First Name
Last Name
Email
Phone Number
Business Name
Looking for field or desk work?
Field
Desk
Remote Desk
Preference (if applicable)
Field
Desk
Remote Desk
Willing to travel for CAT/Event work?
Yes
No
Do you own an adjusting company?
Yes
No
Do you have a Lousiana license?
Yes
No
If yes, license number
Current Available Programs (check if requesting to join roster)
Drone Program
FL Full Claims Handling (cradle to grave)
Florida (field and desk)
Louisiana (field only)
Texas (field only)
North Carolina (field only)
All SE States from NC to TX
Total Years of Adjusting Experience
Years of Residential Field Experience
Years of Residential Desk Experience
Years of Commercial Field Experience
Years of Commercial Desk Experience
Years of Full Claims Handling Experience
Years of File Review/Examiner Experience
Skill Set (check all that apply)
Catastrophe
Large Loss Residential
Large Loss Commercial
Total Loss
MCM (full claims handling, cradle to grave)
Mobile Home Claims
Hail Events
Sinkhole Claims
Flood Claims
Appraisals / RCV / ITV
Farm / Agriculture
Litigation
QA
Supervisory Experience
Yes
No
Contract Requirement
Independent Contractor
Corporation/LLC
Employee
Resume
Additional Information About Yourself
Bilingual
Yes
No
Xactimate Certifications
Level 1
Level 2
Level 3
Symbility Skills
1
2
3
4
5
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