Can you legally work in the United States of America?
Have you ever been convicted of a felony, or any crime involving fraud, dishonesty, or breach of trust—regardless of how long ago it occurred or whether it was expunged?
Are you currently behind on court-ordered child support, owe significant back taxes, or have unresolved civil judgments or liens?
Have you ever had a professional license (insurance or otherwise) denied, suspended, or revoked in any state—or failed to disclose required information on a previous license application?
Do you acknowledge that by completing this form, you are expressing a genuine interest in pursuing a professional and educational relationship with Adjuster University, with the intention of seriously exploring a career in independent claims adjusting—and not submitting this form for casual inquiry or unrelated research purposes?
Preferred Method of Contact
First name
Last name
Phone number
Email