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
/ /
*Position Applied For

Education

High School Name/Location
*Diploma Received
College Name/Location
Degree Earned
Major/Minor

Employment History

*Name of Employer
*Address Line 1
Address Line 2
*City
*State
*Zip Code
*Employed From
/ /
*Employed To
/ /
*Employer Phone:
*Job Title:
*Supervisor Name:
*Reason For Leaving:

Name of Employer
Address Line 1
Address Line 2
City
State
Zip Code
Employed From
/ /
Employed To
/ /
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)

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.