The Georgia 5579 form is the Residential Child Care Records Check Application, essential for individuals seeking employment or licensure in residential child care facilities. This form facilitates the background check process by allowing the Georgia Department of Human Resources to access an applicant's criminal history. To ensure compliance and protect vulnerable populations, completing this form accurately is crucial. Start the process by filling out the form below.
The Georgia 5579 form plays a crucial role in ensuring the safety and security of children in residential care facilities across the state. This application, formally known as the Residential Child Care Records Check Application, is a necessary step for individuals seeking employment or licensure within these facilities. It requires applicants to provide personal information, including their full name, date of birth, and social security number, as well as details regarding their criminal history, if applicable. The form also mandates that applicants authorize the Georgia Department of Human Resources to access their criminal records, emphasizing the importance of background checks in this sensitive sector. Additionally, facility owners or directors must verify the applicant's information, confirming the current licensing status of their residential child care facility. The completion of this form is not just a bureaucratic step; it is a vital safeguard that helps protect vulnerable children and ensures that only qualified individuals are entrusted with their care. Understanding the intricacies of the Georgia 5579 form is essential for both applicants and facility administrators, as it lays the groundwork for a safe and compliant environment for children in residential care.
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)
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.
Filling out the Georgia 5579 form is a crucial step for individuals seeking a background check related to residential child care. Completing this form accurately ensures that your application is processed efficiently and that you receive the necessary determination letter.
The Georgia 5579 form is used to apply for a Residential Child Care Records Check. This process is essential for ensuring the safety of children in residential care facilities by checking the criminal history of directors, owners, and employees of these facilities.
Any individual applying for a position as a director, manager, owner, or employee at a residential child care facility in Georgia must complete this form. This includes those with a criminal history, as their background will be evaluated as part of the application process.
Applicants must provide personal details such as their full name (including maiden name), date of birth, sex, race, Social Security number, place of birth, height, weight, eye color, hair color, home telephone number, and mailing address. This information is crucial for conducting the background check.
Yes, notarization is a mandatory step. All applications must be signed in front of a notary public to ensure the authenticity of the information provided. The notary will also confirm your identity during this process.
The completed form should be brought to the Live Scan appointment at designated locations or mailed to the Office of Investigative Services Background Investigations Unit at the specified address. Ensure that the form is submitted before fingerprinting occurs.
If the Georgia 5579 form is not received by the Office of Investigative Services before your fingerprinting appointment, you will not receive a determination letter regarding your background check. This can delay your application process significantly.
The results of the background check will be mailed to the address provided on the form. It is crucial to ensure that this address is complete and accurate to avoid any delays in receiving your results.
If you have a criminal history, you are still required to complete the form. You must also attach an affidavit that discloses the nature and date of any arrests, charges, or convictions, excluding minor motor vehicle parking violations. Transparency is key in this process.
Yes, you are allowed to duplicate the Georgia 5579 form for your records. Keeping a copy can be beneficial for tracking your application and ensuring that you have all necessary information on hand.
If you have questions regarding the Georgia 5579 form or the application process, it is advisable to contact the Office of Investigative Services or your potential employer for guidance. They can provide you with the most accurate and relevant information.
Failure to Use a Ballpoint Pen: Many applicants use pencils or gel pens, which can lead to illegible forms.
Not Checking the Correct Applicant Type: Applicants often forget to indicate whether they are a director, owner, or employee, which can delay processing.
Incomplete Personal Information: Missing details such as maiden names, social security numbers, or places of birth can result in rejection of the application.
Neglecting Notarization: Some applicants overlook the requirement for notarization, which is mandatory for all applications.
Incorrect Mailing Address: Providing an incorrect or incomplete mailing address can prevent the applicant from receiving important documents.
Failure to Disclose Criminal History: Not attaching the required affidavit detailing any arrests or convictions can lead to disqualification.
