MOCAT Roster Application
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Which Would You Prefer?
Please Select
Desk Adjuster
Field Adjuster(Travel Required)
Are You Willing To Travel
Yes
No
Do You Have A General Knowledge Of Construction?
Yes
No
Are You Willing To Commit To A 10 Day In Person Training Class?
Yes
No
On A Scale From 1-5, Where Would You Rate Your Xactimate Skills?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Do You Have Experience As An Independent Adjuster?
Yes
No
If So, How Many Claims Have You Handled?
0-100
100-500
500+
Can You Pass A Criminal Background Check?
Yes
No
What State Is Your Home State License?
Do You Currently Have Any Specialty Training and/or Industry Certifications? If so, Which Ones?
Which States Do You Currently Hold A License In?
Why Do You Feel You Would Would Be A Good Fit To Join The MOCAT Roster
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