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1. What State or Province do you live in when not deployed?
2. Are you a US citizen or Canadian citizen?
USCN
3. Do you have a current Passport and willing to travel US/Canada for a deployment?
YESNO
4. Other than English, what languages are you fluent in?
Write in Please enter an 'other' value for this selection.

5. If you have done past developments for IRG, What job and  how many months?  # of Months

Field Work Residential
Field Work Commercial
Inside Residential
Inside Comma / Large Loss
Inside Auto
Inside TWIA
IRG Office/Home Remote Property
Other
6. Please check YES to only those area(s) of adjusting work you are interested in being offered Deployment opportunities for:
Field Property Full Adjusting
Remote / Home Office Estimator/Adjuster
Field Inspection Services
Inside Carrier Auto
Inside Carrier Residential
Inside Carrier Commercial
7. For CE Credits, please list the following information on licenses:

Texas
Florida
Alberta

8. Adjuster Contact Information

First Name
Last Name
Street Address
City
Zip / Postal Code
Best Phone Number for you (XXX)XXX-XXXX
Alternative Phone Number
9. Please check off the other States/Provinces where you hold an adjuster license:
Write in Please enter an 'other' value for this selection
10. Please check YES to any of these other Certificates or Designations that you hold?

11. Adjusting Experience -do not list unless you have worked a minimum of 90 days (.25 Years) of each specific job: Enter only the number for years and closest quarter years (example: 1.75; 5.5, 3, 2.25)

Years                                     

Field Residential Daily
Field Res - CAT
Field Commercial/ Large Loss
Field Environmental
Field & Inside Liability
Inside Auto Daily
Inside Auto - CAT
Inside Auto AB/Bod Injury
Inside Residential Daily
Inside Res - CAT
Inside Comm/ Large Loss
Inland Marine
Resolution Umpire
Neutral Umpire
Field Farm or Crop
12. System and Platform Experience: (Check YES to only the systems that you've used for more than 3 months continually in past jobs)
MS Word
MS Excel
MS Outlook
PDF Printer
AS 400
Other
13. Check YES only to the documentation have you sent us in the last 2 years?
Resume in .PDF
Work history in .DOC format for IRG Carrier Submission
Licenses and Certifications

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