Inspector Application

 

We do not use “chargebacks” with our inspectors and we never have!

Applicant: please note that this is not a solicitation for employment. No promise of employment is being offered. We are looking for independent contractors who have insurance inspection experience.

Please fill out this form and we will get back to you as soon as possible. Thank You!

INDEPENDENT CONTRACTORS INFORMATION
Today's Date: 09/07/2010
Name First & Last:    
Middle Name:  
Address:
Street Number Street Name Suite
   
City:    
State:  
Zip:    
Date Of Birth:        
Social Security Number:    
Drivers License Information:
License Number License State
   
Telephone:
Home Business Cell Fax
 
Email Address:    
Photo:  
Height:      
Hair Color:    
Eye Color:    
Type of Digital Camera:    
Type of Computer:    
Type of Printer:    
Do you have a measuring wheel?  
Educational Background:  
Date, Name, And Address of College:    

Work Experience: List Insurance Experience First:
Do you have experience doing insurance inspections?
Do you have experience doing commercial insurance inspections?
    Date Name of Company Address Type Of Work
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Personal References:
1.    
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5.  
Have you Ever Been Convicted of A Felony:  
If Yes, Provide All Details And State of Conviction:  
 
Vehicle Information:
Year Make Model
     
Name of Insurance Company:    
Policy Number:    
Amount of Liability Insurance:    
Expiration Date of Policy:    

Please List Geographic Areas That You Can Provide Quality And Time Service In:
        City, State Zip Code         City, State Zip Code
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Any Additional Information you would like to add:
 
Signature of Independent Contractor (Type Your Name):    
Date:    

Clear