PCA Adjuster of the Year

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Choose Local Association*

Name and address*

Job title*

Company*

Phone Number*

Experience by line*

Education in the insurance field*

designations

College education

Honors and awards received by your company, local association, and community

organizations you are a member of and any offices held

List insurance publications you regularly read

Liat any other insurance courses completed

Why should you be considered for the Adjuster of the year?*

Number of ads you have sold for any of the associations*

What is your current job responsibilities?*

Give a brief history of your experience with your present employer including dates of promotionm etc.*

Greatest contribution to your present employer*

Employment history in claims*

Employment hisory outside of claims

Hobbies and interest

List three persons, their company, title, address, and phone in the claims filed who would recommend you*

Name of the local association you are a member*

List any letters of recommendations or other documents you will submit separately by mail. or email*

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Thank you for your application submission for the Adjuster of the Year. Your application will be reviewed by the appropriate committee.