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DionData Solutions

Home 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.
First Name: M.I. Last Name:
Address:
City: State: Zip
Code:

Your Time Zone:
Phone Number:
Fax Number:
S Citi!en" Yes No I# not$ are you %e&a%%y ab%e to 'or( in the
S" Yes No
SSN 'i%% be re)uested upon appro*a% #or ser*i+es so you may re+ei*e a ,-..
at the end o# the year.
/o' did you hear about us"
0or( at home %ist &roup1s2 you are on:
34Mai% Address:
A5L IM s+reen name:
1No need to be si&ned up 'ith ao% to use the #ree ao% instant messen&er
pro&ram2
Yahoo I6:
1Needed as a%ternate2
0or(78endor /istory: Start 'ith most re+ent:
9,: Company Name:
Type o# :usiness:
From: To:
Address:
Phone Number:
;ob 6es+ription:
Super*isor:
May 'e +onta+t the abo*e" Yes No
9<: Company Name:
Type o# :usiness:
From: To:
Address:
Phone Number:
;ob 6es+ription:
Super*isor:
May 'e +onta+t the abo*e" Yes No
/ours o# A*ai%abi%ity: P%ease state in re%ation to CST in the .S.
From To
6ays:
3*enin&s:
Ni&hts:
List days you are not a*ai%ab%e:
0ee(end A*ai%abi%ity: From To
Saturday:
Sunday:

A*ai%ab%e /o%idays"
Persona% =e#eren+es 1No #ami%y members2:
,. Name Yrs. >no'n
Phone Number:
34mai% address 1i# app%i+ab%e2:
<. Name: Yrs. >no'n

Phone Number:
34mai% address 1i# app%i+ab%e2:
3du+ation:
/i&h S+hoo% ?raduate" Yes No ?36" Yes No
Co%%e&e" Yes No 6e&ree:
Trade S+hoo%:
Course o# Study:
Typin& Speed 10PM2: 6ata 3ntry 1>SP/2:
List any spe+ia% s(i%%s you ha*e re%ated to be+omin& a /ome Contra+ted
8endor"

List Computer1s2 and other 5##i+e 3)uipment you +urrent%y ha*e:

Current ISP Conne+tion: 6ia%4up: Cab%e: 6SL:
Current 0indo's App%i+ation: @P 0indo's A 0indo's B
Si&nature: 6ate:
13%e+troni+ Typed Si&nature A++epted2
C This is an e%e+troni+ si&nature and is &i*en in a++ordan+e 'ith the .S. Federa%
re&u%ations 13SI?N A+t2 &o*ernin& the %e&a% and bindin& e##e+ti*eness o#
e%e+troni+ si&natures.
DThis messa&e and a++ompanyin& do+uments are +o*ered by the 3%e+troni+ Communi+ations Pri*a+y
A+t$ ,B .S.C. Ch.,,. Se+tions <E,-4<E<, et se).$ and +ontains in#ormation intended #or the spe+i#ied
indi*idua%1s2 on%y. This e%e+troni+ +ommuni+ation and any atta+hments may +ontain +on#identia% and
proprietary in#ormation o# 6ion6ata So%utions and its C%ients. I# you are not the intended re+ipient or
an a&ent responsib%e #or de%i*erin& it to the intended re+ipient$ you are hereby noti#ied that you ha*e
re+ei*ed this do+ument in error. Any re*ie'$ dissemination$ +opyin&$ or the ta(in& o# any a+tion based
on the +ontents o# this in#ormation is stri+t%y prohibited. I# you ha*e re+ei*ed this +ommuni+ation in
error$ p%ease noti#y the sender immediate%y by e4mai%$ and de%ete the ori&ina% messa&e. 6ion6ata
So%utions reser*es the ri&ht to monitor any e%e+troni+ +ommuni+ation sent or re+ei*ed by its *endors$
emp%oyees$ a&ents or representati*es.D
Copyri&ht <--<. A%% Federa% and State %a's app%y to the +opyri&ht %a's &o*ernin& this do+ument. Fu%%
'ritten +onsent is re)uired to a%ter$ +opy or use this materia% be%on&in& to 6ion6ata So%utions.

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