Staff view — read-only. Only the candidate can complete this paperwork.Form W-9(Rev. March 2024)Department of the TreasuryInternal Revenue ServiceRequest for Taxpayer Identification Number and Certification▶ Go to www.irs.gov/FormW9 for instructions and the latest information.Give Form to the Requester.Do Not Send to the IRS.OMB No. 1545-00031 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.2 Business name/disregarded entity name, if different from above3a Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/estateLimited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶Other (see instructions) ▶3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions. 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):Exempt payee code (if any)Exemption from FATCA reporting code (if any)5 Address (number, street, and apt. or suite no.) See instructions.6 City, state, and ZIP codeRequester's name and address (optional)7 List account number(s) here (optional)Part ITaxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.Social security numberorEmployer identification numberPart IICertificationUnder penalties of perjury, I certify that:The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); andI am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; andI am a U.S. citizen or other U.S. person (defined below); andThe FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.Sign HereSignature of U.S. person ▶Date ▶Auto-filled on submit© 2026 Alliance Medical Staffing. All rights reserved.