Guardian Dental & Vision Application

TEL Staffing & HR offers all of its partners and employees voluntary Dental and Vision plans through Guardian.

Click a button to learn more about the plans available to you, or fill out the form below to Enroll Now!

Personal Information:

Gender

Employer Information:

About Your Family:

Please include the names of the dependents you wish to enroll for coverage:

Are you married?
Spouse's Gender

Children / Dependents

Child #1 Gender
Is Child #1 a full-time student?
Child #2 Gender
Is Child #2 a full-time student?
Child #3 Gender
Is Child #3 a full-time student?
Child #4 Gender
Is Child #4 a full-time student?

Coverage Options:

Please select the type of DENTAL coverage you would like to recieve:

DENTAL Option 1 Benefit - $1000
DENTAL Option 2 Benefit $1,500

Please select the type of VISION coverage you would like to receive:

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