Fill Out a Valid Georgia 5579 Template Edit Georgia 5579 Here

Fill Out a Valid Georgia 5579 Template

The Georgia 5579 form, also known as the Residential Child Care Records Check Application, is a crucial document required by the Georgia Department of Human Resources. It is designed for individuals applying for roles as directors, managers, owners, or employees (with criminal history) at residential child care facilities. The purpose of this form is to authorize the Department and potential employers to receive any criminal history record information about the applicant that may exist within state or local criminal justice agencies in Georgia.

Edit Georgia 5579 Here

In Georgia, the safeguarding of children within residential care settings is taken very seriously, a commitment embodied in the meticulous procedures outlined in the Georgia 5579 form. This document, crafted by the Georgia Department of Human Resources, is a pivotal part of the application process for individuals aspiring to work in residential child care, whether they aim to serve as directors, managers, owners, or employees with a record of criminal history. The form requires detailed personal information from applicants, including their name, date of birth, Social Security number, physical characteristics, and contact details. Additionally, it mandates an explicit authorization allowing the Department of Human Resources and potential employers to access the applicant's criminal history from state and local criminal justice agencies. A notable feature of the form is the requirement for applicants to disclose any past arrests, charges, or convictions, excluding minor traffic violations, further emphasizing the state's dedication to the well-being of children. The form also includes sections for the residential child care facility’s owner or director to complete, ensuring a thorough verification process. All this information, combined with the fact that the form must be notarized and submitted before undergoing fingerprinting at specified locations, highlights the comprehensive measures Georgia takes to protect children in residential care settings.

Form Example

Georgia Department of Human Resources

RESIDENTIAL CHILD CARE

RECORDS CHECK APPLICATION (See Instructions on Back of Form)

TO BE COMPLETED BY APPLICANT:

1. CHECK APPLICANT TYPE:

Director/Manager

Owner

Employee (with criminal history)

2.Print Name ____________________________________________________________________________

 

(Last)

(First)

(Middle)

(Maiden)

(Date of Birth)

________

______

__________________________

________________________

(Sex)

(Race)

(Social Security Number)

 

 

(Place of Birth)

_________ __________ ______________ _____________ __________________________

(Height) (Weight) (Color of Eyes) (Color of Hair) (Home Telephone)

__________________________________________________________________________________

(Mailing Address)

(City)

(State)

(Zip)

3.I hereby authorize the Department of Human Resources and my potential employer named below to receive any criminal history record information pertaining to me which may be in the files of any state or local criminal justice agency in Georgia. As required by Law, I have attached an affidavit disclosing the nature and date of any arrest, charge, or conviction, for the violation of any law in any state, except for motor vehicle parking violations.

___________________________________

_____________________________________

(Notary)

(Applicant Signature)

Notary Public ________________, Georgia

My Commission Expires: _________________

(County)

(Date)

TO BE COMPLETED BY OWNER/DIRECTOR OF RESIDENTIAL CHILD CARE FACILITY OR APPLICANT FOR LICENSE:

(PLEASE PRINT CLEARLY)

4. _______________________________________________________________________________________

(PRINT Name of Residential Child Care Facility) (PRINT RCC Address) (PRINT City/Zip Code of PCH)

_______________________________________________________________________________________

(PRINT mailing address, if different from RCC address)

(PRINT City/Zip Code/County Name)

5.THE RESIDENTIAL CHILD CARE FACILITY IDENTIFIED ABOVE: (CHECK ONE)

Is currently licensed.

Is applying for an initial (new) license at the above address.

6.My signature indicates that I, as DIRECTOR/OWNER, have verified the above information on the above applicant.

________________________________________

____________________________________________

(PRINT Name of Director/Owner)

(Telephone of Agency)

_______________________________________

____________________________________________

(Signature of Director/Owner)

(Date)

Form 5579 (Rev.4/18/08) YOU MAY DUPLICATE AND KEEP FOR YOUR RECORDS

Application Instructions

Do not have the Live Scan done before turning in your application package.

1.Please use a ball point pen, press firmly, and PRINT legibly.

2.Please indicate if you are a director/ manager, an owner or an employee (with a criminal history). You should check both owner and director/manager if you are both the administrator and the owner.

