Pre-Application Questionnaire

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Occupation Information

Job Duties

If your job duties include any of the following, check all that apply and provide percent of time spent during your typical work week (percentages do not have to total 100%):

If you are a medical professional, please provide your certifications below.


Dray Hicks
(248) 837-0382
Email me

We value your privacy. Due to the confidential nature of the questions being asked, we limit the amount of time that we maintain your information. Once you complete the questionnaire, your answers are delivered securely to your agent, who will complete your official application and send to you securely for your review and signature.

Please call your agent, Dray Hicks at (248) 837-0382 with any questions. Thank you for working with us on your coverage.

Opes One is an independent agency authorized to offer products of The Guardian Life Insurance Company of America (Guardian), New York, NY and its subsidiaries, and is not an affiliate or subsidiary of Guardian. The Guardian Logo is a registered service mark of Guardian, used with permission.