Advanced Adjusting, LTD
th
203 West 8 Ave, LB 14045
Amarillo, TX 79101
Phone 866.553.5004
Fax 806.350.3399
Adjuster Profile
Formal Name:
First______________________Last________________________
Preferred Name: __________________________________________________________________
Address:
___________________________________________________
City_________________State________________Zip_________
E-Mail:
________________________________________________
Phone Number:
(Home)________________________(Cell)_____________________
Emergency Contact:
Name ________________________Phone number____________________Relationship______________
Xactnet Address: ___________________________________
Adjuster Licenses:
FL# ________________Expires:____________
TX#_______________Expires:__________
Other State Licenses:
_______________________________________________________
NFIP Flood FCN#:
_________________
Flood Certified for: Residential_____ MH______Small Commercial______Large Commercial______RCBAP______
Carrier Certifications:
_______________________________________________________
Adjusting Experience (# of years): Daily________CAT ______Flood_________
Wind_________________Hail_______________Fire_______________Water____________
Check if Worked:
Residential Property _____
Commercial Property _____
Business Interruption _____
Mobile Homes _____
Flood _____
Flood ICC _____
Underwriting Inspections ____
Inside Desk Examiner ____
Farm Policy _____
Builder’s Risk ____
Sinkhole ____
Earthquake ____
Lightning ____
Appraisals ____
Liability ____
Auto ____
Advanced Adjusting, LTD
th
203 West 8 Ave, LB 14045
Amarillo, TX 79101
Phone 866.553.5004
Fax 806.350.3399
Check if Proficient
Software Skills:
Xactimate _____
XactAnalysis _____
Filetrac _____
Simsol _____
Co-Insurance Calculator _____
ADP _____
Mitchell _____
Symbility_____
Preferred work: (Circle those that apply):
Type of work (Check all that apply):
Daily
Powerclaim _____
PDF Bundling _____
Word _____
Excel _____
CAT
Adobe PDF _____
Sketch _____
MSB _____
Eagle View _____
Flood
Field Adjuster_________Team Lead____________
File Reviewer_________Inside Adjuster__________Flood Adjuster______________
Preferred States to work:_________________________________________
Willing to travel for CAT: YES____________NO______________
Prior Companies: ________________________________________________________
Business References (2):
Name_________________________Company__________________Phone #_________________
Name_________________________Company__________________Phone #_________________
Other Info:_____________________________________________________________
_______________________________________________________________________
Advanced Adjusting, LTD
th
203 West 8 Ave, LB 14045
Amarillo, TX 79101
Phone 866.553.5004
Fax 806.350.3399
Background Check Release Form
Name:
Address:
First________________MiddleName_________________Last____________________
_____________________________________________County___________________
City____________________State____________________Zip_____________________
Date of Birth: Month__________________Day_____________________Year_________________
Social Security #: ________________________________
Have you ever been convicted of a felony?
YES_________ NO___________
If yes – Explain:_______________________________________________________________
_____________________________________________________________________________
I certify that answers give herein are true and complete.
I authorize investigation of all information contained in this release form as may be
necessary to meet client requirements.
Signature:_______________________________ Date:__________________
Print Name:________________________________________