Schafer, Wood & Associates Application – SWA Claims Management Services LLC

Step 1 of 10

Thank you for your interest in joining SWA Claims Management Services, LLC.
Before you begin the application, please make sure you have a copy of the following items completed & saved for uploading during the application process:

1. Copy of your driver's license.
2. Copy of your adjusters license for your home state or designated home state.
3. ID Photograph (used for badges). You will need to follow these guidelines.
4. Copy of your resume.

You will not be able to complete and submit your application without the required information.

The first step in joining our team is to be added to our roster by completing our online application. Do not leave any items unanswered. After your credentials have been verified by our recruiting department, you will be added to our roster.

The information you are about to provide will be handled securely and is required for SWA Claims Management Services recruiting purposes.

If you have a problem completing this application online, please send an email to adjusterservices@swaclaims.com., noting the nature of the problem you encountered and any error messages you received. *** Please note that applications are not accepted by email ***. .

Once you begin the application process, you will be able to save and return to the application if needed.

APPLICANT'S INFORMATION

Name*

Prefix First Middle Last Suffix

I do not have a middle name.*

I do not have a middle name.

Maiden/Alias

First name you wish to be addressed as

Date of Birth*

Driver's License Number*

Driver's License State*

SSN*

Confirm SSN*

Home Phone

Cell Phone

SWA Claims Management Service may use text messaging as a method of rapidly communicating with our team. May we text messaging to communicate with you?(Message and data rates may apply)

Public Phone (used with clients/public if given)

Email*

Enter Email Confirm Email

Alternate / Secondary Email

Enter Email Confirm Email

Physical Address (No P.O. Boxes)*

City*

State*

Country*

Zip Code*

Mailing Address

Mailing Address is the same as Physical Address

Mailing Address*

City*

State*

Country*

Zip Code*

Emergency Contact Information

ER Contact Name #1

Relationship

Phone Number 1

Phone Number 2

ER Contact Name #2

Relationship

Phone Number 1

Phone Number 2

How did you hear about us?*

Website/Search Engine

Referral

Name of person who referred you:*

Direct Deposit Authorization
I authorize SWA Claims Management Services, LLC. to initiate automatic deposits to my account at the financial institution named below. In the event that SWA Claims Management Services, LLC. deposits funds erroneously into my account, I authorize SWA Claims Management Services, LLC. to debit my account for an amount not to exceed the original amount of the erroneous credit.

This agreement will remain effective until SWA Claims Management Services, LLC. receives a written notice of cancellation from me. I also understand that completing this section allows a photocopy, fax copy, or copy sent by email of this authorization to be valid as the original.

Name(s) on Account*
Name of Financial Institution*
City*
State*
Routing Number*
Account Number*
Account Type*

Checking

Savings

Disclosure Statement
Pursuant to the Violent Crime Control and Law Enforcement Act of 1994, 18 U.S.C. §1033(e), an individual may not engage in the business of insurance if the individual has been convicted of a felony involving dishonesty or breach of trust, unless the individual has the written consent of an appropriate insurance regulatory official.
Have you ever been convicted of a felony?*

Yes

No
Date of Conviction*
MM slash DD slash YYYY

Court*
City*
State*
Describe in detail the conviction and criminal act:*

Type of punishment or penalty received as a result of the conviction:*

Document Upload
Please submit the following documents.
Note: Please upload files with unique filenames.
Drivers License*
Accepted file types: jpg, jpeg, heic, png, pdf, doc, docx, tiff, Max. file size: 15 MB.
Self-Portrait Photograph*
Accepted file types: jpg, jpeg, heic, png, tiff, Max. file size: 15 MB.

Please follow these guidelines.

Resume*
Accepted file types: doc, docx, pdf, Max. file size: 15 MB.
Passport
Accepted file types: jpg, jpeg, heic, png, pdf, Max. file size: 15 MB.

Miscellaneous Files Upload

Drop files here or

Accepted file types: jpg, jpeg, heic, png, pdf, doc, docx, Max. file size: 25 MB.

Certify Info Valid*
I certify the information I have provided to be true to the best of my knowledge.
Agree to Terms and Conditions*
I have read and agree to the Terms & Conditions.

× Please note: After submitting your application, you will be redirected to sign digitally the following documents: Inquiry Release, W9 Form & Consulting agreement. This might take a up to a minute, DO NOT refresh the page.

State	License Number	Issue Date	Expiration Date	Issue Date	Expiration Date	Copy of License	Actions

There are no Licenses.

Application

SWA Adjuster Services - Application

SWA CLAIMS MANAGEMENT SERVICES APPLICATION

APPLICANT'S INFORMATION

Emergency Contact Information

AREAS OF INTEREST

CERTIFICATIONS

SOFTWARE

OTHER QUALIFICATIONS

LICENSE INFORMATION

Direct Deposit Authorization

Disclosure Statement

Document Upload