security – Verification Division. Division ✓ A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized with within the past twelve months). Name of Missouri State Agency, Missouri Job Center, Local Workforce Development Board, Agency or Public University* to which previous Which Previous E-Verify Documentation was submitted:Submitted: *Public University includes the following five schools under chapter 34, RSMo: Xxxxxx-Xxxxx State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Xxxxxx; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau. Date of Previous E-Verify Documentation Submission: Previous Bid/Contract Number for Which Previous E-Verify Documentation Submitted: (if known) Authorized Business Entity Representative’s Authorized Business Entity Name (Please Print) Representative’s Signature E-Verify MOU Company ID Number E-Mail Address Business Entity Name Date Documentation Verification Completed By: Buyer Date This certification is required by 2 CFR Part 180. (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION)