Wadley, GA · Jefferson County
Name-Based Criminal History Record Information Consent/Inquiry Form
This form authorizes an agency or company to request criminal history information and records the individual’s personal details, consent, and inquiry results.
What this form is
An individual completes this form to authorize a named agency or company to inquire about criminal history record information for a listed purpose. It collects identifying details, consent, and signature information, and includes sections for inquiry details and results. The form also includes consent for periodic checks during employment and purpose codes for different types of inquiries.
Who needs it
An individual asked to authorize an agency or company to conduct a criminal history inquiry or periodic checks during employment needs this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This form is signed without a notary; the individual signs and dates it, and the agency designee also signs and provides a title.
How to submit this form
- 1
Download The Form
Download the Name-Based Criminal History Record Information Consent/Inquiry Form.
- 2
Complete The Form
Enter the requested identifying details, purpose code, consent, signature, and date.
- 3
Check The Form
Review the completed information and any inquiry fields before providing the form.
- 4
Submit The Form
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does this criminal history consent form authorize?
- It authorizes the named agency or company to inquire for the purpose listed and receive criminal history record information. It also includes consent for periodic checks during employment.
- What information does the form ask for?
- It asks for the individual’s name, address, sex, race, date of birth, Social Security number, purpose code, signature, and date. It also includes inquiry and results fields.
- Do I need a notary for the criminal history consent form?
- No. This form is signed without a notary; the individual signs and dates it, and the agency designee also signs and provides a title.
- How do I submit the criminal history consent form?
- The form does not state where to submit it. Submit it to the city department named on the form; check the city website for current contact details.