Adjuster Information
(DO NOT upload documents with sensitive information such as Drivers licenses or any document that shows your SSN)
Name
*
First Name
Last Name
Nickname
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you interest in Desk or Field work - Please attach a copy of your resume at the end along with a head shot
Desk
Field
Both
Are you a licensed Appraiser? Please attach a copy of your license below
Yes
No
Are you experienced in P&C Residential Adjusting
Yes
No
Are you experienced in P&C Commercial Adjusting
Yes
No
Are you interested in Flood Adjusting
Yes
No
Are you interested in P&C Adjusting
Yes
No
Are you interested in Roof Claims
Yes
No
Are you interested in Fire Claims
Yes
No
Are you interested in Earthquake Claims
Yes
No
Would you like training in Flood claims
Yes
No
Would you like training in P&C claims
Yes
No
Would you like training in Xactimate
Yes
No
Would you like training in Symbility
Yes
No
Would you like training in earthquake claims
Yes
No
Would you like training in roof claims
Yes
No
Do you hold certificates in (please attach certificates below):
Earthquake
Haag Certified
Rope & Hareness
Texas Wind
Xact Address - Please attach certificates below
Symbility ID Number
FCN # - Please attach a copy of your most recent FCN Card at the end
State Adjuster Licenses - Please attach copies of your licenses at the end
Rows
License Number
Expiration Date
Alabama
Alaska
Arizona
Arkansas
Califorina
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Indiana
Kentucky
Louisiana
Maine
Michigan
Minnesota
Missississippi
Montana
Nevada
New Hampshire
New Mexico
New York
North Carolina
Oklahoma
Oregon
Puerto Rico
Rhode Island
South Carolina
Texas
Utah
Vermont
Washington
West Virgina
Wyoming
Upload Resume, Photo, Adjusting Licenses & FCN Card
*
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