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Independent Contractor Screening Questionnaire

Please answer each of the following questions with a "yes" or "no," providing license numbers where appropriate. Please print clearly and boldly. Remember to attach copies of your licenses and certifications.

Select Position

First Name

Last Name

Address

City

State

Zip

Mobile Phone

Office Phone

What software do you use? If using Xactimate, please provide your Xactnet address.

What areas will you work? Be specific, or provide a map.

Are you available to work Daily Claims?

Are you able to be dispatched and leave within 48 hours of notice for Storm duty?

Are you able to be away from home for 30 days if needed?

Do you have prior experience as a file examiner?

Are you qualified for Property?

How much experience do you have in Property?

Are you qualified for Commercial?

Are you qualified for Inland Marine?

Are you Flood certified? If yes, provide your license number.

What states are you licensed in? (Include license numbers for each state, along with the expiration date)

Upload Resume (PDF)