504 A5 Disclosure of Information Received from GCIC and/or FBI
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Georgia Department of Human Services |
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Disclosure of Information Received from GCIC and/or FBI |
Employee Letter Sample
[Date]
[Name]
[Address]
Dear [Applicant/Employee Name],
A criminal history record check was conducted on you as a condition of employment with the Department of Human Services, [Insert DHS Organizational Unit]. Information received from the Georgia Crime Information Center (GCIC) and/or the Federal Bureau of Investigation (FBI) [Only include the applicable agency] indicates the following pending charge(s) and/or conviction(s) in your record:
Crime |
Designate One: |
Date |
Location |
In accordance with the Rules of the GCIC Council, this letter serves as notice that your separation from employment is based, in part, on the above information.
Sincerely,
Name
Title
Note to Hiring Officials:
The disclosure notice must be filed in a separate file, not in the employee’s personnel file. In addition to this disclosure notice, a separation letter must be issued to the employee. The separation letter is to be filed in the employee’s personnel file.