Back To Results
Please Complete This Form
1
2
PLEASE COMPLETE ALL REQUIRED FIELDS
Adjuster Application
Date of Birth*
State*
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
CA-ALBERTA
CA-BRITISH COLUMBIA
CA-MANITOBA
CA-NEW BRUNSWICK
CA-NEWFOUNDLAND
CA-NOVA SCOTIA
CA-NORTHWEST TERRITORIES
CA-NUNAVUT
CA-ONTARIO
CA-PRINCE EDWARD ISLAND
CA-QUEBEC
CA-SASKATCHEWAN
CA-YUKON TERRITORY
US-AMERICAN SAMOA
US-FEDERATED STATES OF MICRONESIA
US-GUAM
US-MARSHALL ISLANDS
US-NORTHERN MARIANA ISLANDS
US-PALAU
US-PUERTO RICO
Languages Spoken*
English
Spanish
Other
Education
Loading...
School Type:
(Please Select a Value)
High School
College
Other
School:
Begin Date:
End Date:
Degree Attained:
(Please Select a Value)
Yes
No
Name of Degree:
Adjuster Experience
Date Entered The Industry*
Xactimate*
No Experience
Less than 1 year
1 year
2-3 years
4-5 years
More than 5 years
Filetrac*
No Experience
Less than 1 year
1 year
2-3 years
4-5 years
More than 5 years
Simsol*
No Experience
Less than 1 year
1 year
2-3 years
4-5 years
More than 5 years
Residential Experience
Date Residential Experience Began
Desk or Field
Desk
Field
Both
Commercial Experience
Date Commercial Experience Began
Desk or Field
Desk
Field
Both
General Liability Experience
Date Gen Liability Experience Began
Auto Experience
Date Auto Experience Began
Appraisal & Mediation Experience
Appraisal Experience*
Yes
No
Mediation Experience*
Yes
No
Flood Experience
Are you NFIP Certified?*
Yes
No
Date Flood Experience Began
File Reviewer & Desk Adjuster Experience
Date File Reviewing Experience Began
Date Desk Adjusting Experience Began
Claims Types Handled
Residential
Commercial
Auto
General Liability
Flood
Adjuster Licenses & Certifications - Click "Add Licensing" below for additional entries
Loading...
License / Certification:
(Please Select a Value)
Adjuster License
AAA TX
Allstate
American Family
ASI
California Earthquake Authority
Citizens of Florida
Citizens of Louisiana
Federated National
HAAG
NFIP (Flood)
Rope and Harness
State Farm
TWIA / TFPA
USAA
Xactimate Level 1
Xactimate Level 2
Xactimate Level 3
Other
Initial Date:
Lic. Expiriation / Recert Date:
License / Certification Number:
State Issued:
(Please Select a State)
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
CA-ALBERTA
CA-BRITISH COLUMBIA
CA-MANITOBA
CA-NEW BRUNSWICK
CA-NEWFOUNDLAND
CA-NOVA SCOTIA
CA-NORTHWEST TERRITORIES
CA-NUNAVUT
CA-ONTARIO
CA-PRINCE EDWARD ISLAND
CA-QUEBEC
CA-SASKATCHEWAN
CA-YUKON TERRITORY
US-AMERICAN SAMOA
US-FEDERATED STATES OF MICRONESIA
US-GUAM
US-MARSHALL ISLANDS
US-NORTHERN MARIANA ISLANDS
US-PALAU
US-PUERTO RICO
US-VIRGIN ISLANDS
If Other, Name License or Certification:
References
Loading...
First Name:
Last Name:
Phone:
Email:
Relationship:
Loading...
First Name:
Last Name:
Phone:
Email:
Relationship:
Loading...
First Name:
Last Name:
Phone:
Email:
Relationship:
How did you hear about CAG?
Adjusting School
CatAdjuster.org
Convention (Ex: NACA)
Facebook
Indeed
LinkedIn
Local Claims Association
Other
Referred
Twitter
Upload Resume*
Upload Attachment 1
Upload Attachment 2
Upload Attachment 3
Next