ADJUSTER QUESTIONNAIRE

Are you interested in joining our roster?

Please complete the following adjuster questionnaire and a member of our team will reach out to you as soon as possible should we find your experience and background align with our current needs. Thank you!

PERSONAL INFO

access please willing

Name *

First

Middle

Last

Preferred Name

Date of Birth *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Adjuster Company Name/LLC

LANGUAGES SPOKEN

Select all that apply. Please only include languages for which you are fully proficient in speaking.

What languages do you speak? *

Do you speak any other languages? *

ADJUSTER PREFERENCES

AVAILABLITY AND DEPLOYMENT

Are you willing to travel outside of your local area for CAT deployments? *

Are you willing to take daily claims in your local area? *

Are you available for immediate CAT deployment should an event arise? *

Are you available to receive Daily Claims immediately? *

EQUIPMENT AND SOFTWARE

Do you own a ladder? *

Do you own a primary ladder or a secondary ladder that provides 2 Story Access? *

Do you own rope and harness and/or steep access equipment (Rope and Harness, Goat, RidgePro)? *

Do you own a laptop capable of running Xactimate or Symbility? *

Do you own a quality digital camera? *

Do you own basic adjusting tool/accessories (pitch gauge, shingle gauge, tape measure, etc)? *

Please upload a photo overview of your adjusting equipment (optional but recommended)

Click or drag a file to this area to upload.

JPEG or PNG Only

Do you have a current Xactimate Subscription? *

Do you have a Corelogic/Symbility Login ID? *

ADJUSTER EXPERIENCE

(Years of Experience)

Field Property Adjusting Experience *

Field Auto Adjusting Experience *

Field Commercial Adjusting Experience *

Litigated/Disputed Claims Experience *

Property Flood Experience *

Virtual Trainer Experience *

Team Lead (Virtual/Onsite) Experience *

Symbility Experience *

Mitchell Experience *

Symsol Experience *

Desk Property Adjusting Experience *

Desk Auto Adjusting Experience *

Desk Commercial Adjusting Experience *

Farm and Ranch Experience *

File Reviewer Experience *

Field Trainer Experience *

Account Manager/Vendor Manager Experience *

Xactimate Experience *

CCC Experience *

CARRIER EXPERIENCE

Carrier Name *

Years of Experience *

Type of Experience *

If carrier name is not on this list, please type below with years and type(s) of experience:

PROPERTY CLAIM HANDLING EXPERIENCE

# of Total CAT FIELD Claims Handled *

# of Total CAT DESK Claims Handled *

# of Total Daily Claims Handled *

# of Total Wind Claims Handled *

# of Total Hail Claims Handled *

# of Wind - Tornado Claims Handled *

# of Wind - Hurricane Claims Handled *

# of Water – Pipes/Supply Lines Claims Handled *

# of Fire Claims Handled *

# of Freeze Claims Handled *

# of Water – Rainstorm Claims Handled *

# of Lightning Claims Handled *

# of Ice/Snow Claims Handled *

# of Theft/Vandalism Claims Handled *

# of Mold Claims Handled *

# of Flood Claims Handled *

# of Liability Claims Handled *

# of Equipment Breakdown Claims Handled *

# of Commercial Claims Handled *

AUTO CLAIM HANDLING EXPERIENCE

# of Total CAT Claims Handled *

# of Total Hail Claims Handled *

# of Wind - Hurricane Claims Handled *

# of Liability Claims Handled *

# of Total Daily Claims Handled *

# of Total Wind Claims Handled *

# of Wind - Tornado Claims Handled *

# of Flood Claims Handled *

LICENSES AND CERTIFICATIONS

NPN# *

Find My NPN#

Resident or Designated Home State License

Resident/DHS State *

Valid On *

Expires On *

Resident/DHS License # *

Do you have licenses for any other states? *

Certifications

Certification Type

Valid On

Recertification Date

Certification #

SUPPORTING DOCUMENTS

Please upload a copy of your active license(s) and certificate(s) in PDF format here: *

Click or drag files to this area to upload. You can upload up to 100 files.

Please upload your resume in PDF format here: *

Click or drag files to this area to upload. You can upload up to 2 files.

Please upload your photo/headshot here: *

Click or drag a file to this area to upload.

JPEG or PNG format only. Please ensure the photo is professional in nature as it will be used for your badge.

BACKGROUND AND SCREENING

Do you consent to a background check? *

Have you ever been convicted of a felony? *

Have you had any insurance license suspensions or revocations? *

EMERGENCY CONTACT INFORMATION

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Emergency Contact Relationship To You *

REFERENCES AND REFERRALS

Please enter at least two professional references below:

Name *

Title/Company *

Phone *

Email *

Name *

Title/Company *

Phone *

Email *

Name

Title/Company

Phone

If provided with a referral code from a member of the AmerAdjust Leadership Team, enter here (ALL CAPS):

How did you hear about AmerAdjust? *

ELECTRONIC MESSAGING

By checking the box below and providing your phone number above, you agree to receive informational text and/or email messages from AmerAdjust, LLC. Message and data rates may apply, depending on your mobile phone service plan. Message frequency varies. At any time you can get more help by replying to the designated email or text address, or you can opt-out completely by replying STOP ELECTRONIC MESSAGES to hr@ameradjust.com. The confirmation becomes effective after the application is approved.

Would you like to receive informational texts and email messages from AmerAdjust? *

I AGREE to receive informational text and email messages
I DO NOT want to receive informational text and email messages

CONFIRMATION AND SIGNATURE

By completing and submitting this form I confirm that all information provided is true and accurate to the best of my knowledge. I understand that with the submission of this form, it does not guarantee employment, assignments, and/or deployments with AmerAdjust, LLC for any current or future openings and does not obligate AmerAdjust in anyway.

Confirm your full name: *

First

Middle

Last

Today's Date *

Signature *

Clear Signature

Captcha *

What is 7+4?

ADJUSTER QUESTIONNAIRE

Are you interested in joining our roster?

Please complete the following adjuster questionnaire and a member of our team will reach out to you as soon as possible should we find your experience and background align with our current needs. Thank you!

PERSONAL INFO

LANGUAGES SPOKEN

ADJUSTER PREFERENCES

AVAILABLITY AND DEPLOYMENT

EQUIPMENT AND SOFTWARE

ADJUSTER EXPERIENCE

CARRIER EXPERIENCE

PROPERTY CLAIM HANDLING EXPERIENCE

AUTO CLAIM HANDLING EXPERIENCE

LICENSES AND CERTIFICATIONS

Resident or Designated Home State License

Additional Licenses

Certifications

SUPPORTING DOCUMENTS

BACKGROUND AND SCREENING

EMERGENCY CONTACT INFORMATION

REFERENCES AND REFERRALS

Please enter at least two professional references below:

ELECTRONIC MESSAGING

CONFIRMATION AND SIGNATURE

Links

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