Employee FW9 Form

EMPLOYEE FW9 FORM

Employee Tax Information (FW9)

Name (as shown on federal tax return):

Individual/sole proprietor or single-member LLC    C Corporation    S Corporation

Partnership    Trust/Estate    Limited liability company — classification:

Taxpayer Identification Number (enter SSN for individuals; EIN for entities):    or   

Certification — Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number; and

2. I am not subject to backup withholding due to failure to report interest and dividend income, or I have been notified that I am no longer subject to backup withholding; and

3. I am a U.S. person (including a U.S. resident alien) for federal tax purposes. I understand that providing false information may subject me to civil and criminal penalties.

Personal Information

Position Information

Proposed start date:    Annual salary/pay rate:

Employment type: Full-Time    Part-Time    Temporary/Contract

Employment History (Most Recent Two Employers)

Dates employed: From to

Dates employed: From to

Education

Graduation date:

Professional References

Legal Disclosures

At-Will Employment: I acknowledge that, unless otherwise set forth in a separate written agreement signed by an authorized representative of the employer, my employment is at-will. Either I or the employer may terminate the employment relationship at any time, with or without cause or advance notice.

Equal Employment Opportunity: The employer provides equal employment opportunities to all applicants and employees without regard to protected characteristics. Employment decisions are based on business needs, job requirements, and individual qualifications.

By checking the box below I acknowledge receipt of, and assent to, the above At-Will and Equal Opportunity statements:

I acknowledge and agree to the At-Will Employment statement.    I have read and accept the Equal Employment Opportunity statement.

Applicant Certification & Authorization

I certify that all information provided on this form is true, correct, and complete to the best of my knowledge. I understand that false or misleading statements, omissions, or misrepresentations may result in the denial of employment or, if employed, termination.

Authorization to Verify: I authorize the employer and its agents to verify any information provided, including employment history, education, professional licenses, and motor vehicle records where relevant. I further authorize former employers, educational institutions, and references to provide information regarding my background and release them from any liability for providing such information.

Criminal Background and Drug Screening: I consent to and authorize criminal background checks, consumer reports, and drug screening as a condition of employment where permitted by law. I understand that adverse information discovered may be considered in the employment decision, subject to applicable law.

Please indicate consent:

I consent to background checks and verification of information.    I consent to pre-employment drug screening if requested.

Release of Claims: To the extent permitted by law, I release and hold harmless any party providing information in good faith in response to inquiries authorized by this form from any liability arising from such disclosure.

Acknowledgment and Signature

By signing below I certify under penalty of perjury that the information provided on this Employee FW9 Form is accurate and complete, that I have the authority to provide the information supplied, and that I authorize verification as described above.

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