Can the statement be e-signed?

Yes. Electronic signatures meet federal requirements under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and record retention are present.

Is notarization always required?

Not always. Notarization depends on procurement instructions or state rules. When a contract or agency requires notarized evidence, follow the specific notary or RON procedures applicable in that jurisdiction.

What supporting documents are acceptable?

Common proofs include a utility bill, lease agreement, or state ID showing the residential address. Record the document type and collection date for each supporting item to simplify audits.

How should I handle an address change?

Obtain an updated employment statement and supporting proof promptly. Update HR records and any active HUBZone certifications if the change affects the employee’s HUBZone residency status.

Can health information appear on the form?

Avoid including protected health information (PHI) unless strictly necessary. If PHI is present, handle records under HIPAA rules and ensure any eSignature vendor executes a BAA.

How long before an audit should records be accessible?

Maintain signed statements and supporting records according to retention policy; ensure retrieval within the agency’s response timeframe, typically days to weeks depending on the request.

Electronic Signature
Templates
HR
HUBZone Employment Statement

HUBZone Employment Statement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

HUBZone Employment Statement

Employer Information

Company Name Company Address Authorized Official

Phone

Email

Employee Information

Employee Full Name Residential Address (principal residence)

Phone

Email

Position and Work Location

Job Title: Department:

Immediate Supervisor: Proposed Start Date:

Employment Status: Full-time Part-time Average Hours per Week:

Primary Work Site Address (where employee will perform duties)

Is the primary work site located within a HUBZone? Yes No

Telework arrangements (if any):

HUBZone Residency and Certification

The undersigned employer certifies, under penalty of perjury, that the employee named above maintains a principal residence within a Historically Underutilized Business Zone (HUBZone) as defined by applicable regulations, and that the residence provided on this form is the employee's principal place of abode. Employer further certifies that employee occupies the residence identified above and that the information supplied is true and correct to the best of the employer's knowledge.

Employer affirms that, if the employee's work location or residence changes in a manner that affects HUBZone status, employer will document the change and retain records to support any determinations. Employer acknowledges that intentional falsification of residency or employment information may subject the company and responsible individuals to administrative remedies.

Supporting Documentation Provided (check all that apply)

Driver's license or state ID showing residential address
Utility bill (within last 60 days)
Lease or mortgage statement
Other (describe below)

If Other, describe

Employment History (Most Recent)

Previous Employer 1 - Company Name

Title

From

To

Responsibilities Reason for Leaving Previous Employer 2 - Company Name

Title

From

To

Responsibilities Reason for Leaving

Education

Highest Degree or Certification Institution Graduation Date

Professional References

Reference 1 - Name

Phone

Email

Relationship Reference 2 - Name

Phone

Email

Relationship Reference 3 - Name

Phone

Email

Relationship

Legal Disclosures

At-Will Employment: Nothing in this statement creates a contract guaranteeing employment for any specific period. Employment is at will and may be terminated by the employer or the employee at any time, with or without cause or notice, unless otherwise set forth in a separate, written agreement signed by an authorized company representative.

Equal Opportunity: The employer is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law. Applicants and employees will be considered based on qualifications and merit.

Applicant Certification and Authorization

I certify that all information provided on this HUBZone Employment Statement is true, complete, and accurate to the best of my knowledge. I understand that false statements or material omissions may be grounds for disciplinary action, up to and including termination, and may subject me or the employer to penalties under applicable laws and regulations.

I authorize the employer to contact prior employers and references listed on this form and to conduct appropriate background and residency verification as necessary to support HUBZone eligibility determinations. I consent to the employer's retention of copies of supporting documentation used to verify residency.

I certify the foregoing and authorize prior employer and reference contacts.

Acknowledgment of Record Retention

Employer will retain copies of this statement and supporting documentation for the period required by applicable procurement and recordkeeping regulations or company retention policy, whichever is longer. Documentation must be made available to authorized auditors or officials upon lawful request.

Employer (Company) - Printed Name:

By (Authorized Signature):

Date:

Employee - Printed Name:

By (Employee Signature):

Date:

What the HUBZone Employment Statement Is and When it’s Used

A HUBZone Employment Statement documents an employee’s residency and employment details for purposes of the U.S. Small Business Administration’s HUBZone program and related contracting or certification processes. Typically completed by an employer or HR representative, it records the employee’s name, residential address, start date, job title, and an attestation that the listed residence is within a designated HUBZone census tract. The form supports initial HUBZone applications, periodic recertification, and verifications during contract award reviews or audits by federal contracting officers.

Why a Clear HUBZone Employment Statement Matters

A precise employment statement helps demonstrate compliance with HUBZone residency requirements, reduces the risk of audit findings, and supports timely contract awards. Properly completed statements make verifications faster and help protect a firm from eligibility challenges or corrective actions during SBA reviews.

Who Typically Prepares and Uses This Statement

Employers, HR teams, and contracting officers rely on this statement during HUBZone certification, recertification, and contract procurement reviews.

Small business owners and compliance leads preparing HUBZone certification materials.
Human resources staff collecting and verifying employee residency evidence.
Contracting officers and proposals teams confirming contractor eligibility for set-aside awards.

Knowing which roles prepare, review, and sign the statement helps set internal workflows and approval authorities for accurate submissions.

Essential Parts of a Professional HUBZone Employment Statement

A thorough statement groups employer details, employee data, residency attestation, verification method, signature and date, and retention instructions so reviewers can confirm eligibility without follow-up. Each element should be explicit, verifiable, and consistent with supporting documents such as utility bills or driver's licenses.

