APPLICATION FORM

Current Date:

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dd-MMM-yyyy

Full Name (first & last name mandatory):

First Name Middle Name Last Name

Email Address (adjuster email preferred):

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Phone Number (preferably cell phone):

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If Yes, How Many Claims Have You Completed?

If Yes, what kind of claims did you complete?

Please list the types of claims you have worked on (ie property, auto, workman's comp, marine, crop, etc.)

Relevant Training and Certifications:

Any previous experience in insurance or a related field?

Explain, if any.

Resume Upload

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How Did You Hear About MileHigh Adjusters Houston?

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Were you referred by someone? Did you find us on a job board? Was it a Googe search for adjuster training?

Any Additional Comments or Questions?

I understand that the technical processing and transmission of my application, including personal information, may involve transmissions to the United States and/or other countries for storage, processing, and use by MileHigh Adjusters Houston, its affiliates, and their agents. I consent to these transmissions and changes necessary for technical requirements.

Application Statement:

I certify that all of the above information is true and complete, and I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination regardless of the time elapsed before discovery.

I understand that by providing my contact information, I may receive emails, text messages, or electronic notifications from MileHigh Adjusters Houston regarding updates, promotions, and other relevant information.

Note: An offer of employment is conditioned upon complying with Company's requirements including, but not limited to, signing a consent to conduct a background investigation.

I AGREE, AND IT IS MY INTENT, TO SIGN THIS EMPLOYMENT APPLICATION BY CHECKING THE "I ACCEPT" BOX BELOW AND BY ELECTRONICALLY SUBMITTING THIS DOCUMENT TO THE COMPANY, I UNDERSTAND THAT BY CHECKING "I ACCEPT" ON THIS DOCUMENT IN THIS FASHION IS THE LEGAL EQUIVALENT OF HAVING PLACED MY HANDWRITTEN SIGNATURE ON THE SUBMITTED DOCUMENT.

APPLICATION FORM

Personal Information

Professional Background

Please review each paragraph thoroughly prior to accepting. I have provided all pertinent information relevant to my candidacy for employment.

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