[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-288847-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-288847-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","malpb-background-authorization-form","MALPB - Background Authorization Form","","Background check authorization form granting the Department of Banking and Finance permission to obtain criminal history data about the undersigned. The authorization covers identity and background information and specifies a FBI criminal background check as well as related character, ethical reputation, and financial responsibility information under Georgia law. It limits use to official responsibilities, states that conviction data is not a public record, outlines administrative action if violations exist, and notes procedures for record correction.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/malpb-background-authorization-form/288847/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/malpb-background-authorization-form/288847.png","ImageObject",442,249,{"name":42,"@type":43},"Ben Jamin","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-12","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What authorization does the applicant grant in this form?","Question",{"text":63,"@type":64},"The applicant authorizes the Department of Banking and Finance to obtain criminal history data and related information about the undersigned for official review purposes.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How will the background check results be used?",{"text":68,"@type":64},"The Department will use any received information for the exclusive purpose of carrying out its responsibilities under the referenced article, and conviction data shall not be a public record and is not disclosed except as legally permitted.",{"name":70,"@type":61,"acceptedAnswer":71},"How long does this authorization remain effective?",{"text":72,"@type":64},"The authorization remains effective as long as the applicant is employed in the Georgia Merchant Acquirer Limited Purpose Bank industry, and a copy of the authorization is accepted with the same validity as the original.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},288847,1790445856,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":4},2336478466772,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Complete Applicant Name (First, Middle , Last)    \nName of Entity (Existing or Proposed)    \nBACKGROUND CHECK AUTHORIZATION FORM  \nTO WHOM IT MAY CONCERN:  \nI hereby authorize the Department of Banking and Finance (Department) to obtain criminal history data on the undersigned in his/her capacity as a director, officer, principal, owner, policymaker, manager or employee of the above entity. I understand this will be a FBI criminal background check. Also, pursuant to Section 7-9-7 of the Official Code of Georgia Annotated and the Rules of the Department of Banking and Finance, the Department is authorized to obtain information regarding character, ethical reputation and financial responsibility. Such information and any conviction data received by the Department shall be used by the Department for the exclusive purpose of carrying out the responsibilities of this article, shall not be a public record, shall be privileged, and shall not be disclosed to another person or agency except to any person or agency which otherwise has a legal right to inspect the file. In order to facilitate this inquiry, I understand that I must provide the information below. The Department will notify me if further information is required. Should the data show that a violation of the Georgia Merchant Acquirer Limited Purpose Bank Act and/or the Rules of the Department of Banking and Finance exists, I understand that the Department may take the appropriate administrative action against me and/or the affiliated entity. The procedures for changing, correcting, or updating a criminal history record is set forth in Title 28, Code of Federal Regulations (CFR), Section 16.30 through 16.34.  \nThis authorization remains effective as long as I am employed in the Georgia Merchant Acquirer Limited Purpose Bank industry. A copy of this authorization shall be accepted with the same force and validity as the original.  \nType of Government ID Presented Signature    \n  Print Full Name    \nID Number/Expiration  \nPrint Alias    \nStreet Address    \nCity, State, Zip Code    \nSocial Security Number    \nDate of Birth    \nSex    \n(M or F)  \nDate    \nRace    \nB-Black W-White  \nI -American Indian or Alaskan Native  \nA-Asian or Pacific Islander H-Hispanic  \nWitness","cbCaiu2xaycl1W3K","https://ap.wps.com/l/cbCaiu2xaycl1W3K","pdf",129176,"English","# Applicant and Entity Information\n# Authorization and Legal Terms\n# Government ID and Personal Details\n# Witness and Signatures","[{\"question\":\"What authorization does the applicant grant in this form?\",\"answer\":\"The applicant authorizes the Department of Banking and Finance to obtain criminal history data and related information about the undersigned for official review purposes.\"},{\"question\":\"How will the background check results be used?\",\"answer\":\"The Department will use any received information for the exclusive purpose of carrying out its responsibilities under the referenced article, and conviction data shall not be a public record and is not disclosed except as legally permitted.\"},{\"question\":\"How long does this authorization remain effective?\",\"answer\":\"The authorization remains effective as long as the applicant is employed in the Georgia Merchant Acquirer Limited Purpose Bank industry, and a copy of the authorization is accepted with the same validity as the original.\"}]","MALPB - Background Authorization Form | PDF",1789634092]