3.Print your full name, including your MAIDEN name. DO NOT use initials if your have a given name.

Print your date of birth. Print either: Male or Female.

Print your race: Black, White, or Other. Print your Social Security Number.

Print your place of birth: City or County, State and Country if not USA. Print your height.

Print your weight.

Print the color of your eyes: Do NOT abbreviate: Brown, Black, Grey, Blue, Green, or Hazel.

Print the color of your hair: DO NOT abbreviate: Brown, Black, Grey, Red, Blonde, or Bald. Print your home address.

Print your home telephone number.

4.ALL APPLICATIONS MUST BE NOTARIZED. Read the consent statement.

Sign your name as you would on a bank check or business letter.

DIRECTOR/OWNER WILL COMPLETE THE FOLLOWING

5.Record check results will be mailed to the address that is entered here. Print clearly and give complete mailing address.

Indicate name of your facility as it appears on your permit or permit application. Print the address of the Residential Child Care Facility.

Print the mailing address where the letter of determination is to be sent. Print the city/zip/county.

6.Check the correct box to indicate current licensure status for your Residential Child Care facility.

7.Director or Owner must sign his/her name as it would appear on a bank check or business letter.

8.This form must be completed and brought with you for Live Scans at 2 Peachtree or specified DHR-DFCS offices OR, if the Live Scan is done at a COGENT/GAPS location, this form must be mailed to:

Office of Investigative Services

Background Investigations Unit

2 Peachtree Street, N.W., Suite 30.482

Atlanta, GA. 30303-3142

9.If the Criminal Records Check Application is not received by OIS, you will not receive a determination letter.

10.This form should be sent to OIS before the fingerprinting at the COGENT/GAPS location is done.

Document Details

Fact Detail
Form Title Georgia Department of Human Resources RESIDENTIAL CHILD CARE RECORDS CHECK APPLICATION
Purpose To authorize the Department of Human Resources and the potential employer to receive any criminal history record information pertaining to the applicant.
Applicant Categories Director/Manager, Owner, Employee (with criminal history)
Notarization All applications must be notarized to verify the authenticity of the applicant's signature.
Submission Before Live Scan The form needs to be completed and brought for Live Scans at specified locations, or if done at a COGENT/GAPS location, mailed to the Office of Investigative Services Background Investigations Unit.
Director/Owner Verification The signature of the director or owner of the residential child care facility indicates verification of the applicant's information.
Address for Mailing Results Results of the records check will be mailed to the address provided by the director/owner of the residential child care facility on the form.
Governing Law The applicant must attach an affidavit disclosing the nature, date of any arrests, charges, or convictions for the violation of any laws in any state, except for motor vehicle parking violations as required by law.

Detailed Guide for Using Georgia 5579

Once you're in the process of either applying to work in a residential child care facility in Georgia or handling administrative responsibilities for such an establishment, completing the Georgia 5579 form becomes a crucial step. This form acts as an application for a records check, which is a mandatory procedure to ensure the safety and well-being of children. Paying attention to detail and following the instructions carefully will simplify the process and expedite the outcome. Below is a step-by-step guide on how to fill out the form accurately.

  1. Start by identifying your role related to the residential child care facility by checking the appropriate box: Director/Manager, Owner, or Employee (with criminal history).
  2. Print your full name in the order of Last, First, Middle, and Maiden names where applicable. Ensure you also accurately enter your Date of Birth, Sex, Race, Social Security Number, and Place of Birth including City or County, State, and if born outside the USA, the Country.
  3. Fill in your physical characteristics including your Height, Weight, and the Color of your Eyes and Hair without abbreviating.
  4. Enter your Home Telephone Number followed by your Mailing Address, City, State, and Zip code.
  5. Read through the consent statement carefully, acknowledging that it authorizes the Department of Human Resources and your potential or current employer to access criminal history record information pertaining to you. After understanding the statement, sign your name as indicated and have it notarized. Remember to attach an affidavit disclosing the specifics of any arrest, charge, or conviction as required by law, excluding motor vehicle parking violations.
  6. For the Director/Owner of the Residential Child Care Facility or Applicant for License: Print the name of the Residential Child Care Facility and its address clearly. Include the mailing address if it's different from the facility's address.
  7. Indicate the current licensure status of the facility by checking the appropriate box.
  8. The Director/Owner of the facility must then verify the information provided above by signing their name and providing a contact telephone number.
  9. Once completed, if the Live Scan is being done at a COGENT/GAPS location, mail this form to the Office of Investigative Services Background Investigations Unit at the provided address before your fingerprinting appointment.

