Canada Independent Adjuster Application

Contact Information
Education
Please list name, location, and diploma/degree for each attended.
Previous crop adjusting experience (if any):
Such as managing or operating a farm, attending an Agricultural College, etc.
Such as, but not limited to climbing bins, walking in fields, working outdoors, driving long distances, etc.
Crop Damaging Items
Re: Insects, Disease, Herbicide
References
Reference 1
Reference 2
Reference 3
Certification and Release

I certify that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said person, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing the information.

I also understand that any services provided by me would be as an independent contractor, and not as an employee of the Company, and would therefore not qualify for unemployment compensation. In addition, I assume all responsibility with respect to the payment of federal taxes as a self-employed individual.

If you are a California resident, please read our Notice of Collection.