If there is any question or statement on this form that you do not understand, ask for assistance by calling Cindy Smith, Vice President, Operations at Health Force of Georgia: 770-458-8500 ext. 704.

Thank you for completing the caregiver career application at Health Force of Georgia. There are three sections to the Health/Medical Questionnaire form. Be sure to complete ALL sections before clicking submit. The form will prompt you if there is required information missing in any section. Fields marked with a red * are required.