Inaccurate Facility Information: Applicants sometimes provide incorrect names or addresses for the residential child care facility, which can cause processing delays.
Missing Signature: Forgetting to sign the application or having a signature that does not match the name can result in rejection.
Not Following Submission Instructions: Failing to send the form to the correct address or not submitting it before fingerprinting can lead to significant delays.
The Georgia 5579 form is a crucial document used in the process of conducting background checks for individuals involved in residential child care facilities. However, several other forms and documents are often required to complete the application process effectively. Each of these documents plays a specific role in ensuring compliance with state regulations and safeguarding the welfare of children in care. Below is a list of commonly associated forms and documents.
Collectively, these documents support the application process for individuals seeking to work in or operate residential child care facilities in Georgia. Proper completion and submission of these forms help ensure that all applicants meet the necessary legal and safety standards, ultimately protecting the children in their care.
The Georgia 5579 form is similar to the Child Care Provider Background Check form used in various states. This form collects personal information from individuals seeking employment in child care facilities. It requires applicants to disclose their criminal history, if any, and authorizes the agency to conduct background checks. Like the Georgia 5579, this form typically includes sections for personal identification and requires notarization to ensure the authenticity of the information provided.
Another comparable document is the Employment Background Check Authorization form. This form is often used by employers to obtain permission from potential employees to conduct background checks, including criminal history. It includes personal details such as name, date of birth, and social security number. Similar to the Georgia 5579, it emphasizes the importance of consent and often requires a signature to validate the request.
The Fingerprint Card is also related to the Georgia 5579 form. This document is used to collect fingerprints for background checks in various employment sectors, including child care. It serves as a means of identifying individuals through biometric data. The fingerprint card, like the Georgia 5579, is crucial for ensuring the safety of vulnerable populations by checking for any past criminal activity.
The Application for Child Care License is another document that shares similarities with the Georgia 5579. This application is submitted by individuals or organizations seeking to operate a child care facility. It requires detailed information about the applicant and the facility, including background checks for all staff members. Both forms aim to ensure that individuals working with children meet safety and eligibility standards.
The Criminal History Record Check form used in many states is also akin to the Georgia 5579. This form allows individuals to request their criminal history records from law enforcement agencies. It collects similar personal information and often requires notarization. The purpose of both forms is to ensure that individuals with a criminal background are identified before being allowed to work in sensitive positions, such as child care.
The Child Abuse and Neglect Registry Check form is another document that parallels the Georgia 5579. This form is used to check if an individual has a history of child abuse or neglect. Like the Georgia 5579, it requires personal identification information and serves to protect children by ensuring that only qualified individuals are allowed to work in child care settings.
The Request for Criminal History Information form is also similar to the Georgia 5579. This form is often used by employers to request background checks on potential hires. It includes sections for personal information and consent, similar to the Georgia 5579. Both forms aim to ensure that employers can make informed decisions regarding the safety of their work environments.
The Volunteer Background Check form is another document that shares similarities with the Georgia 5579. This form is used by organizations to screen volunteers who will be working with children or vulnerable populations. It requires personal information and consent for background checks, ensuring that only suitable individuals are allowed to participate in programs that involve direct contact with children.
Finally, the Professional License Application form is comparable to the Georgia 5579. This form is used by individuals seeking licensure in various professions, including child care. It collects personal information and often requires background checks to ensure that applicants meet the necessary qualifications. Both forms emphasize the importance of safety and accountability in professions that impact the well-being of others.
When filling out the Georgia 5579 form, it is essential to follow specific guidelines to ensure that your application is processed smoothly. Below is a list of things to do and things to avoid.
Here are nine common misconceptions about the Georgia 5579 form, along with clarifications for each:
When filling out and using the Georgia 5579 form, there are several important points to keep in mind. This form is essential for individuals seeking employment in residential child care facilities in Georgia.
Following these guidelines will help ensure that your application process runs smoothly and efficiently. It is vital to double-check all entries for accuracy and completeness before submission.