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Application
Name
Address
Home Phone Number
Mobile Phone Number
Email Address
Are you available to work west coast storms this winter?
Yes
No
Are you California Earthquake Certified?
Yes
No
If Yes, Date:
License #1
License #2
License #3
License #4
Please indicate which claims you have experience with and for how many years.
Property Dwelling
Property Commercial
Mobile Home
General Liability
Flood
Earthquake
Would you be interested examining files in a cat office?
Yes
No
Do you have experience examining files in a cat office?
Yes
No
If Yes, How many years of experience?
Last Employer #1
Last Employer #2
Last Employer #3
Last Employer #4
Last Employer #5
What estimating program do you use?
MS/B IntegriClaim
Simsol
Xactimate
Other
If you selected other please specify which estimating program you use.
Have you ever done claim reporting on a website?
Yes
No
Do you have capability to do paperless files?
Yes
No
Not Sure
Do you have a digital camera?
Yes
No
Additional Comments
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