Your First Name
Your Last Name
Your Phone
City & State
Your Designated Home State
Email Address
Designated Home State Adjuster License#
Have you ever taken any Auto Adjuster Training Course?
Yes / No
Yes ( Online Version)
Yes ( In-person Training)
No
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States you are licensed in
Years of Experience
0
1
2
3
4
5
6+
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What Department are you proficient in and prefer to deploy as? Select as many that applies.
Liability
Bodily Injury
Subrogation. (Demander)
Subrogation (Reciever)
Total Loss
Complex Claims
PIP / MPC
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Do you hold any Certification as an Auto Insurance Adjuster? (If yes please Upload your Certificates. Even if Cert is expired)
Do you hold any Certification as an Insurance Adjuster?
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