2/3/2012 First Name Last Name Address1 Address2 City State --Select-- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip code Home # Cell # Office # Fax # E - Mail SSN # Have you worked for LIA Before? Yes No Have you worked with Citizens? Yes No How many years? What capacity they worked with Citizens?    Residential Experience Yes No How many years? Experience handling catastrophes in FL? Yes No Flood Experience Yes No How many years? No.of flood claims adjusted Current flood certification Yes No Mobile Home Experience Yes No How many years? Experience handling mobile homes in FL? Yes No Condo Experience Yes No How many years? Experience handling condos in FL? Yes No Commercial Experience Yes No How many years? No. of commercial claims adjusted  Large Loss Claim Experience Yes No How many years? No. of commercial claims adjusted What is the gross loss of the largest claim handled?    $ Wind Experience Yes No How many years? Were you certified with FWUA? What property estimating platforms are you proficient in? Simsol Xactimate Powerclaim IntegraClaim Other Write program Name  Have you worked with FIGA previously? Yes No In What capacity?     Have you ever worked as a file examiner? Yes No What was the total amount of time deployed/worked? Have you ever worked as a desk adjuster? Yes No What was the total amount of time deployed/worked? Do you speak any languages other than English? Yes No What languages?     Do you have the capacity to submit files electronically? Yes No Preference : Would you prefer to be considered for a field adjuster position or as an in-house examiner? All Adjusters Examiner