Employer Details

Company legal name, DBA if any, mailing address, and a contact person for verification. Include DUNS or SAM registration number if applicable and relevant to procurement reviews.

Employee Identity

Full legal name, job title, employee ID or personnel number, and the effective employment start date as recorded in payroll or HRIS systems to match other records.

Residential Address

Complete street address, city, state, and ZIP code. Use the exact address that will be cross-checked against HUBZone census tracts during SBA eligibility review.

Residency Attestation

Clear statement signed by employee or employer asserting the residence is within a HUBZone-designated area and noting the residency start date when applicable.

Verification Method

List documents used to confirm address (utility bill, lease, driver’s license) and the date those supporting documents were collected and reviewed by HR.

Signature and Date

Signature lines for the employee and an authorized company representative plus dates. If notarization is required or chosen, include that block as specified.

Stepwise Process: From Collection to Submission

Complete the statement in a consistent order to streamline verification and archival.

01

Gather Documents: Collect ID and proof-of-residence documents before starting the form.
02

Populate Statement: Enter employer and employee fields exactly as supporting documents show.
03

Authenticate Signatures: Obtain required signatures, notarization, or witness attestations as applicable.
04

Store and Submit: Retain copies with HR records and submit with HUBZone application or contract file.

Where to Send or File the Completed Statement

Know the proper recipients and file locations so the statement supports certification and procurement records.

SBA Certification: Attach to the company’s HUBZone application or recertification package for SBA reviewers.
Contract File: Include a copy in procurement proposal binders and contract award packages for federal contracting officers.
HR Recordkeeping: Retain a signed copy in the employee’s HR personnel file and payroll records.
Audit Copies: Provide certified copies to auditors or contracting officers upon formal request.

Configuring an Electronic Workflow for the Statement

Set up a consistent template and authentication controls when using digital workflows to collect and store statements.

Field	Configuration
Signature Field	Required; date stamp enabled
Authentication	Email plus SMS code or stronger KBA for verification
Conditional Fields	Show notarization block when user selects 'Notarized' option
Notifications	Enable receipts to signer and HR when completed

Digital Signing and Platform Needs

Choose a platform that supports legal e-signatures, audit trails, and secure storage for PII.

File Formats: PDF, DOCX supported
Integrations: Salesforce, NetSuite, Google Workspace
Security: AES-256 at rest; TLS 1.2/1.3 in transit

Timelines and Common Timing Triggers

Understand when to collect and when to refresh statements to support initial certification, recertification, and contract award timelines.

Initial Application:

Collect statements before initial HUBZone application submission

Recertification:

Refresh statements when completing periodic recertification or material change filings

Contract Award:

Provide up-to-date statements at proposal or pre-award verification requests

Employee Moves:

Update statements promptly when an employee changes residence

Audit Response:

Respond within contract-specified deadlines when requested by auditors

Key Processing Milestones for Statement Handling

Follow a clear milestone sequence from document creation through retention to reduce compliance gaps.

01

Prepare Packet

Assemble statement plus supporting proofs for each employee.

02

Verify Evidence

HR confirms documents match the address on the statement.

03

Submit with Application

Attach statements to HUBZone application or contract package.

04

Archive Record

Store signed copies per retention policy and make accessible for audits.

Common Mistakes That Cause Delays or Eligibility Questions

Using a P.O. box instead of a physical residential address can lead to failed HUBZone residency mapping and requests for corrected documentation.
Mismatched names between the statement and supporting ID or utility bills triggers additional verification and slows certification or award processes.
Failing to date documents or using inconsistent date formats complicates timeline verification and may be treated as incomplete by reviewers.
Skipping notarization or witness lines when state or contracting instructions require them may render a statement unacceptable for procurement review.

Consequences of Inaccurate or Misleading Statements

False Statement: Possible contract termination

Debarment Risk: Debarment or suspension proceedings

Repayment: Requirement to return improperly awarded funds

Civil Penalties: Potential fines or administrative sanctions

Procurement Ineligibility: Loss of current or future contract awards

Reputational Harm: Long-term business credibility impact

Personal and Company Data Typically Collected

Employee Name: Full legal name

Employee Address: Residential street address

Employment Start: Hire or residency start date

Job Title: Position as on payroll

Supporting ID: Type of document used (license, bill)

Signature: Signer name, role, and date

Comparing eSignature Vendors for HUBZone Statement Workflows

Vendor feature and pricing comparisons help determine which eSignature solution aligns with volume, security, and compliance needs for HUBZone documentation.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day trial	Varies	Varies	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently Asked Questions and Troubleshooting

Answers to common questions about e-signing, notarization, and evidence for HUBZone residency verifications.

Need help? Contact support

Can the statement be e-signed?
Yes. Electronic signatures meet federal requirements under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and record retention are present.
Is notarization always required?
Not always. Notarization depends on procurement instructions or state rules. When a contract or agency requires notarized evidence, follow the specific notary or RON procedures applicable in that jurisdiction.
What supporting documents are acceptable?
Common proofs include a utility bill, lease agreement, or state ID showing the residential address. Record the document type and collection date for each supporting item to simplify audits.
How should I handle an address change?
Obtain an updated employment statement and supporting proof promptly. Update HR records and any active HUBZone certifications if the change affects the employee’s HUBZone residency status.
Can health information appear on the form?
Avoid including protected health information (PHI) unless strictly necessary. If PHI is present, handle records under HIPAA rules and ensure any eSignature vendor executes a BAA.
How long before an audit should records be accessible?
Maintain signed statements and supporting records according to retention policy; ensure retrieval within the agency’s response timeframe, typically days to weeks depending on the request.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now