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

Attach Resume

Acceptable file types: doc, pdf, jpg, jpeg.
Maximum file size: 2MB.

CAPTCHA Code: