Informus - Form CRGA

Authorization Form For File Release Of Copies
For The State of Georgia
Criminal History Records

I hereby authorize Informus acting as an agent for ___________________________________________ to receive any criminal history record information pertaining to me which may be in the files of any state or any local criminal justice agency.

To be completed by EMPLOYER:


Date of request:___________________________________________

Signature of requester:___________________________________________

Employer's Full Name:___________________________________________

Employer's Street Address:___________________________________________

Employer's City, State and Zip Code:___________________________________________

To be completed by EMPLOYEE:


Employee's Social Security Number:___________________________________________

Employee's Date of Birth:___________________________________________

Employee's Full Name:___________________________________________

Employee's Street Address:___________________________________________

Employee's City, State and Zip Code:___________________________________________

Signature of Employee:___________________________________________






Account Name:Informus                  Account Number:1133






Informus Form-CRGA

Date of request:_____________________ Signature of requester:_ Employer's Full Name:_ Employer's Street Address:_ Employer's City, State and Zip Code:_______________________

Employee's Social Security Number:_____________________ Employee's Date of Birth:_ Employee's Full Name:_ Employee's Street Address:_ Employee's City, State and Zip Code:_ Signature of Employee:_____________________ Account Name:Informus Account Number:1133

Informus Form-CRGA