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Personnel Update

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Name *

First

Last

Phone Number *

Email *

Address *

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Line 2

City

State

Zip Code

Country

Are you available for field deployment? *

Yes No

Are you still available for Inside Desk Examiner Deployment *

Yes No

Do you have Xactimate Experience *

Yes No

*** Xactnet Address *** *

Active State Adjuster License(s) *

Texas Florida North Carolina Alabama Louisiana Mississippi Alabama South Carolina Georgia Massachussetts New York

Please Select ALL states where you have an active adjuster's license.

Do you have Experience with Symbility *

Yes No

Residential Property Claims Experience *

None Less than 2 years 2 - 5 Years Over 6 Years

Commercial Property Claims Experience *

None 1 - 3 Years 4 - 10 years Over 10 Years

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