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GCIC Consent Form Template

Your Essential Tool for Securing Background Check Consent

Getting the right consent for GCIC background checks can be a hassle, but it doesn't have to be. This GCIC Consent Form Template is designed for both employers and organizations needing fast compliance with Georgia's regulations. With this template, you can simplify the consent process, ensure legal protection, and enhance trust with your applicants, helping you stay organized and compliant during hiring. Plus, our form is WCAG-aligned for accessibility. Feel free to explore the live template!

Use this Template (FREE) Live Preview
Legal name
Other names used (if any)
Date of birth
Gender
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Social Security number
Driver's license number and state
Race
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Two or more races
Prefer not to say
Residential address (street, city, state, ZIP)
Email address
Phone number
Requesting agency or employer name
If Other, please specify purpose
Purpose of background check
Employment
Licensing/Certification
Volunteer
Tenant screening
Adoption/Foster care
Personal record review
Other
Please Specify:
I authorize the requesting agency to obtain my criminal history record information from GCIC for the stated purpose.
Yes
No
I agree that my typed name below shall constitute my electronic signature.
Yes
No
I certify that the information provided in this form is true, correct, and complete to the best of my knowledge.
Yes
No
Type your full name as signature
Date of signature
{"name":"Legal name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Legal name, Other names used (if any), Date of birth","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
paper art illustration related to GCIC consent form template and FormCreatorAI

When to use this form

This template helps Georgia employers, licensing boards, and public agencies get written permission to run a state criminal history search through GCIC. Use it when screening job applicants for roles in childcare or healthcare, approving volunteers in schools, issuing permits, or renewing professional licenses. The form documents the purpose, scope, and how long the consent lasts, reducing disputes and audit risk. If you collect signatures online, pair it with an Electronic informed consent form. For employment programs that also require drug screening, use a separate Drug test consent form. Share a copy of the signed consent with the applicant.

Must Ask GCIC Consent Questions

  1. Do you authorize the requesting organization to obtain your Georgia criminal history record information (GCIC) for the stated purpose?

    This captures clear, informed permission and the reason for access. It protects you and the applicant by limiting the check to what is allowed.

  2. What is the specific purpose of this background check (employment, licensing, volunteer, or tenancy)?

    Purpose drives what data you may request and the legality of the search. It also tells your team which level of check and retention rules apply.

  3. What is your full legal name, any prior names, date of birth, and last four digits of your SSN?

    These identifiers improve match accuracy and reduce false positives. Using only the last four of SSN balances verification with privacy.

  4. Have you lived outside Georgia in the past seven years?

    If yes, you may need out-of-state or FBI checks in addition to GCIC. Asking now sets expectations and avoids delays.

  5. How long do you authorize this consent to remain valid, and do you understand how to revoke it?

    Time-bound consent reduces overreach and keeps you compliant with your policy. Provide simple revocation steps and, if needed, link to the Withdrawal of consent form.

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