Your Name (required)

Your Phone Number (required)

Your Email (required)

Resident City and State (required)

Below, please answer each question carefully and honestly.

How many Years’ Experience do you have as an Independent Field Adjuster?

Please list several Carriers you have serviced claims for as an Independent Field Adjuster

Please name the IA Firms you have worked for as an Independent Field Adjuster

What is your Xactimate Address?

What is your level of expertise and proficiency with the program?
BeginnerModerateExpert

Is your Xactimate address open now?
YesNo

In what states do you maintain a Current Adjuster’s License?

Have you ever done large losses ($70k+) as an Independent Field Adjuster?
YesNo

Have you done commercial claims as an Independent Field Adjuster??
YesNo

Are you seeking a position as a Field Adjuster or Desk Adjuster?
Desk Adjuster - Daily and/or CatField Adjuster - Daily and/or Cat

Have you ever worked as a Desk Adjuster with a Carrier?
YesNo

If so, What Carriers did you work for in that capacity?

How many Years’ Experience do you have as a Desk Adjuster?

Please attach your Current Resume when you return your questionnaire.

Can you please also attach a Sample of a claim you serviced as an Independent Field adjuster including your Field Report & Xactimate Estimate and Photos?

If not, please explain why?

Do you carry your own Certificate of Insurance?
YesNo