After the form is filled out correctly and sent to the designated office, the next step involves either attending a scheduled Live Scan session for fingerprints at 2 Peachtree or a specified DHR-DFCS office, or heading to a COGENT/GAPS location if that's your chosen method. Careful adherence to these steps not only complifies with legal requirements but also expedites the processing of your application, ensuring a smoother transition into your role within the Georgia residential child care facility.

More About Georgia 5579

Welcome to the FAQ section for the Georgia 5579 Form, an essential document for those involved with residential child care facilities in Georgia. This form is pivotal for completing residential child care records checks, ensuring the safety and suitability of individuals who work with children. Here, we address some of the most common questions regarding the form and its processing.

  1. What is the purpose of the Georgia 5579 form?
  2. The Georgia 5579 form is designed for use by applicants seeking positions within residential child care facilities, as well as for the facilities applying for licensure. Its primary purpose is to authorize the Georgia Department of Human Resources and potential employers to access any criminal history record information that may exist on the applicant within any state or local criminal justice agency in Georgia. This thorough vetting process is part of ensuring the safety and security of children in residential care settings.

  3. Who needs to complete the Georgia 5579 form?
  4. Three categories of individuals are required to complete the form: Directors/Managers, Owners, and Employees with a criminal history seeking employment within a licensed residential child care facility in Georgia. Additionally, facilities seeking initial licensure or those renewing or verifying current licenses must also process these forms for pertinent individuals.

  5. How should the Georgia 5579 form be completed?
  6. To fill out the form correctly, applicants should use a ballpoint pen, pressing firmly, and ensuring legibility. All fields must be completed, including personal identification information, such as the applicant's full name (including maiden name), date of birth, and social security number, among other details. It's crucial to check the appropriate applicant type box and to have the form notarized upon completion. For facilities, detailed information regarding the name and address of the child care facility must be provided clearly.

  7. What steps should be taken after completing the form?
  8. Once the form is completed and duly notarized, it must accompany the applicant for Live Scans fingerprinting at designated DHR-DFCS offices or COGENT/GAPS locations. Important to note, the Live Scan should not be done before submitting the application package. If fingerprinting at COGENT/GAPS, the form must be mailed to the Office of Investigative Services Background Investigations Unit at the provided address in Atlanta, GA. Timely submission is critical to avoid delays in processing.

  9. What happens if the Criminal Records Check Application is not received by the Office of Investigative Services (OIS)?
  10. If OIS does not receive the completed Georgia 5579 form, the applicant will not receive a determination letter. This step is crucial in the licensure process for individuals and facilities alike, as a determination letter is needed to confirm either the suitability for employment within a residential child care facility or the facility’s compliance with safety standards. Timely and accurate completion and submission of the form are therefore essential to ensure compliance with state regulations.

This FAQ aims to clarify the process surrounding the Georgia 5579 form, facilitating a smoother application process for all parties involved in residential child care services. Remember, the safety of children is paramount, making the thorough and careful completion of this form a vital responsibility.

Common mistakes

When filling out the Georgia 5579 form for a Residential Child Care Records Check Application, individuals often make mistakes that can delay processing. Understanding these common errors will help ensure the application is completed correctly and efficiently.

  1. Applicant Type Confusion: One of the first mistakes involves not clearly indicating whether the applicant is a director/manager, owner, or employee with a criminal history. It’s crucial to check the appropriate box to avoid confusion and processing delays.

  2. Incorrect or Incomplete Personal Information: Applicants frequently make errors by not printing their full name including the maiden name, not using their given name instead of initials, or leaving out other critical personal details such as date of birth, Social Security Number, and contact information. Ensuring all information is accurately and legibly printed using a ballpoint pen is essential.

