Employment  

Employment Application Form

Insurance Claims Adjusters, Inc. 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, Inc. 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.

First Name  
Middle Initial
Last Name  
Adjusting Firm
Number of Employees doing business under this name
Social Security Number
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Confirm Social Security Number
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Federal Tax ID Number
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Confirm Federal Tax ID Number
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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  
Current Zip  
Current County
List Memberships in professionals organizations
Other Organizations
List your PHYSICAL residences of the last ten(10) years, starting with your current address:
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Address1CityStateZipCountyOn RentReside FromReside To  
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Education Qualification:
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College/Facility NameLocationAttendance DateDegree  
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