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Employment     Employment Application Form Insurance Claims Adjusters, Inc. is an Affirmative Action employer and provides Equal Employment Opportunities to all employees and applicants for employment. ICA does not discriminate on the basis of race, religion, color, sex, age, national origin, disability unrelated to ability to perform job duties, marital or veterans status, or any other legally protected status, in accordance with all applicable laws and regulations. This employment application is used by ICA, Inc. and all of its affiliated and/or subsidiary companies. Do not leave any items unanswered. If you wish to not answer a question, please put an "n/a" for your answer. Back to Main Employment page <<     First Name Middle Name Last Name Home Phone Area Code    Phone Number Email Address Current Address Current Address 2 Current City Current State n/a Outside United States/Canada Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Current Zip Current County Length of Time at     Current Address 0 1 2 3 4 5 6 7 8 9 10 Years 0 1 2 3 4 5 6 7 8 9 10 11 12 Months Note: If you've been at your current address for more than 5 years, you do not need to provide a previous address. Previous Address Previous City Previous State n/a Outside United States/Canada Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Previous Zip Previous County Length of Time at     Previous Address 0 1 2 3 4 5 6 7 8 9 10 Years 0 1 2 3 4 5 6 7 8 9 10 11 12 Months Are you legally eligible     for employment in     the US? Yes No How did you hear of     our company? Advertising Personal Research Employee Referral Other     If Other, please explan     If Employee Referral,     name of employee For what position are     you applying? Auto Adjuster Property Adjuster Home Office Other What are your salary expectations? If hired, when could you start work? Have you ever been convicted of     a crime in the last five (5) years     (include any traffic violations)? No Yes     If yes, explain Have you ever been convicted of     a felony? No Yes     If yes, explain

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