  3. Notary Issues: The application must be notarized, yet applicants often overlook this step or submit the form without the necessary notarization. This oversight can lead to significant delays in processing the application.

  4. Omission of the Affidavit: The requirement to attach an affidavit disclosing the nature and date of any arrest, charge, or conviction (except for motor vehicle parking violations) is frequently missed. This affidavit is critical for the background check process, and its absence can halt the entire application process.

By avoiding these common mistakes, the process of applying for a Residential Child Care Record Check through the Georgia Department of Human Resources can be smoother and more efficient, ensuring no unnecessary delays in the clearance process.

Documents used along the form

When completing the Georgia 5579 form, individuals and facilities are often required to prepare additional documents to ensure compliance with the Department of Human Resources guidelines. These documents play a crucial role in streamlining the application process for Residential Child Care Records Check Applications.

  • Affidavit of Criminal History: This document is a sworn statement where the applicant must disclose the nature, date, and outcome of any arrests, charges, or convictions for violations of any laws, except for parking violations. It serves as a personal declaration of one's criminal history, if any, ensuring transparency and adherence to legal requirements.
  • Proof of Identity: Applicants must provide valid government-issued identification. This could include a driver's license, passport, or state identification card. Proof of identity is required to verify that the information provided on the Georgia 5579 form matches the applicant's official records.
  • Consent for Background Check: A signed consent form is necessary for processing the criminal history record check. This document indicates that the applicant agrees to allow the Department of Human Resources and potential employers to access their criminal history record information from state or local criminal justice agencies in Georgia.
  • Live Scan Fingerprinting Receipt: After completing the Live Scan fingerprinting process, applicants receive a receipt or form that must be submitted alongside the Georgia 5579 form. This receipt proves that the applicant has undergone the fingerprinting process, which is essential for obtaining the criminal history record from the Georgia Bureau of Investigation and the FBI.

In conclusion, the successful submission of the Georgia 5579 form requires careful preparation of several supporting documents. These documents are vital for verifying the identity of applicants, disclosing their criminal history, authorizing the background check, and confirming that fingerprinting has been completed. Together, they ensure a seamless and compliant application process for individuals seeking employment or involvement in residential child care facilities in Georgia.

Similar forms

The Georgia 5579 form, utilized for Residential Child Care Records Check Applications, is similar to other forms used in various sectors that require background checks or personal information for verification purposes. Each form, while tailored to its specific sector, shares common elements aimed at ensuring safety and compliance with legal requirements.

Similar to the FBI FD-258 Fingerprint Card, the Georgia 5579 form requires detailed personal information and is an integral part of background checking processes. The FD-258 is universally used for collecting fingerprints for applicants requiring federal background checks, just as Georgia 5579 is designed for those in residential child care in Georgia. Both forms require accurate personal details and are crucial for conducting background checks. However, the FD-258 specifically includes fields for fingerprinting, while Georgia 5579 focuses more on personal information and consent for a background check.

Comparable to the I-9 Employment Eligibility Verification form, the Georgia 5579 form plays a crucial role in verifying the identity and eligibility of individuals. While the I-9 is focused on establishing employment eligibility in the United States, verifying identity and work authorization, the Georgia 5579 is aimed at ensuring that individuals working in residential child care facilities in Georgia have undergone a proper background check. Both forms serve as tools for compliance, ensuring that individuals meet specific criteria before employment.

Reflects similarities with the Child Abuse Registry Check form used in many states to screen individuals working with children. Like the Georgia 5579 form, these registry checks are designed to protect vulnerable populations by preventing those with histories of abuse or neglect from working with children. Both types of forms require personal information and consent to conduct a thorough background investigation, emphasizing the safety and well-being of children in care settings.

