CONFIDENTIAL (DO NOT ATTACH TO PETITION)
GC-212
FOR COURT USE ONLY
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FAX NO. (Optional):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
GUARDIANSHIP OF
MINOR
CONFIDENTIAL GUARDIAN SCREENING FORM
CASE NUMBER:
PersonGuardianship of
Estate
The proposed guardian must complete and sign this form. The person requesting appointment of a
guardian must submit the completed and signed form to the court with the guardianship petition.
How This Form Will Be Used
This form is confidential and will not be a part of the public file in this case. Each proposed guardian must complete and sign a
separate copy of this form under rule 7.1001 of the California Rules of Court. The information provided will be used by the court and
by persons and agencies designated by the court to assist the court in determining whether to appoint the proposed guardian as
guardian. The proposed guardian must respond to each item.
State:
Work: Other:
2. I am I am not required to register as a sex offender under California Penal Code section 290.
(If you checked "I am," explain in Attachment 2.)
3. I have
4. I have had a restraining order or protective order filed against me in the last 10 years.
(If you checked "I have," explain in Attachment 4.)
5. I am I am not receiving services from a psychiatrist, psychologist, or therapist for a mental health–related issue.
(If you checked "I am," explain in Attachment 5.)
Do you, or does any other person living in your home, have a social worker or parole or probation officer assigned to him or her?
Yes
(If you checked "Yes," explain in Attachment 6 and provide the name and address of each social
worker, parole officer, or probation officer.)
Have you, or has any other person living in your home, been charged with, arrested for, or convicted of any form of child abuse,
Yes
Form Adopted for Mandatory Use
Judicial Council of California
GC-212 [Rev. July 1, 2009]
CONFIDENTIAL GUARDIAN SCREENING FORM
(Probate—Guardianships and Conservatorships)
No
1.
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
Probate Code, § 1516;
Family Code, § 3011;
Cal. Rules of Court, rule 7.1001
www.courtinfo.ca.gov
8.
7.
Page 1 of 2
a.
b.
c.
e.
Proposed guardian (name):
Telephone numbers: Home:
Date of birth:
Social security number:
Driver's license number:
6.
I have not
(Check here if you have been arrested for drug or alcohol-related offenses.)
I have not
been charged with, arrested for, or convicted of a crime deemed to be a felony or a
misdemeanor. (If you checked "I have," explain in Attachment 3.)
neglect, or molestation?
I am I am not aware of any reports alleging any form of child abuse, neglect, or molestation made to any
agency charged with protecting children (e.g., Child Protective Services) or any other law
enforcement agency regarding me or any other person living in my home. (If you checked "I am,"
explain in Attachment 8 and provide the name and address of each agency.)
Have you, or has any other person living in your home, habitually used any illegal substances or abused alcohol?9.
Yes (If you checked "Yes," explain in Attachment 9.)No
This form must remain confidential.
(Name):
d.
No (If you checked "Yes," explain in Attachment 7.)
HEARING DATE AND TIME: DEPT.:
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seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
