The obvious answer is to have the jpeg image as the background of the element that contains the form fields.
CSS:
.myformbox {
background-image:url(myimage.jpg);
height:100px; /*or whatever the height of the image is*/
width:100px; /*ditto*/
}
HTML:
....input fields here....
...or something like that.
I note your edit which says "image should be in full dimensions". That is still ambiguous language: do you mean "the box needs to be the full size of the image", or "the image needs to scale to the size of the box"?
For the first of those, see above, where I've added height and width parameters to the CSS.
For the second one however, you have a problem, which is that background image scaling isn't currently supported by CSS (yet!). Solutions to this are a bit more complex, but if this is the question you're asking, here is a page that might help.