CERTIFICATION OF ALIEN EMPLOYMENT* 

 I certify that I am an authorized representative of the applicant and as such am authorized to make the statement of
  affirmation contained herein.
 I certify that the applicant does NOT knowingly employ any person who is an unauthorized alien and that the applicant
  has complied with federal law (8 U.S.C. § 1324a) requiring the examination of an appropriate document or documents
  to verify that each individual is not an unauthorized alien.
 I certify that applicant is enrolled and will participate in a federal work authorization program as defined in Section
  285.525(6), RSMo., with respect to employees working in connection with the activities that qualify applicant for this
  program. I certify that applicant will maintain and, upon request, provide the Department of Economic Development
  documentation demonstrating applicant’s participation in a federal work authorization program with respect to
  employees working in connection with the activities that qualify applicant for this program.
 I certify that applicant shall include in any contract it enters with a subcontractor in connection with the activities that
  qualify applicant for this program, an affirmative statement from the subcontractor that such subcontractor is not
  knowingly in violation of Section 285.530.1, RSMo, and shall not be in violation during the length of the contract.  In
  addition applicant will receive a sworn affidavit from the subcontractor under the penalty of perjury, attesting that the
  subcontractor’s employees are lawfully present in the United States. I certify that applicant will maintain and provide the
  Department of Economic Development access to documentation demonstrating compliance with this requirement.
 I understand that if the applicant is found to have employed an unauthorized alien, applicant may subject to penalties
  pursuant to Sections 135.815, 285.025, and 285.535, RSMo.
  I certify that I have included a copy of the executed E-Verify Program for Employment Verification Memorandum of
  Understanding between the company/organization and the Department of Homeland Security, United States Citizenship
  and Immigration Services (DHS-USCIS) and Social Security Administration.
  I am not a business entity as defined in RSMo 285.525 (1) as “any person or group of persons performing or engaging in
  any activity, enterprise, profession, or occupation for gain, benefit, advantage or livelihood.  The term “business entity”
  shall include but not be limited to self-employed individuals, partnerships, corporations, contractors, and subcontractors.
  The term “business entity” shall include any business entity that possesses a business permit, license, or tax certificate,
  issued by the state, any business entity that is exempt by law from obtaining such a business permit, any business entity
  that is operating unlawfully without such a business permit.  The term “business entity” shall not include a self-employed
  individual with no employees or entities utilizing the services of direct sellers as defined in subdivision (17) of subsection 12
  of section 288.034, RSMo.”
 I certify under penalties of perjury that the above statements, information contained in the application and attachments
  are complete, true, and correct to the best of my knowledge.

NAME (SIGNATURE)                                                         DATE 

NAME (PRINTED OR TYPED)                                                  APPLICANT/PROJECT NAME (PRINTED OR TYPED) 

TITLE (PRINTED OR TYPED) 

NOTARY PUBLIC EMBOSSER OR BLACK INK STATE                                                      COUNTY (OR CITY OF ST. LOUIS) 
RUBBER STAMP SEAL 
                                    SUBSCRIBED AND SWORN BEFORE ME, THIS 
                                                                                               USE RUBBER STAMP IN CLEAR AREA BELOW.
                                          DAY OF                     YEAR  
                                    NOTARY PUBLIC SIGNATURE              MY COMMISSION EXPIRES 

                                    NOTARY PUBLIC NAME (TYPED OR PRINTED) 

  MO 419-2484 (10-99)