Field Inspector recruiting form Step 1 of 3 - Page 1 0% Today's Date* MM slash DD slash YYYY (MM/DD/YYYY) Your Name* First Middle Last Suffix Business name (if applicable) Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell Phone*Email Address* Enter Email Confirm Email Date of Birth* MM slash DD slash YYYY Primary Language*EnglishSpanishFrenchChineseJapanesePortugueseArabicHindi-UrduBengaliItalianGermanRussianSwedishPolishPersianMalaysianTurkishDutchSwahiliTamilOtherAdditional Languages Spoken English Spanish French Chinese Japanese Portuguese Arabic Hindi-Urdu Bengali Italian German Russian Swedish Polish Persian Malaysian Turkish Dutch Swahili Tamil Other How did you hear about TelaClaims?*LinkedinReferred by friendFound onlineInstructed by employerInterNACHI ConventionOther (Please provide source)Other source (If Applicable) Have You Been a Member Of The US Armed Forces?* Yes No Have You Ever Worked For TelaClaims Before?YesNo Do you have an active adjusters license?*YesNoPrimary Licensed StateALABAMAALASKAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREFLORIDAGEORGIAHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUSIANAMAINEMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTAOHIOOKLAHOMAOREGONPENNSVLVANIARHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMINGInfoAdjuster License NumberExpiration Date (MM/YYYY) If applicable, list additional states, adjusters license numbers, and expiration.StateLicense NumberExpiration (MM/YYYY) Have you ever worked as a carrier staff adjuster?*YesNoList all carriers that you have worked for and in what position/role (If Applicable)CarrierPosition/Role Carrier certification(s) (If Applicable)Certification NameExpiration Date (MM/YYYY) Do you have a reliable source of transportation?*Yes/NoYearMakeModel Do you have a basic understanding of construction? If so, please elaborate.*Are you capable to lift more than thirty (30) pounds (lbs) or more?* Yes No For example: A ladder Are you comfortable getting on a roof?* Yes No Do you have a Haag Roofing Certificate?*YesNoHaag Roofing Certificates license number (If Applicable)License NumberExpiration Date (MM/YYYY)Do you have a Rope and Harness Certification?*YesNoDo you have a IICRC Certification? If so, list your active certifications.* Not Applicable AMRT (Applied Microbial Remediation Technician) ASD (Applied Structural Drying Technician) BMI (Building Moisture Inspection) CCMT (Commercial Carpet Maintenance Technician) CCT (Carpet Cleaning Technician) CDS (Commercial Drying Specialist) CPT (Contents Processing Technician) CRT (Color Repair Technician) FCT (Floor Care Technician) FSRT (Fire and Smoke Damage Restoration Technician) HCT (House Cleaning Technician) HST (Health and Safety Technician) ISSI (Introduction to Substrate and Subfloor Inspection) LCT (Leather Cleaning Technician) MRS (Mold Remediation Specialist) OCT (Odor Control Technician) RCT (Rug Cleaning Technician) RFI (Resilient Flooring Inspector) RFMT (Resilient Flooring Maintenance Technician) RRT (Carpet Repair and Reinstallation Technician) SCI (Senior Carpet Inspector) SMT (Stone, Masonry and Ceramic Tile Cleaning Technician) TCST (Trauma and Crime Scene Technician) UFT (Upholstery and Fabric Cleaning Technician) WFMT (Wood Floor Maintenance Technician) WLFI (Wood and Laminate Flooring Inspector) WRT (Water Damage Restoration Technician) By selecting this box, you acknowledge all of the equipment listed in the job description are required.* I acknowledgeIf unclear, please refer back to the job description.By selecting this box, you authorize TelaClaims Adjusting LLC to remit your information for a full background check and share your resume as needed.* I agreeYour information may be shared with insurance carriers for possible job opportunities. Please upload your current resume.* Drop files here or Select files Accepted file types: pdf, Max. file size: 15 MB, Max. files: 4. Please only upload your resume in PDF format Δ
