Sometimes associated with Saint George, the military saint, often depicted as a crusader from the late Middle Ages, the cross has appeared on many flags, emblems, standards, and coats of arms.

Its first documented use was as the ensign of the Republic of Genoa, whereafter it was used successively by crusaders.

The symbol has since been adopted by the Swabian League in the pre-Reformation Holy Roman Empire, and it was introduced as the emblem of several countries and cities which have or had Saint George as a patron saint, notably the Republic of Genoa, the Duchy of Milan, England, Wales, and Georgia in the Caucasus Mountains of Eastern Europe.