CNC - Employment Application

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 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 complete ALL areas below. You will be able to review all input prior to final submission of your application


Position(s) Applying For | |

Personal Information
Emergency Contact Information


Certifications

 




Additional Qualifications
Casualty / Other# Yrs Exp

  
Automotive# Yrs Exp

  
Property# Yrs Exp


Current and Valid State Insurance Adjuster's License(s)


Work Questions

If employment is offered, you must show verifiable documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.


Driver's License Information



Computer, Software, and Language Skills



Required Equipment


PREVIOUS CLAIMS ADJUSTING EXPERIENCE


Employment History


References

Education
High School
College

Application Attachments

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.