Adjuster Information Form

Thank you for your interest in joining The Littleton Group as a catastrophe adjuster. By joining our team, you will be a part of one of the leading catastrophe companies in the nation. You will have the opportunity to work for some of the largest insurance carriers in the United States.

Your information will be forwarded to our Catastrophe office for processing.

Please contact us with any questions or comments.

NOTE: Fields marked with an asterisk (*) are required.

Contact Information
First Name:*
Last Name:*
Email:*
Alternate Email:
Street Address:*
Street Address (cont):
City:*
State:*	AL-Alabama AK-Alaska AZ-Arizona AR-Arkansas CA-California CO-Colorado CT-Connecticut DC-Washington D.C. DE-Delaware FL-Florida GA-Georgia HI-Hawaii ID-Idaho IL-Illinois IN-Indiana IA-Iowa KS-Kansas KY-Kentucky LA-Louisiana MA-Massachusetts ME-Maine MD-Maryland MI-Michigan MN-Minnesota MS-Mississippi MO-Missouri MT-Montana NE-Nebraska NV-Nevada NH-New Hampshire NJ-New Jersey NM-New Mexico NY-New York NC-North Carolina ND-North Dakota OH-Ohio OK-Oklahoma OR-Oregon PA-Pennsylvania PR-Puerto Rico RI-Rhode Island SC-South Carolina SD-South Dakota TN-Tennessee TX-Texas UT-Utah VT-Vermont VA-Virginia VI-Virgin Islands WA-Washington WV-West Virginia WI-Wisconsin WY-Wyoming
Zip / Postal code:*
Home Phone:*
Business Phone:*
Cell Phone:*
Emergency Contact:*
Emergency Contact Phone:*
Desired Postion
Select the position that best describes your previous claims handling experience. If no experience, select desired position. Please choose top 2 positions:
Desired Position #1:	File Reviewer Inside Adjuster Outside Adjuster Umpire Appraiser Team Lead
Desired Position #2:	File Reviewer Inside Adjuster Outside Adjuster Umpire Appraiser Team Lead

License Information
Provide information for the licenses you hold in each state. Click the "Add Another License" button below to add fields for additional licenses.
License State:*	NFIP AL-Alabama AK-Alaska AZ-Arizona AR-Arkansas CA-California CO-Colorado CT-Connecticut DC-Washington D.C. DE-Delaware FL-Florida GA-Georgia HI-Hawaii ID-Idaho IL-Illinois IN-Indiana IA-Iowa KS-Kansas KY-Kentucky LA-Louisiana MA-Massachusetts ME-Maine MD-Maryland MI-Michigan MN-Minnesota MS-Mississippi MO-Missouri MT-Montana NE-Nebraska NV-Nevada NH-New Hampshire NJ-New Jersey NM-New Mexico NY-New York NC-North Carolina ND-North Dakota OH-Ohio OK-Oklahoma OR-Oregon PA-Pennsylvania PR-Puerto Rico RI-Rhode Island SC-South Carolina SD-South Dakota TN-Tennessee TX-Texas UT-Utah VT-Vermont VA-Virginia VI-Virgin Islands WA-Washington WV-West Virginia WI-Wisconsin WY-Wyoming
License Number:*
License Expiration Date:*

No License/Pending License:

Certifications *
Check all that apply below:
CPIC
TWIA Certified
Shelter
State Farm
Allstate
USAA

Estimating Platform
1st Choice: (Pick one)
Xactimate	License #:
Integra	License #:
Other	License #:
2nd Choice: (Pick one)
Xactimate	License #:
Integra	License #:
Other	License #:

Experience
Light & Heavy Commercial
Light - Yrs Experience:	Heavy - Yrs Experience:
Light & Heavy Residential
Light - Yrs Experience:	Heavy - Yrs Experience:
Mobile Home
Light - Yrs Experience:	Heavy - Yrs Experience:
No Previous Experience

Availability
Preferred Work:
Daily Claims
Catastrophe
Anything Available
Currently Deployed:	Yes No
Date Available:
I am willing to travel.
Documents
Upload Resume (DOC or PDF only please):
Upon submission, you will receive an email confirmation for your records.