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Private Employer Affidavit Of Compliance Pursuant To O. C. G.A. 36-60-6 d By executing this affidavit the undersigned private employer verifies its compliance with O. C. G*A. 36-60-6 stating affirmatively that the individual firm or corporation employs more than ten employees and has registered with and utilizes the federal work authorization program commonly known as E-Verify or any subsequent replacement program in accordance with the applicable provisions and deadlines established in O. C. G*A. 13-10-90. Furthermore the undersigned private employer hereby attests that its federal work authorization user identification number and date of authorization are as follows Federal Work Authorization User Identification Number Date of Authorization Name of Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on 201 in city state. Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF 201. C. G*A. 36-60-6 stating affirmatively that the individual firm or corporation employs more than ten employees and has registered with and utilizes the federal work authorization program commonly known as E-Verify or any subsequent replacement program in accordance with the applicable provisions and deadlines established in O. C. G*A. 13-10-90. Furthermore the undersigned private employer hereby attests that its federal work authorization user identification number and date of authorization are as follows Federal Work Authorization User Identification Number Date of Authorization Name of Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. C. G*A. 13-10-90. Furthermore the undersigned private employer hereby attests that its federal work authorization user identification number and date of authorization are as follows Federal Work Authorization User Identification Number Date of Authorization Name of Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on 201 in city state. Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF 201. C. G*A. 36-60-6 stating affirmatively that the individual firm or corporation employs more than ten employees and has registered with and utilizes the federal work authorization program commonly known as E-Verify or any subsequent replacement program in accordance with the applicable provisions and deadlines established in O. C. G*A. 13-10-90. Furthermore the undersigned private employer hereby attests that its federal work authorization user identification number and date of authorization are as follows Federal Work Authorization User Identification Number Date of Authorization Name of Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on 201 in city state. Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF 201. .

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