Occupations Questionnaire



Preferra and NOHS are diligently working in providing liability coverage to new human services occupations for which we currently DO NOT have an insurance solution in place.

By sharing the information in the below form, you are allowing us to start our due diligence and assessment of insurability for your particular occupation. Please be aware that this process could take several months. Once a decision has been made regarding the possibility of coverage for your occupation, we will inform you.

Name

First

Middle

Last

Current Job Title

Education (Highest Level)

Mobile/Cell Phone

State

Confirm Email

in provide Current

Is any certification or licensure required by your state for the delivery of your services?

What job functions are provided in your work?

Are you required to provide any physical support, hygiene assistance and or medication management in your work?