Dos and Don'ts

When filling out the Georgia 5579 form, it's essential to pay close attention to the details. To help, here's a compiled list of dos and don'ts that should guide you through the process:

  • Do use a ballpoint pen to ensure that your entries are clear and legible. This prevents any misunderstandings or processing delays.
  • Do print legibly in each section of the form. If the information is not easy to read, it might lead to unnecessary delays or errors in processing your application.
  • Do check the appropriate applicant type box at the top of the form to indicate if you are a director/manager, an owner, or an employee with a criminal history. This helps in categorizing your application correctly.
  • Do include your full name and any maiden names if applicable. Providing complete information is crucial for an accurate background check.
  • Do not leave any fields blank. If a section does not apply to you, mark it with “N/A” (not applicable). This indicates that you have read and acknowledged every part of the form.
  • Do ensure the application is notarized. This is a legal requirement and validates the authenticity of your submission.
  • Do not perform the Live Scan before submitting your application package. The form must be completed and either brought with you to the Live Scan appointment or mailed in if using a COGENT/GAPS location.
  • Do not forget to attach an affidavit if required by law, especially revealing the nature and date of any arrests, charges, or convictions for violations of the law in any state, except for motor vehicle parking violations.

Following these guidelines will ensure a smoother process when submitting your Georgia 5779 form. Keep in mind to regularly check for any updates or changes to the procedure to remain compliant with current requirements.

Misconceptions

When discussing the Georgia 5579 form, used for Residential Child Care Records Check Applications, there are several common misconceptions that need to be clarified to ensure applicants provide accurate information and comply with the process effectively.

  • Misconception 1: The form only needs to be completed by those with a criminal history.

    This is incorrect. The form must be completed by all applicants, including directors/managers, owners, and employees, regardless of whether they have a criminal history. The form is designed to initiate a background check for any individual in a position that may involve the care of children, ensuring the safety and welfare of children in residential care settings.

  • Misconception 2: Personal details such as height, weight, and eye color are optional.

    Every section of the Georgia 5579 form is crucial, including seemingly minute details like height, weight, and eye color. These specifics can help accurately identify the applicant, ensuring that the background check corresponds to the correct individual, especially in cases where names and other identifiers may be similar to others.

  • Misconception 3: The form can be submitted electronically.

    As of the latest guidance, the Georgia 5579 form must be completed in pen, notarized, and then submitted as part of a physical application packet to the Department of Human Resources. Electronic submissions are not accepted unless specified by updated regulations. The form, along with the necessary attachments, must be sent through traditional mail or delivered by hand to the specified locations.

  • Misconception 4: Live Scan fingerprinting can be done before submitting the form.

    The instructions explicitly advise against having the Live Scan done before turning in your application package. This sequence is important as the form includes consent and verifies the applicant's identity, which must be confirmed before fingerprinting can proceed. Moreover, completing the form and other preliminary steps ensures that the Live Scan results are matched with the correct application.

Understanding these aspects of the Georgia 5579 form is essential for a smooth application process, ensuring that all requirements are met and the safety of children in residential care settings is upheld.

Key takeaways

When filling out and using the Georgia 5579 form for residential child care records checks, it’s crucial to understand the process and requirements to ensure accuracy and compliance. Here are key takeaways:

  • Clearly identify your role: Indicate whether you are applying as a director/manager, an owner, or an employee with a criminal history. If you hold multiple positions, like both administrator and owner, make sure to check all that apply.
  • Provide accurate personal information: Fill out the form using a ballpoint pen, pressing firmly to ensure legibility. Include your full legal name, maiden name if applicable, date of birth, gender, race, Social Security number, place of birth, physical attributes, and contact details without abbreviating or using initials.
  • Notarization is mandatory: The form requires notarization, underscoring the importance of reading the consent statement carefully before signing your name as it would appear on a bank check or business letter.
  • Director/Owner verification: If you are a director or owner of a residential child care facility, you must verify the information provided by the applicant and indicate the facility’s licensure status. Remember to sign your name as it would appear on official documents.
  • Understand the mailing requirements: If completing the Live Scan at a COGENT/GAPS location, the form must be mailed to the Office of Investigative Services (OIS) at the provided address. This step is crucial as failure to send the form results in not receiving a determination letter.
  • Follow pre-fingerprinting instructions: Do not undergo Live Scan fingerprinting before submitting your application package. Ensure that all necessary information is correctly filled out and the form is notarized before proceeding with fingerprinting, whether at specified DHR-DFCS offices or a COGENT/GAPS location.

Adhering to these guidelines will facilitate a smoother process for carrying out background checks for personnel in residential child care settings in Georgia, helping to ensure the safety and well-being of children in these environments.

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