Caregiver (CNA/PCA) Application

Dear Applicant,

Thank you for your interest in Vital Care Services. In order to apply for the CNA/PCA position, please fill out the online application below, as well as, be prepared to provide updated originals (copies to be made at the office) of the following documents:

Please send copies of:

  1. Resume
  2. Driver’s License
  3. Social Security Card
  4. Current physical exam with immunization such as TB Test, Rubella, Varicella
  5. CPR and other healthcare-related training certificates (BLS OR ACLS)
  6. State of Georgia Nurse Aide Certification
  7. Car Insurance

Upon review of your application and the required documents, we will contact you for an initial interview and orientation.  Please note, all documents must be completed before an orientation can be scheduled.

Best of luck!

Director of Clinical Services

Application For Employment - CNA/PCA

Are you licensed/certified for the job applied for?

Emergency Contact Information


Below, please list all days and times you are available for work. *Please note that some weekends are mandatory for employment with GHS.

*(Note: No applicant will be denied employment based solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, surrounding circumstances, and relevance of the offense to the position(s) applied for might and can be the primary reason for a “no” hire.
Do you understand sign language and/or can hand sign

Education Background, Training & Military Experience

All positions at GHS requires a minimum educational level of a High School Diploma or equivalent.

Employment History

List your last three (3) employers stating with the most recent.

Military Experience

List three persons not related to you who have knowledge of your work performance within the last three years.

If you are applying for a position that requires driving, please complete this section:

If you are selected for an interview, you are required to present a copy of your driving record that is not more than four (4) weeks old. After being hired, a copy of this driving record will be placed into your personnel file. An annual update record is required.


In exchange for the consideration of my job application by GHS, Inc., I agree that neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of GHS, Inc. or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Director or the company. Both the undersigned and the Director may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I hereby state that all information provided is accurate and may be verified by you. I agree that I may be discharged if GHS at any time learns of falsification or material omission in the information provided on this application form and related documents. GHS may contact my former employer in connection with the consideration of my employment with them. I hereby release GHS, its affiliates, successors and assign, and all references from any liability that might be claimed because of information provided by such references. I agree that I will follow all company policies, rules, procedures, and other directions pertaining to my employment. I understand that GHS reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at any time. NO CONSIDERATION WILL BE GIVEN TO ANYONE WHO DOES NOT SIGN THE ABOVE STATEMENT.
Geenline Health Services, Inc. is committed to the principle of equal employment opportunity for all applicants, and to providing them with a work environment free of harassment and/or discrimination. All employment decisions are based on each applicant’s qualifications, training, experience, and the company’s need without regard to race, religion, sex (including pregnancy), origin, age, disability, sexual orientation, gender, marital status, or any other status protected by all applicable laws.