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Contact ICA
Employment
Employment Application Form
ICA, LP is an Affirmative Action employer and provides Equal Employment Opportunities to all employees and applicants for employment. ICA does not discriminate on the basis of race, religion, color, sex, age, national origin, disability unrelated to ability to perform job duties, marital or veterans status, or any other legally protected status, in accordance with all applicable laws and regulations.
This employment application is used by ICA, LP and all of its affiliated and/or subsidiary companies. Do not leave any items unanswered. If you wish to not answer a question, please put an "n/a" for your answer.
Personal Details
Other Details
Other Documents
First Name
Middle Initial
Last Name
Adjusting Firm
Number of Employees doing business under this name
Xactnet ID
MSB ID
Home Phone
Work Phone
Mobile Phone
Pager
Fax Number
Email Address
Confirm Email Address
Current Address
Current Address 2
Current City
Current State
Select
AA
AE
AK
AL
AP
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Z1
Z2
Z3
Z4
Current Zip
Current County
List Memberships in professionals organizations
NAIIA
NACA
IADA
Other Organizations
List your PHYSICAL residences of the last ten(10) years, starting with your current address:
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Address1
City
State
Zip
County
On Rent
Reside From
Reside To
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Education Qualification:
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Refresh
College/Facility Name
Location
Attendance Date
Degree
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Have you ever worked with ICA, LP or Insurance Claims Adjusters, Inc. in the past?
Yes
No
If yes, when and where?
If you have worked for ICA in the past, were you doing business under another (Comapny)name?
Yes
No
If yes, Provide the name
I am interested in handling claims
Daily Claims
Cat/StormsClaims
Both
May we contact your former employer?
Yes
No
What current adjusting/estimating software are you using
Simsol
Xactimate User
ADP User
CCC User
MSB User
Symbility User
Other Software
During the past ten (10) years, have you ever been refused a professional, occupational, or vocational license by any public or governmental licensing agency or regulatory authority, or has license held by you ever been suspended or revoked?
Yes
No
If yes then please provide details
List any insurers in which you control directly or indirectly, or own legally or beneficially 10% or more of the outstanding stock (voting power)
Have you ever been convicted,or had sentence imposed or suspended , or had pronouncement of a sentence suspended, or been pardon for conviction or pledge guilty or nolo contendere to an information Or indictment charging any felony, or charging a misdemeanor involving embezzlement, theft,larceny,mail fraud,or charging a violation of any corporate sucurities statue or any insurance law, or have you been the subject of any disciplinary proceedings of any federal or state requlatory agency
Yes
No
If yes, then please give details and location (county) of offense
Has any company been so charged, allegedly as a result of any action or conduct on your part?
Yes
No
If yes, then please give details
Primary Language
Other languages
Do you have a valid passport
Yes
No
If yes, Expiration Date
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Please indicate you years of experience on the following claim areas. Be as accurate as possible
Years Experience
Auto Liability
Auto Appraisal
Boat Physical Damage
Ocean Marine
Inland Marine
Flood
Crop Loss
Construction
Environmental
Earthquake
Mold
Hazardous Material
Fine Arts:
Fire Investigation:
Underground Storage:
Mobile Home
Property Dwelling
Heavy Equipment
Guaranty Fund Losses
General Liability
Product Liability
Property Commercial
Professional Liability
Property Time Element
Workers Compensation
Driver's License State
Select
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VT
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Driver's License Number
Does your state require an Adjusters License?
Yes
No
Do you have a current Adjuster/Appraiser's License?
Yes
No
Adjuster License Details
Add new record
Refresh
License State
License Number
License Expiration Date
NPN Number
Is Primary
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AR
AZ
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FL
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HI
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ME
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MN
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Automobile/Insurance Details
Name of insured on your auto liability policy
Year, Make and Model of automobile
Auto Liability Carrier
Pol#
Exp. Date
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Limits
Error and ommissions carrier
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Limits
Names and phone number numbers of two references in the insurance industry
1)Name
Phone Number
2)Name
Phone Number
Upload Documents
Note: Please upload with unique filename.
Resume
You must have a copy of the following completed and saved for uploading during the Registration process.
Social Security Card
Copy of Driver's License
Any Adjuster Licenses
A Photograph
Resume
Independent Contractor Agreement
Form W-9
Background Authorization Form
Direct Deposit Authorization
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