about us
Field Rep Job Application





 * Denotes required fields
Your Contact Information
First Name    
*
Last Name     *
Home Address      *
City     *
State     *
Zip     *
Company Name    
Work/Office Address     
City    
State    
Zip    
Tax ID      *
E-mail Address     *
Web Site Address/URL    
 (if available)    
Business Phone  (### ### ####)     *   Ext  
Home Phone (### ### ####)     *
Cell Phone (### ### ####)    
Fax (### ### ####)    
Checks Mailed* Home Office Other
Checks Issued To* Company Name Legal Name Other

About You		  
Date of Birth (mm/dd/yyyy)      *
Education     
Special Training     
(indicate type and/or description)     
Professional Licenses     

Your Technological Skills		  
Do you currently own or have access to the following: *
Personal Computer       Yes No
High Speed Internet Access       Yes No
Microsoft® Word       Yes No
Digital Camera       Yes No
 
How proficient are you in using the following: *
Personal Computer     Expert Somewhat
Knowledgeable		 Don't Use
High Speed
Internet Access		   Expert Somewhat
Knowledgeable		 Don't Use
Microsoft® Word     Expert Somewhat
Knowledgeable		 Don't Use
Digital Camera     Expert Somewhat
Knowledgeable		 Don't Use
Are you prepared to complete and deliver assignments in a paperless environment?           Yes   No *

Your Loss Control Experience
Number of years' experience     
in loss control     		 *
Residential Insurance      
Commercial Insurance     
Mortgage      
Home Inspection     
Others (Please list)         
What types of properties have you inspected (please check all that apply):
Office Buildings     
Retail     
Apartment Complexes     
Dwellings      
Hotels/Motels/Hospitality     
Restaurants     
Industrial/Warehouse     
Senior Housing     
Manufactures      
Contractors      
Others (Please list)         
Please provide any pertinent  information    
about your background and experience in     loss control     

Territory Covered		  
Base Location Zip Code      *
Radius covered from  Base Location      * miles

References		  
Please list two (2) professional references you have known for at least two (2) years:
Reference #1
Name     
Company     
Phone (### ### ####)     
Reference #2
Name     
Company     
Phone (### ### ####)     

Comments
Is there anything else we should know about you? If yes, please feel free to list your comments here or paste your resume

Terms & Conditions
By submitting this electronic application:  
  I certify that the facts contained herein are true, accurate and complete to the best of my knowledge.  
  I authorize investigation of all statements contained herein, as well as the companies and references indicated above to give you all information concerning my experience and any other pertinent information they may have, personal or otherwise, and release Site Inspection, LLC from all liability for any damage that may result from the use of such information.  
  I agree that I am requesting to work as an independent contractor for Site Inspection, LLC.   
  I understand that the completion of this application shall not be construed as creating an employee/employer/agency, partnership, or joint venture relationship between you or any of your agents and employees and Site Inspection, LLC and/or affiliates; that it is the intent of the parties that every vendor/contractor performing work for Site Inspection, LLC be and remains an independent vendor/contractor and not employees of Site Inspection, LLC; and that no vendor has the right to receive work from Site Inspection, LLC, and that work shall be awarded based on performance which is determined on an individual basis.  
    Agree  Disagree  
Back to top