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Become a VA
About Us
Programs
- Partner Program
- Buffalo City VA
Resources
CALL US
GET A QUOTE

VA Database Form

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First Name:*
Last Name:*
Nickname:*
Date of Birth:*
MM slash DD slash YYYY
Civil Status:
- Single with no Kid(s)
- Single with Kid(s)
- Married
- Separated
- Divorced
- Widowed
Upload your Photo in Gdrive, We Transfer, Dropbox etc. and paste the Downloadable Link:*

Upload a valid Govt ID in Gdrive, We Transfer, Dropbox etc. and paste the Downloadable Link:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Timezone:*
Power Provider:*
Internet Service Provider:*
Company Email:*
Personal Email Address:*

NOTE: Please use the email you used on your initial application.

Your Payroll Information :
Please select your Country:*
Bank Name:*
Swift Code:*
Account Number:*
Account Name:*
Home Address:*
MUST be the address registered with the Bank.
City:*
Postcode:*
Please enter your Payoneer email address:*

Company Skype ID :*
Personal Skype ID :*
Mobile Number :*
Landline :*
Emergency Contact Number :*
Company ID Number :*
Client Name :*
First Last
VA Services :*
- Admin VA
- eCommerce VA
- Specialist VA
VA Service Levels :*
Employment Type :*
- Part-time
- Full-time
- Project-based
No. of Hours :*
Hire Date :*
MM slash DD slash YYYY
Work Schedule Type :
- Flexible
- Fixed
Orientation Call Date (Eastern Time) :*
MM slash DD slash YYYY
Orientation Call Time (Eastern Time) :*

: Hours

Minutes

AM/PM
How did you find us?*
- Internet Search
- Referral
- Social Media
- Employment Site
- Word of Mouth
Search Engine (Google, Yahoo, Bing, etc.) :*
Name of the Person who referred you :*
Social Media Site or Platform :*
Employment Site Name :*
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Date:
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