Month

Day

Year

Date: 

First

Middle Initial

Last

Name: 

Present Address:

Street: 

City: 

State/Province: 

Zip/Postal Code: 

Country: 

Permanent Address:

Same as Above: 

Street: 

City: 

State/Province: 

Zip/Postal Code: 

Country: 

Previous Address:

Street: 

City: 

State/Province: 

Zip/Postal Code: 

Country: 

Previous Address:

Street: 

City: 

State/Province: 

Zip/Postal Code: 

Country: 

Home Phone: 

Work Phone: 

Cell Phone: 

E-mail: 

Birth Date: 

Driver's Licence #: 

State Issued In: 

If related to anyone in our employ, state their name below:

Referred By: 

Have you ever been convicted of a misdemeanor or felony (excluding traffic violations)? Yes No

If yes, please explain:

Note for CA Applicants only: Please exclude misdemeanor convictions for marijuana-related offenses more than two years old; convictions that have been sealed, expunged, or legally eradicated; and misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed. A conviction is not an automatic bar to employment. Each case will be considered on its own merits.

Position: 

Location: 

Date you can start: 

Desired Salary: 

How did you hear about this position? 

Are you employed now? 

Yes No

If yes, may we speak to your present employer? 

Yes No

Have you ever been employed by JNet or its subsidiaries?
(Vitel or Servicom)

Yes No

If yes, approximate dates - From: 

Position: 

Location: 

Monday: 

 From: 

 To: 

Tuesday: 

 From: 

 To: 

Wednesday: 

 From: 

 To: 

Thursday: 

 From: 

 To: 

Friday: 

 From: 

 To: 

Saturday: 

 From: 

 To: 

Sunday: 

 From: 

 To: 

High School

College or
Trade School

Other School

Other Training

Computer Skills: 

Typing WPM: 

Areas of special study: 

Bilingual: 

List all other languages in which you are fluent

Certifications

Certification: 

Certification: 

Certification: 

Previous Employer #1

Previous Employer #2

Previous Employer #3

Previous Employer #4

Previous Employer #5

Reference #1

Reference #2

Reference #3

I certify that the information contained in this application and any attachments is true to the best of my knowledge, and that I have answered each question completely. I consent to having any of the information verified by the company. I authorize my references and supervisors to provide information concerning my previous employment. I release all parties from all liability for damages that may result from furnishing such information, as well as from the use of or disclosure of such information by the company or its agents. I understand that any misrepresentation or material omission in this application may result in my failure to receive an offer or, if I am hired, in my immediate dismissal from employment.

I understand and agree that if I am hired, my employment can be terminated at will, with or without cause, at any time, either at my option or at the option of the company. No representative of the company other than the Chief Executive Officer has any authority to agree to the contrary. Further, the Chief Executive Officer may not alter the at-will nature of my employment unless the Chief Executive Officer does so specifically in a written agreement signed by both of us.

I understand that any offer of employment is contingent on the satisfactory results of an employment reference check, as well as on the satisfactory results of a criminal background investigation, and drug/alcohol, credit, and driving record checks as appropriate to the position for which my application is tendered. I further understand that all offers of employment are conditioned on my providing satisfactory proof of my identity and legal authority to work in the United States.

Date: 

Sex: 

Male Female

Position Applied for: 

Ethnic Group: (Please select one of the descriptions below corresponding to the ethnic group with which you most identify.)

None Indicated - No Race Selected

American Indian or Alaskan Native - A person having origins in any of the original peoples of North America and South America (including Central America), and you maintains tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thialand, and Vietnam.

Black or African American - A person having origins in any of the Black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."

White - A person having origins in of the original peoples of Europe, North Africa, or the Middle East.

Hispanic or Latino (All races) - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

Hispanic or Latino (White races only) - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of the White race.

Hispanic or Latino (all other races) - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of any race other than White.

None Selected: No Veteran Staus applies.

Special Disabled Veteran: Means (A) a veteran who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to compensation) under laws administered by the Department of Veteran Affairs for a disability rated at 10 or 20 percent in the case of a vetreran who has been determined to have a serious employment disability or (B) a person who was discharged or released from active duty because of a service-connected disability.

Vietnam Era Veteran: A Vietnam era veteran is a person who (1) served on active duty for a period of more than 180 days, any part or which occurred between August 5, 1964 and May 7, 1975, and was discharged or released with other than a dishonorable discharge; (2) was discharged or released from active duty for a service connected disability if any part of such active duty was performed between August 5, 1964 and May 7, 1975; or (3) served on active duty for more than 180 days and sereved in the Republic of Vietnam between February 28, 1961 and May 7, 1975

Newly Separated Veteran

Other Protected Veteran