| First Name |
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| Last Name |
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| Cell Phone |
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| Home Phone |
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| Email Address |
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| Address1 |
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| Address2 |
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| City |
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| State |
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| Zip |
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| Country |
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| Are you an Auto adjuster? |
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| Are you a Property adjuster? |
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| How many years of residential property adjusting experience do you have? |
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| How many years of commercial property adjusting experience do you have? |
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| Are you certified with any other companies? |
(
Select multiple values with the help of Ctrl/Shif key) |
| Are you bilingual? |
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| If so what language? |
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| Have you ever adjusted claims for Citizens Insurance of Florida? |
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| If so with whom and when? |
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| Available: |
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| Day Claims: |
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| NFIP Experience: |
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| NFIP FCN Number: |
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| Field Adjuster: |
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| Inside Adjuster: |
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| Content/ALE |
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| Manager |
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| Examiner |
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| SIU |
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| Reinspector |
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| Have you ever adjusted claims with State Farm? |
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| If so with whom and when? |
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| How many residential claims have you completed in your career?
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| How many commercial claims have you completed in your career? |
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| How many heavy commercial claims have you completed in your career? |
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| Bus Interruption: |
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| Mediation: |
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| Casualty |
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| SAS Complete |
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| How many claims can you inspect and close per day? |
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| How much notice do you need to deploy (arrive at the CAT site)? |
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| What state adjusters license do you currently hold? |
( Select multiple values with the help of Ctrl/Shift key) |
| License No.: |
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| Are there any states you do not want to travel? |
( Select multiple values with the help of Ctrl/Shift key) |
| What certifications do you hold? (Example: flood, earthquake) |
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| What estimating software do you currently utilize? |
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| Do you have experience with Xactimate? |
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| Do you have experience using any other software? |
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| How many years? |
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| Do you have experience with paperless file processing, including digital photography? |
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| Are you hotel dependent or do you have an RV or camper? |
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| Are there any companies that you are signed up to work with? |
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| Would you be interested in a performance bonus? |
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|
XactNet Address |
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Professional Property Adjusters that know your work - name and telephone number please |
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| Other Relevant Experience |
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| Notes: |
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