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181 Larkin Street, Cornelia, GA 30531
706-778-8585
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Departments
Mayor & Commission
City Manager’s Office
City Clerk
Building & Zoning
Code Enforcement
Community Development
Finance
Fire Department
Fire Marshal
Human Resources
Career Opportunities
Municipal Court
Unified Planning Commission
Police Department
Police Crime Tip Form
Public Utilities
Public Works
Sanitation
Staff Directory
General Administration
Community Service Program
Apply For
ACH Draft Form (Fillable)
ACH Draft Form (Printable)
Application for Temporary Food Vendor Permit
Application for Utility Services (Fillable)
Application for Utility Services (Printable)
Disability Backdoor Service (PDF)
Bid Opportunites
Certificate of Occupancy Application
Business License Application
Career Opportunities
Homestead Exemption (Fillable)
Homestead Exemption (Printable)
New Vendor Application
Occupational Tax Certificate
Permit Information
Senior Utility Discount Application (Fillable)
Senior Discount Utility Application (Printable)
Special Events Application
Taxes & Licenses
Utility Disconnection Form (Fillable)
Utility Disconnection Form (Printable)
Services
Alerts
Consumer Confidence Report
Form Center
Online Payments
Report a Concern
Community House
Victim Notification Program
Water & Sewer
Sanitation
Utility Billing
Residents
History
City Parks
Links
Tim Loves Tink Mural
Visiting
Places of Interest
Overnight Stay
Living & Visiting
Contact Us
181 Larkin Street, Cornelia, GA 30531
(706) 778-8585
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Twitter
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Home
Departments
Mayor & Commission
City Manager’s Office
City Clerk
Building & Zoning
Code Enforcement
Community Development
Community Service Program
General Administration
Finance
Fire Department
Fire Marshal
Human Resources
Municipal Court
Career Opportunities
Police Department
Police Crime Tip Form
Public Utilities
Public Works
Sanitation
Staff Directory
Unified Planning Commission
Apply For
ACH Draft Form (Fillable)
ACH Draft Form (Printable)
Application for Utility Services (Fillable)
Application for Utility Services (Printable)
Application for Temporary Food Vendor Permit
Bid Opportunites
Business License Application
Certificate of Occupancy Application
Career Opportunities
New Vendor Application
Occupational Tax Certificate
Permit Information
Senior Utility Discount Application (Fillable)
Senior Discount Utility Application (Printable)
Special Events Application
Taxes & Licenses
Utility Disconnection Form (Fillable)
Utility Disconnection Form (Printable)
Disability Backdoor Service (PDF)
Homestead Exemption (Fillable)
Homestead Exemption (Printable)
Services
Alerts
Consumer Confidence Report
Community House
Form Center
Online Payments
Report a Concern
Sanitation
Victim Notification Program
Water & Sewer
Utility Billing
Residents
City Parks
History
Links
Tim Loves Tink Mural
Visiting
Living & Visiting
Overnight Stay
Places of Interest
Contact Us
Consent Form
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Consent Form
Consent Form - Revised March 2019
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Name-Based Criminal History Record Information Consent/Inquiry Form
I hereby authorize Agency/Company to conduct an inquiry for
Agency/Company
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The purpose listed below and receive any Georgia and/or national criminal history record information as authorized by state and federal law.
Full Name
*
Email
*
Address
*
Sex
*
Race
*
Date Of Birth
*
Social Security Number
*
This authorization is valid for days from date of signature
*
I, _______ , give consent to the above-named entity to perform periodic criminal history background checks for the duration of my employment.
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Signature
*
Date
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Attorney for Individual (Pur E and U Only)
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Bar Number
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Date
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Purpose Code Used: (check one)
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E - Employment
M - Working with Mentally Disabled
N - Working with Elderly
W - Working with Children
P - Public Records (no consent required)
U - Personal Copy
J - Civilian Criminal Justice Employment (State & III Info Received)
Z - Sworn Criminal Justice Employment (State & III Info Received)
NON-CRIMINAL JUSTICE PURPOSES, PERSONAL REQUEST (INDIVIDUAL OR THEIR ATTORNEY), CRIMINAL JUSTICE EMPLOYMENT
The inquiry resulted in the following: (check all that apply)
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No Criminal Record Available
Criminal Record (Attached/Released)
No NCIC/GCIC Warrant
Possible NCIC/GCIC Warrant (List Wanting Agency Below)
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