INDEPENDENT CLAIMS ADJUSTING SINCE 1948
Address Line 2
State / Province / Region
ZIP / Postal Code
Questions for Applicant
MM slash DD slash YYYY
Are you willing to sign a 1099 Agreement?
Thank you for considering us, we don’t use anyone without a signed 1099 Agreement.
Are you willing to sign a Confidentiality and Non-Disclosure document?
Thank you for considering us, we don’t use anyone without a signed Confidentiality and Non-Disclosure.
How many years have you been an adjuster?
10 or more
We only use adjusters with a minimum of 3 years experience.
What type of claims have you handles in the past?
Heavy Equipment & Cargo
Please list all types of claims that you have worked
Would you like to accept daily claims in the area that you live?
What zip code would you be billing your mileage from?
Are you interested handling CAT Work?
What CAT Events or Named Storm events have you worked in the past
How many claims do you need guaranteed to travel to a CAT area?
26 – 50
51 – 75
Please list all states and license numbers
What Industry Specific Software are you Proficient with?
File Trac CMS
Do you have your own Work Comp Insurance?
Work Comp Insurance Carrier
Work Comp Insurance Policy Number
Do you have E&O Insurance?
E&O Insurance Carrier Name
E&O Insurance Policy Limits
E&O Insurance Policy Number
Do you participate in any Adjuster Associations?
Please list Adjuster Associations
Upload Your Resume
Drop files here or
Accepted file types: doc, pdf, Max. file size: 4 MB.
Do you have an Adjuster License?
What is your Home State?
What is your Home State License Number?
Do you have HAAG certification?
What type of work do you desire?
Insurance Accreditation - Please list AIC, CPCU, ARM, or other designations
Drone Operator License Information
Are you interested in Task Assignments?
Please list any past employers or references that we can contact on your behalf.
Highest level of education achieved
High School graduate
Why should we consider you for part of our team?
I have read and agree to the
IC Agreement and NDA.
Initials entered will be added on the INDEPENDENT CONTRACTOR AGREEMENT which will be email to you.