<div class="dol-form-section-title">
  <h2>
    <span id="assurancesHeading">Representations and Written Assurances</span>
    <helplink aria-controls="assurancesHelp" aria-describedby="assurancesHeading"></helplink>
  </h2>
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  All fields are required unless indicated as optional.
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<helptext  id="assurancesHelp">An authorized representative of the employer must provide an electronic signature certifying to the information included in this section.  SWEP applications must be signed by the school counselor or coordinating official.</helptext>
<div class="dol-form-page">
  <div class="usa-content">
    <p>
      I certify that I have read this application and to the best of my knowledge and belief, all answers and information given in the application and attachments are true; that the representations set forth in support of this application to obtain or continue the authorization to pay workers with disabilities at subminimum wage rates are true; and I acknowledge that the authorization, if issued or continued, is subject to revocation in accordance with the provisions of <a href="https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=2c2c1e5e4f61356b4516a55834d00bfd&r=PART&n=29y3.1.1.1.17" target="_blank">29 C.F.R. part 525</a>.
    </p>  
    <p>
      I represent that as set forth in the regulations governing the employment of workers with disabilities, the following conditions exist and will continue to exist:
    </p>
    <ol type="1">
      <li>Workers employed under the authority in <a href="https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=2c2c1e5e4f61356b4516a55834d00bfd&r=PART&n=29y3.1.1.1.17" target="_blank">29 C.F.R. part 525</a> have disabilities for the work to be performed;</li>
      <li>Wage rates paid to workers with disabilities under the authority in <a href="https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=2c2c1e5e4f61356b4516a55834d00bfd&r=PART&n=29y3.1.1.1.17" target="_blank">29 C.F.R. part 525</a> are commensurate with those paid experienced workers, who do not have disabilities, in industry in the vicinity for essentially the same type, quality, and quantity of work;</li>
      <li>The operations are and will continue to be in compliance with the Fair Labor Standards Act (FLSA), the Walsh-Healey Public Contracts Act (PCA), the McNamara-O’Hara Service Contract Act (SCA), and the Contract Work Hours and Safety Standards Act (CWHSSA), an overtime statute for Federal contract work, as applicable;</li>
      <li>No deductions will be made from the commensurate wages earned by a patient worker to cover the cost of room, board or other services provided by the facility;</li>
      <li>Records required under <a href="https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=2c2c1e5e4f61356b4516a55834d00bfd&r=PART&n=29y3.1.1.1.17" target="_blank">29 C.F.R. part 525</a> with respect to documentation of disability, productivity, work measurements or time studies, and prevailing wage surveys will be maintained.</li>
    </ol>
    <p>Further, I certify that:</p>
    <ol type="1">
      <li>The wage rates of all hourly-rated employees paid in accordance with FLSA section 14(c) will be reviewed at least every six months; and</li>
      <li>Wages paid to all employees under FLSA section 14(c) will be adjusted at periodic intervals, at least once a year, to reflect changes in the prevailing wage paid to experienced workers, who do not have disabilities, employed in the vicinity for essentially the same type of work.</li>
    </ol>
  </div>
  <div class="dol-form-question-block" ng-class="validate('signature.agreement') ? 'usa-input-error margintop' : 'margintop'">
    <span class="usa-input-error-message" role="alert" tabindex="0" ng-show="validate('signature.agreement')">{{ validate('signature.agreement') }}</span>
    <ul class="usa-unstyled-list">
      <li>
        <input id="agreement" type="checkbox" name="agreement" ng-value="true" ng-model="formData.signature.agreement"></input>
        <label for="agreement" class="full-width-label">I agree to use an electronic signature. By entering my Full Name and Title below, I certify that I am authorized to accept these representations and assurances on behalf of the organization named on this application.</label>
      </li>
    </ul>
  </div>
  <div class="dol-form-question-block" ng-class="validate('signature.firstName') ? 'usa-input-error margintop' : 'margintop'">
    <label for="firstName" class="dol-form-question-text">First Name</label>
    <span class="usa-input-error-message" role="alert" tabindex="0" ng-show="validate('signature.firstName')">{{ validate('signature.firstName') }}</span>
    <input id="firstName" name="firstName" type="text" ng-model="formData.signature.firstName" />
  </div>
  <div class="dol-form-question-block" ng-class="validate('signature.lastName') ? 'usa-input-error margintop' : 'margintop'">
    <label for="lastName" class="dol-form-question-text">Last Name</label>
    <span class="usa-input-error-message" role="alert" tabindex="0" ng-show="validate('signature.lastName')">{{ validate('signature.lastName') }}</span>
    <input id="lastName" name="lastName" type="text" ng-model="formData.signature.lastName" />
  </div>
  <div class="dol-form-question-block" ng-class="validate('signature.title') ? 'usa-input-error margintop' : 'margintop'">
    <label for="title" class="dol-form-question-text">Title</label>
    <span class="usa-input-error-message" role="alert" tabindex="0" ng-show="validate('signature.title')">{{ validate('signature.title') }}</span>
    <input id="title" name="title" type="text" ng-model="formData.signature.title" />
  </div>
  <div class="dol-form-question-block" ng-class="validate('signature.date') ? 'usa-input-error margintop' : 'margintop'">
    <fieldset>
      <legend class="dol-form-question-text">Date</legend>
      <span class="usa-input-error-message" role="alert" tabindex="0" ng-show="validate('signature.date')">{{ validate('signature.date') }}</span>
      <date-field date-val="formData.signature.date"></date-field>
    </fieldset>
  </div>
</div>
