Laserfiche WebLink
WV FORM <br />WORKER VERIFICATION CERTIFICATION — 3rd PARTY VERIFIER ' <br />WV Auditor Name: <br />WV Auditor principal place of business: , <br />Business Name: <br />Title: <br />Street Address: , <br />City, State, Zip: <br />Telephone: <br />E-mail: , <br />Website (if any): <br />I, the undersigned, do hereby attest and affirm that: <br />1. I have reviewed the Form(s) I-9 executed in connection with the individual(s) listed be- <br />low and their employment with (Employer). <br />2. As to each individual listed below, Employer has on file a Form I-9 that is free of sub- <br />stantive or uncorrected technical deficiencies (other than timeliness deficiencies) and that <br />reflects that the individual is lawfully eligible to work for Employer. <br />3. I possess the requisite skill and knowledge to conduct an effective and meaningful com- <br />pliance review of Forms I-9 and related documents. <br />Full Legal Name of Individual Name of Employer <br />This Certification may be delivered to and relied upon by Wal-Mart Stores, Inc. <br />Certified by the undersigned as true, correct and complete this day of , <br />20 <br />Signed: <br />Name: <br />Contractor (/Subcontractor (circle one) further certifies the following <br />1. As to each individual listed above, Contractor/Subcontractor has on file a Form 1-9 that is <br />free of substantive or uncorrected technical deficiencies (other than timeliness deficien- <br />cies) and that reflects that the individual is lawfully eligible to work for Contractor /Sub- <br />contractor. <br />2. Copies of the employment eligibility and identity documentation for individuals who were <br />hired after the award of the Project to Contractor have been and will continue to be main- <br />tained by Contractor/Subcontractor for the life of the Contract/Subcontract. <br />01351-30 <br />0706 - Zephyrhills, Florida - 16592140 February 16, 2017 ' <br />