Application


Thank you for your interest in working with CEFCO National Claims Services, Inc., dba CNC Catastrophe & National Claims, also referred to as “CNC” and “Company”, as an independent contractor and/or at-will employee catastrophe insurance adjuster and/or claims processor (non-catastrophe assignments) and/or office staff/examiner. All applications will be considered without regard to race, color, religion, sex, national origin, age, disability, veteran status, military obligations, genetic information and any other characteristic protected by law. Before approving any applicant for assignment, the Company will consider the results of a thorough background check, which may include prior employment and education verification, verification of adjuster licensure and any other credentials required by law or client requirements, criminal conviction record, driving record, pre-employment drugscreening and other areas.



INSTRUCTIONS AND INFORMATION

You MUST complete this application IN FULL in order to be considered to work with CNC as an as an independent contractor and/or at-will employee catastrophe insurance adjuster and/or claims processor (non-catastrophe assignments) and/or office staff/examiner. Make sure that all the information you supply is complete and correct. Failure to do so may result in disqualification from consideration or termination. The information provided in this application will be used to determine your eligibility. Please print legibly. Please complete ALL areas below.



POSITIONS YOU ARE APPLYING FOR

Personal Information
Last name: First name: M.I.:
Address: City: State: Zip:
Email Address: Home phone: Work phone: Cell phone:
May we contact you at work?


Emergency Contact Information Emergency Contact Name: Emergency Contact Home: Emergency Contact Cell:

In what states do you hold a valid insurance adjuster's license?
State License #: Expiration date:


Certifications Are you auto certified? If yes, list carriers:
What is your flood certification number?
Do you have a current NFIP Card? If yes, cert. start date is? End date?
What is your certification level? (Check all that apply)
Are you property certified? If yes, list carriers:
Are you a property adjuster? (Check all that apply)

Can you travel on short notice for extended periods of time?
Do you have a valid driver's license?
Do you have reliable transporation?
Have you attended school under any other names? If so, what names?
Have you previously worked with CNC as an adjuster? If so, when was your last assignment?
Are you related to anyone who is currently employed with CNC or who works with CNC as an independent contractor? List name(s) and relationship:

Are you comfortable working outdoors in inclement weather including humidity, heat, sun and cold?
Are you willing and able to carry and climb a ladder to inspect and/or measure roofs of dwellings and other structures?
Are you willing and able to inspect and measure all interior and exterior areas of dwellings and other structures, including but not limited to basements, attics, crawl spaces?
Are you legally authorized to work in the US?
If employment is offered, you must show documents for verification that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.

Are you ineligible to handle claims from any insurer?
If yes, please explain:


Education and Credentials
High School Name of school:
City: State:
Graduate?
GED?
College Name of school:
City: State:
# Years Complete: Graduate? If no, hours completed?
Degree/Diploma: Course of study:

Relevant Skills/Language Fluency/Other Certifications & Training
Explain:
Explain:
Required Equipment: What items do you own or have access to use for adjusting assignments? (check box for all that apply)
Smartphone Laptop Computer
Digital Camera iPad3 or better - must be 3G or 4G with not less than 16GB of memory, with camera and Wi-Fi capability
If you do not possess any of the required equipment items, are you willing to acquire each item (at your expense) prior to accepting adjusting assignments, if such assignments are offered?

PREVIOUS CLAIMS ADJUSTING EXPERIENCE Please list the ten most recent catastrophes you have worked as a claims adjuster. If you have worked fewer than ten events, please list all events you have worked.
Event: Start date: End date:
Organization name: Supervisor name: Number of Claims:
Duties:

Employment History List all current and previous employment (other than catastrophe claims adjusting work referenced above) for the last ten years, including military service, starting with the most recent position held. Whether or not you attach a resume, this section must be completed in its entirety. Information will be used in reference checks. Failure to completely and truthfully answer all items in the following section may eliminate you from further consideration.
Employed from: To: Position title:
Wages Start: Per: Wages End: Per: Organization Name:
Employment status: May we contact for references? Organization Address:
Supervisor name/title: Supervisor phone number: Reason for leaving:
Duties:
References
First and last name: Street address: City: State: Zip: Phone: Email:

PLEASE READ CAREFULLY

By pressing submit below, I certify that the above statements are true and complete. I understand that any false information or omissions (including, but not limited to, failure to reveal prior employers) in this application or its supporting documents, or in an interview, will be sufficient grounds for refusal to consider me for work, as an independent contractor and/or at-will employee catastrophe insurance adjuster and/or claims processor (non-catastrophe assignments) and/or office staff/examiner, and to terminate my relationship with CNC as an independent contractor or employee, if such is offered. I understand that completion of this application in no way constitutes an offer of employment or assignment as an independent contractor. I understand that this application form will be active for 30 days from the date of completion. If I wish to be considered to work with CNC after that time, I understand that I will be required to complete and submit a new application form. I authorize CNC to obtain information about me from my previous employers and to review my education, previous employment, driving records, criminal records, references, professional licenses and other background data. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you. I also acknowledge that a pre-employment or preassignment drug screening and further background screening may be required and agree to voluntarily consent to both, if such is required. I agree that a facsimile, electronic or photographic copy of this Application shall be valid as the original.