In Georgia, all employers with more than ten employees are required to provide workers' compensation insurance coverage for their employees. However, there are some specific exemptions to this rule, which this article will explore. Employers who do not have to provide workers' compensation insurance coverage include farm owners and farmers, household domestic workers, and casual laborers. Additionally, self-employed individuals are not required to provide workers' compensation insurance for themselves if they have no employees. Finally, churches and other religious organizations are exempt from the requirement to provide workers' compensation insurance. If you are an employer in Georgia and are unsure whether you are required to provide coverage, or if you have any other questions related to workers' compensation insurance, please contact an experienced attorney today.
Question | Answer |
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Form Name | Form Gbi Bo2 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | georgia beuro of investigation, gbi drug submission form, gbi bo2, gbi crime lab submission |
GEORGIA BUREAU OF INVESTIGATION BINGO SECTION
P. O. BOX 370808
DECATUR, GA
FOR GBI USE ONLY
REGION:
FP:
FORM GBI/BO2 (04/2013)PERSONAL HISTORY & BACKGROUND
INSTRUCTIONS: This form must be executed under oath, by every officer, director, board member and person associated with operations, advertising, or promoting a bingo operation, or who has a vote within the organization on how bingo funds are expended.. TYPE OR PRINT LEGIBLY. Each question must be answered fully. This form, including a
1. |
Full Name ___________________________________________________ Social Security No. __________________________________________ |
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Last |
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Name of Organization of which this personal history is a part (include Post/Lodge/Club No.) _____________________________________________ |
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3. |
Are you a member of this organization.? YES ( |
) NO ( |
) How long have you been a member of this Post/Lodge/Club? ____________________ |
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Your position in organization? _________________ Salary? _______________ |
Type of Membership? ________________________________ |
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(Regular, Auxiliary, Honorary, Associate, other) |
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4. |
Other names used by you (include maiden name) ______________________________________________________________________________ |
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5. |
BIRTHDATE _____/____/____ |
RACE ____ SEX ___ |
HEIGHT ____ |
WEIGHT ____ COLOR EYES ________ |
COLOR HAIR __________ |
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6. |
Place of Birth _______________________ Are you a U.S. Citizen? Yes ( |
) NO ( |
) By Birth? _____ Naturalized? |
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Date ___/___/___ |
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7. |
Are you a Georgia Resident? |
Yes ( ) No ( |
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How long have you resided in Georgia? _______________________________________ |
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8. |
Home Address ______________________________________________________________________ Home Phone No. (_____)______________ |
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Street number and name |
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City |
State |
Zip |
Area Code & Number |
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9. |
Mailing Address if different from above _______________________________________________________________________________________ |
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(P. O. Box) |
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City |
State |
Zip |
10. |
Business Address __________________________________________________________________ Work Phone No. (_____)_______________ |
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Street |
City |
State |
Zip |
Area Code & Number |
11. |
Military Service ________________________________________________________________________________________________________ |
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Branch |
Serial Number |
Years of Service |
Type of Discharge |
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12. |
Single ( ) Married ( ) Other __________________ Full Name of Spouse (include maiden name) ___________________________________ |
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Date of Marriage:____/____/___ |
Spouse’s SSN _________________ Birth Date____/____/___ |
Employer ______________________________ |
13. Employment Record (in reverse chronological order) for the last five (5) years; if self employed give details of employment.
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EMPLOYER |
STATE |
OCCUPATION |
SALARY
REASON FOR LEAVING
14. List in reverse chronological order all your residences for the last five years:
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Mo. |
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STREET
CITY
STATE
ZIP
15. Are you a bingo worker for any other organization? YES ( ) NO ( )
List name of the previousorganization(s): _________________________________________________________________________
(Over)
16.Have you ever been convicted of a violation of any federal, state, county or municipal law? (Include pleas of
Nolo Contendere). YES ( ) NO ( ). Include traffic violations such as DUI, Homicide by Vehicle, Serious Injury by Vehicle, Fleeing or Attempting to Elude a Police Officer, and Impersonating a Law Enforcement Officer. Do not list other minor traffic violations. List the offense, date of offense, location (City or County), and provide the disposition of case (i.e., dismissed, nolle prossed, suspended, 1st offender waiver, convicted). If you have a conviction or pled Nolo Contendere, list the sentence and/or fine imposed. Use additional sheets as necessary to completely answer this question.
(1)
Offense |
Date |
Location |
Disposition of Case |
Sentence and/or Fine Imposed |
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Offense |
Date |
Location |
Disposition of Case |
Sentence and/or Fine Imposed |
(3) |
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Offense |
Date |
Location |
Disposition of Case |
Sentence and/or Fine Imposed |
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Offense |
Date |
Location |
Disposition of Case |
Sentence and/or Fine Imposed |
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Offense |
Date |
Location |
Disposition of Case |
Sentence and/or Fine Imposed |
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_________________________________________________________________________________________________________________________
18.Attach a
Do not submit xeroxed copies of driver's licenses!
**NOTE: Before signing this statement, check all answers to see that all questions have been answered completely. This statement is to be executed under oath and is subject to the penalties for false swearing.
(Attach Photograph Here)
PRIVACY ACT NOTIFICATION
The Privacy Act of 1974 provides that each State agency inform individuals from whom information is solicited as to the authority for the solicitation of such information and whether disclosure of the information is mandatory or voluntary. The principal purpose for soliciting the information requested herein is to administer the State Bingo Laws and Regulations. The completion of all appropriate items is voluntary. The failure to furnish or supply information, or the furnishing of misleading or untrue information will cause denial of the bingo license applied for or denial of the applicant officer/worker of the organization shown in Item 2 hereof.
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VERIFICATION
State of Georgia, ________________________________________ County
I, ____________________________________________________________________________ do solemnly swear, subject to the penalties of false
swearing, that the statements and answers made by me in the foregoing personal statement are true.
This _________ day of ______________________, 20_______ ___________________________________________________________
Applicant’s signature (full name and in ink)
ADDITIONAL APPLICANT CONTACT INFORMATION:
Applicant’s Cellular Telephone Number: ___________________________________________________
Applicant’s Contact Email Address:____________________________________________________________________