Scribd
Upload
63 views4 pages

Independent Contracted Vendor Application: General Information

The document is an application for an independent contracted vendor position with DionData Solutions. It requests general information about the applicant such as contact details, work eligibility, skills and experience. Applicants are asked to provide information on their education, references, availability and technical skills. The application notes that due to the high volume of responses, not all applicants will be contacted. It includes a signature block to confirm the applicant agrees to the terms and conditions.

Uploaded by

Raj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
63 views4 pages

Independent Contracted Vendor Application: General Information

The document is an application for an independent contracted vendor position with DionData Solutions. It requests general information about the applicant such as contact details, work eligibility, skills and experience. Applicants are asked to provide information on their education, references, availability and technical skills. The application notes that due to the high volume of responses, not all applicants will be contacted. It includes a signature block to confirm the applicant agrees to the terms and conditions.

Uploaded by

Raj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 4

Independent Contracted Vendor Application

Due to the overwhelming responses from applicants unfortunately DionData Solutions will not be
able to respond to every application received. You will hear from us when your application is
approved. Thank you for your interest in DionData Solutions.

General Information:
First Name: Last Name: Date:
Address:
City:

State: Zipcode:

Email:
Phone:-- Fax:--
What time zone are you in?
Are you a citizen of the U.S.? Yes:
No:
If no are you legal to work in the U.S.? Yes:

No:

Note: SSN will be requested upon approval so you may receive a 1099 at the end of the
year.
Typing Speed: Words Per Minute: Keystrokes Per Minute:
-----------------------------------------------------------------------------------------------------------Have you ever been a home contractor for any company before? Yes:
for whom?
How did you hear about us?:

No:

If yes,

Do you belong to any list groups?:


AOL IM screen name:
(No need to be signed up with aol to use the free AOL Instant Messenger program or
AOL Express)

Work/ Vendor History:


1: Company Name:
Type Of Business:
Address:
City:
Zipcode: Phone:--
Supervisors Name:
From:- To:
Job Description:
May we contact?: Yes:
No:
2: Company Name:
Type Of Business:
Address:
City:
Zipcode: Phone:--
Supervisors Name:
From:- To:
Job Description:
May we contact?: Yes:
No:
3: Company Name:
Type Of Business:
Address:
City:
Zipcode: Phone:--
Supervisors Name:
From:- To:
Job Description:
May we contact?: Yes:
No:

State:

State:

State:

Education:
High School Graduate? Yes
College? Yes
No
Trade School:
Course of Study:

No
GED? Yes
Degree:

No

Personal References (No family members):


1. Name:
Phone Number:--
E-mail address:

Yrs. Known

2. Name:
Phone Number:--
E-mail address:

Yrs. Known

3. Name:
Phone Number:--
E-mail address:

Yrs. Known

Additional Information:
Hours of Availability: Please state in relation to CST in the U.S.
Days:
Evenings:
Nights:

From

To

List days you are not available:


Weekend Availability:
From
Saturday:

Sunday:

To

Available Holidays?
Current Internet Connection: Cable:
(mbs):

DSL:

Other:

Internet Connection Speed

Working Computer(s):
Current Operating System:Windows XP:
List Other:

Windows 7:

Windows 8:

Other Office Equipment:


Briefly describe any special skills you might bring to DionData Solutions, LLC. As an
independent home contracted vendor:

Signature:
(* Electronic Typed Signature Accepted)

Date:

* This is an electronic signature and is given in accordance with the U.S. Federal regulations
(ESIGN Act) governing the legal and binding effectiveness of electronic signatures.

Due to the overwhelming responses from applicants unfortunately DionData Solutions will not be able to
respond to every application received. You will hear from us when your application is approved. Thank you
for your interest in DionData Solutions.
"This message and accompanying documents are covered by the Electronic Communications Privacy Act, 18 U.S.C.
Ch.119 Sections 2510-2521 et seq., and contains information intended for the specified individual(s) only. This
electronic communication and any attachments may contain confidential and proprietary information of DionData
Solutions and its Clients. If you are not the intended recipient or an agent responsible for delivering it to the intended
recipient, you are hereby notified that you have received this document in error. Any review, dissemination, copying, or
the taking of any action based on the contents of this information is strictly prohibited. If you have received this
communication in error, please notify the sender immediately by e-mail, and delete the original message. DionData
Solutions reserves the right to monitor any electronic communication sent or received by its vendors, employees, agents
or representatives."
Copyright 1999-present. All Federal and State laws apply to the copyright laws governing this document. Full written
consent is required to alter, copy or use this material belonging to DionData Solutions. Revised: 03/13/2015.

You might also like