I certify that the answers given on this application are true and complete to the best of my knowledge. I hereby give Heart of Georgia Hospice, Inc. permission to conduct a background check. I agree to submit to a drug screening. I understand that volunteer placement is contingent upon the results of the background check and drug screening, and upon completing all initial and future requirements set fourth by Heart of Georgia Hospice, Inc. I understand checking the box is the equivalent of a physical signature.

By checking, I agree to share my form responses.