Catastrophe Employment Application
Contact Information
First Name Address 1
M.I. Address 2
Last Name
Phone 1 State
Phone 2 Zip Code
Fax Country
Employment History
Do you have earthquake claims experience?
Yes     No
Do you have a Passport?
Yes     No
List your history as follows (Please list most recent employer first):
- Dates employed
- Name of employer
- Employer's address
- Your position and duties

Example: 1997-Present, ABC Adjusters 1982-1997 XYZ Adjusters Property Adjuster, worked property claims which included taking proofs, recorded statements, non-waivers and completing caption reports.

List your certifications
Examples: NFIP, CPCU, IIA, State Farm, FWUA, etc.
List any licenses that you hold
List State, Type and expiration date
Most recent first
Expertise (select all that apply)
Auto Appraisal
Heavy Equipment
Workers Comp