Benefits Counselor Information

Benefits Counselor Information

We are always looking for quality benefits counselors. Please fill out the form below for us to consider you for our next project.

Date*

First Name*

Last Name*

Preferred Name*

Mobile Phone*

Phone

Email*

NPN#*

E&O Expiration

Corporate name (If you want to paid as a corp)

Bilingual*

Select or enter value

Address*

City*

State*

Zip*

Time Zone*

Select

Have You Enrolled in ADP Workforce Now*

Select or enter value

LTC Certified*

Select

Will Do Call Center Enrollments*

Select

Will Do Onsite Enrollments*

Select

Referred By*

What Makes You a Benefits Counselor We Should Use?*

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