Employment

General Info

Required fields in RED | Dates must be entered in mm/dd/yy format (e.g. 6/29/11).

Check your Interest as an Adjuster:

Daily Claims Adjuster

Catastrophic Adjuster

First Name:		Adj. Code:
Middle Name:		Last Name:
Email:		Nick Name:
Alt Phone:		Cell Phone:
Fax:		Home Phone:
Address:		Date Available:
City:		Deployed Address:
State:		Deployed City:
Zip:		Deployed State:
Mailing Address (If Different):		Deployed Zip:

Xactimate Address:

Experience:

Trade Specialty:		Trade Specialty 2:
Trade Specialty 3:		Trade Specialty 4:
Trade Specialty 5:		Trade Specialty 6:

* Please enter ALL states that you are licensed in.

Flood Certification:

NFIP#:

Appointed in FLorida:

Enter certifications, prior carriers, and IAs separated by commas:

Prior Carriers:

Prior IAs:

In order of expertise or extent of experience:

Claim Types *	01.	02.	03.	04.	05.
	06.	07.	08.	09.	10.

General Skills:

Bilingual:

Birthdate:

Language(s):

Citizen (check for yes)?:

Place of Birth:

Individual / Corporation:

Worker's Comp:

E & O ?

Notes:

24/7 Claims Reporting
(251) 433-2756
24/7 Central Dispatch Fax
(251) 433-2759

EMAIL US HERE claims@davidsonadjusters.com

Estimating Software Used:	Xactimate	Reflections	Pen Pro	Power Claims
Software goes in field below; click circle to auto-fill or enter manually below.	Xactimate 24	EZ-Bid	Accu Bid	IntegriClaim
	Xactimate 25	Mitchell	CCC	ADP
	Simsol	Symbility
Software: