[Pinal County] PC TRP Employee Verification Form

Travel Reduction Progam (TRP) Employee Verification Form

Employers must submit an Employee Verification Form (EVF) for all worksite locations within Pinal County identifying the number of employees reporting to each site. All teleworkers that reside in Arizona and any vacant positions that are planned to be filled should be included in the employee count. TRP reserves the right to contact the organization at any time or request any additional supporting documentation. Please email AirQualityTRP@pinal.gov or call (520) 866-6806 if you need assistance or have questions.

Organization Name:

Number of Employees (count employees that work 3 or more days per week for at least 6 months out of the year)

Number of Driving Aged Students:

Transportation Coordinator Name

Transportation Coordinator Information

Title: *

Phone: *

Email: *

Highest Ranking Local Official Name:

Highest Ranking Local Official Information

Title: *

Phone: *

Email: *

Highest Ranking Local Offical Signature

First Name

Last Name

Choose how to sign

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CERTIFICATION OF TRUTH, ACCURACY, AND COMPLETENESS: Any application form or report submitted under A.R.S. §49-581 et. seq., and the Pinal County Area A Travel Reduction Program Ordinance shall contain a certification by a responsible official of truth, accuracy, and completeness of the application form or report as of the time of submittal. This certification and any other certification required under these rules shall state that, based on information and belief formed after reasonable inquiry, the statements and information in the document are true, accurate, and complete.