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ACC Adjuster Application
Please fill out the following form
Please fully review the following form before starting to fill it out.
Personal Information
*E-Mail
*First Name
*Last Name
*Address Line 1
Address Line 2
* City
* State
* Zip Code
* Home Phone
Business Phone
Cell Phone
Work Preference
* Date Available
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*Position Applied For
Education
High School Name/Location
*Diploma Received
Diploma
Equivalency
None
College Name/Location
Degree Earned
Major/Minor
Employment History
*Name of Employer
*Address Line 1
Address Line 2
*City
*State
*Zip Code
*Employed From
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*Employed To
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*Employer Phone:
*Job Title:
*Supervisor Name:
*Reason For Leaving:
Name of Employer
Address Line 1
Address Line 2
City
State
Zip Code
Employed From
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Employer Phone:
Job Title:
Supervisor Name:
Reason For Leaving:
*Related Knowledge/Skills
Professional References
Please list three references that have knowledge of your professional experience.
*Reference Name
*Address
*Occupation
*Phone
*Reference Name
*Address
*Occupation
*Phone
*Reference Name
*Address
*Occupation
*Phone
Background
Have you ever been convicted of a felony or a first degree misdemeanor?
Yes
No
Have you ever pled no contest or guilty to a felony or a first degree misdemeanor?
Yes
No
Are you a U.S. citizen or are you legally authorized to work in the U.S.?
Yes
No
* Do you consent to a background check?
Yes
No
Adjuster Profile
Do you have Residential Claims Experience?
Yes
No
No. of Yrs
No. of Claims
Do you have Commercial Claims Experience?
Yes
No
No. of Yrs
No. of Claims
Please select the types of claims in which you have experience handling:
Wind
Hurricane
Tornado
Hail
Flood
Ice Storms
Fire
Plumbing Failures
Theft
Ground Subsidence
Third Party Property
Please select the type of claims which you are interested in working:
Catastrophe
Daily
Flood
Do you have NFIP experience?
Yes
No
NFIP Certification:
Please provide the territory and/or states you are willing to work
Which estimating program do you utilize?
Xactimate
MSB/Integra
Simsol
Other
Do you have experience working within a web based claims management program?
Yes
No
Do you have experience with converting and combining documents into PDF format?
Yes
No
Please list the states in which you currently hold a valid adjusting licenses (include license number)
Human Test
Just answer this math problem to prove that you're not a robot.
*What is six + zero?
zero
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Documents
If you have a resume, please upload it here. (PDF preferred.)
Please upload a stacked PDF file of a sample claim. The sample claim should contain a captioned report, estimate, labeled photos and sketch. Please delete sensitive information.
If the file is bigger than 10MB or you are having trouble uploading the file, use
this link
to send it to us.