General Counsel Events

No alterations to the document (such as white out) should be made.

Please see below for a sample of a completed form. Please only complete the highlighted sections identified on the sample form.

In the section outlined by a red box below, please only check one of the boxes.

• The first box allows for the authorization to be used for a specific amount of time.

• The second box allows for periodic checks. Do NOT select both or the form will be rejected by the state.

If you prefer to use e-signature, please make sure to use DocuSign to sign the form. DocuSign will have a second and third page with the IP Address and a date and timestamp. Please include the additional pages when sending the document to First Advantage. An example of a completed DocuSign form can be found on page 2 and 3 of this document. Georgia Statewide Instructions

Summary – The state of Georgia requires a signed authorization form in order to process the statewide criminal search.

GCIC Authorization Form

To submit your request, the form on page 4 needs to be filled out, signed and dated within 90 days of submission. If you received a link and are logged into our Missing Information portal the document can be loaded directly to the site or you may scan and email the completed form to the below email address. Email: *************@****.***

Important Notes:

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp

Sent: 5/30/2023 6:35:36 AM

Envelope Id: B626E014335C46228AC7021300813DEE

Subject: Complete with DocuSign: Company:

PSAN:

Source Envelope:

Status: Completed

Document Pages: 7 Signatures: 1 Envelope Originator: Certificate Pages: 5 Initials: 0 Amy Clancy

AutoNav: Enabled

EnvelopeId Stamping: Enabled

Time Zone: (UTC-08:00) Pacific Time (US & Canada)

1 Concourse Parkway NE, Ste 200

Atlanta, GA 30328

***.******@****.***

IP Address: 23.28.129.149

Status: Original

5/30/2023 6:34:53 AM

Holder: Amy Clancy

***.******@****.***

Location: DocuSign

Bret T. Jardine

****.*******@****.***

General Counsel

First Advantage

Security Level: Email, Account Authentication

(None)

Signature Adoption: Pre-selected Style

Using IP Address: 104.129.206.203

Sent: 5/30/2023 6:35:35 AM

Viewed: 5/30/2023 6:43:12 AM

Signed: 5/30/2023 6:43:19 AM

Electronic Record and Signature Disclosure:

Not Offered via DocuSign

Accepted: 8/29/2018 11:39:28 AM

ID: 3fad7c72-4a79-40aa-8333-3f221a51faba

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps

Envelope Sent Hashed/Encrypted 5/30/2023 6:35:36 AM Certified Delivered Security Checked 5/30/2023 6:43:12 AM Signing Complete Security Checked 5/30/2023 6:43:19 AM Certificate Of Completion

Record Tracking

Signer Events Signature Timestamp

Payment Events Status Timestamps

Completed Security Checked 5/30/2023 6:43:19 AM

Envelope Summary Events Status Timestamps

Electronic Record and Signature Disclosure

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