The Applicant Status Affidavit (DOL-1054A) is a mandatory legal document issued by the Georgia Department of Labor. Under the Official Code of Georgia Annotated (O.C.G.A. 50-36-1), any individual seeking state-administered public benefits must complete this sworn declaration. The document confirms the applicant's identity and lawful presence in the United States. It applies to programs administered by the Georgia DOL and related state agencies. For other Georgia government documents, visit our Georgia Department of Labor forms page.
To complete the Applicant Status Affidavit, you must provide: your full legal name, Social Security Number, country of birth, and valid photo identification. You must declare your citizenship status as a U.S. citizen, legal permanent resident, or qualified alien under federal immigration law. Non-citizens must present an unexpired employment authorization document or another valid form of lawful presence documentation. The affidavit also includes a consent section that authorizes disclosure of your immigration status to relevant government agencies to confirm benefit eligibility.
Accuracy on this form is critical. Under O.C.G.A. Code Section 16-10-20, falsifying any information on the Applicant Status Affidavit is a criminal offense with serious legal consequences. After completing and signing the form, submit it to the claims taker or agency processing your public benefit application. If you need related documentation, our affidavit forms library includes additional resources for identity and legal status verification.
| Question | Answer |
|---|---|
| Form Name | Applicant Status Affidavit |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | applicant status affidavit, bybadd cwb date, unemployment affidavit georgia, georgia status affidavit form |
