Agents Application

VIPERCONN with XFINITY requires a National Background Check for All Agents!!!

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APPLICANT INFORMATION

First Name

Middle Name

Last Name

Street

City

State

ZIP Code

Cell Phone (to receive text messages)

Date of Birth (required for background check)

Social Security No. (required for background check)

Agents select a preferred district to work ( All Districst Details)

Are you citizen of United States?

If no, are you authorized to work in United States?

Have you ever sold Xfinity products?

If yes, select dates
From

To

Have you ever been convicted of a felony?

If yes, explain

EDUCATION

High School

Address

Did you graduate?
YesNo

Institution

Year of Graduation

College

Address

Year of Graduation

Degree

Other Education

Address

Year of Graduation

Degree

References

Please list three professional references.

Full Name

Relation

Company

Phone

Address

Disclaimer and Signature

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Viperconn may obtain a “consumer report” about you from a consumer reporting agency for employment purposes. A “consumer” report is a background screening report that may contain information regarding your criminal history, and other information about you. It may bear upon your character, general reputation, personal characteristics, and/or mode of living.

I certify that my answers are accurate and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I hereby acknowledge and certify that I am of legal age.

Accept Terms & Conditions

Signature

Date

Upload resume

Upload Valid ID

We would like to know a little bit more about you; what are your goals?

Please download the W-9 form and fill it out completely, then email it back to cv@viperconn.com

Download W-9 Form