Blank Georgia Psc Employer Assurance PDF Form

Blank Georgia Psc Employer Assurance PDF Form

The Georgia PSC Employer Assurance Form is a crucial document designed to verify the employment status of individuals seeking certification as educators in Georgia. This form ensures that all necessary background checks have been completed and that the applicant adheres to the Georgia Code of Ethics for Educators. If you are an employer, you can facilitate the certification process by filling out this form; just click the button below to get started.

The Georgia PSC Employer Assurance Form serves a critical role in the certification process for educators within the state. This form is designed for both public school employers and other educational institutions in Georgia, allowing them to verify an applicant's employment status and background checks. The form requires detailed information about the applicant, including their name, certification ID, and date of birth, all of which must be filled out in dark ink. Employers are tasked with completing sections that confirm the applicant's employment in a position requiring Georgia Professional Standards Commission (GaPSC) certification. They must also certify that all necessary background checks have been conducted and that any violations of the Georgia Code of Ethics have been reported. Additionally, the form allows employers to request specific transactions on behalf of the applicant, such as the issuance of a first certificate or the renewal of an existing one. Employers must provide their information, including their title and contact details, and they are required to sign the form to validate the information provided. The form should be submitted electronically through the appropriate channels, ensuring a streamlined process for certification applications.

Document Sample

Georgia PSC Employer Assurance Form – Revised June 2021

DO NOT MAIL!

Public School Employer: Must submit electronic form through www.gapsc.org account

All other GA Employers may complete the form for applicant to upload via MyPSC

This form is to be used to verify current employment as a Georgia educator.

1. Applicant Information

 

 

 

 

 

 

 

Please use dark ink.

 

Title

 

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mr. Ms.

Dr.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GaPSC Certification ID Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth (MM/DD/YY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Sections 2, 3, & 4 must be completed by the employer.

2. Employment Verification:

In submitting this form, I certify that all required background checks have been completed for this applicant and any violations of the Georgia Code of Ethics for Educators have been reported to the GaPSC. I also certify that the applicant is/will be working within the local unit of administration (LUA) I represent in a position requiring GaPSC certification and that the applicant is/will be employed by the LUA or by an outside agency contracted by the LUA to provide staffing or educational services.

Employment is in the certification field of :

Employment in this certificate field began on:

/

(MM/DD/YY)

/

3. Transaction Request:

I am requesting the following transaction(s) on behalf of the applicant listed above (check all that apply):

First GA certificate (applicant holds professional out-of- state certificate)

Renewal- A PLP/PLG has been established and the educator is making adequate progress toward meeting the plan/goals?

Yes No Addition of a new field

Conversion or Extension

Upgrade

Montessori certificate Educational Interpreter

Non-Renewable type certificate and field:

 

Field Code:

 

 

(see reverse)

Non-Renewable Types: Induction, International Exchange, Military Support, Permit, Provisional, or Waiver

Other unlisted transaction (please specify):

4. Employer Information:

Name of Superintendent or authorized designee (print/type)

 

Signature (eSignature not accepted)

 

 

 

 

 

 

 

Title

 

 

Date

 

 

 

 

 

Phone Number

Email Address

 

Name of Local Unit of Administration (School System / Agency / Private School / Institution)

Initial if applicable: __________ This is a virtual school based outside of Georgia. I certify that the applicant listed above will be working with Georgia students.

EMPLOYER ASSURANCE FORM INSTRUCTIONS – Revised June 2021

Note: Please complete all forms legibly in black ink or type.

The Georgia PSC Employer Assurance Form should accompany all applications for certification when the applicant is employed or will be employed by a Georgia public or private school system/agency. When possible, this form should be submitted electronically through the employer’s account on

www.gapsc.org. This form is used for the following:

To verify that the applicant is currently employed or will be employed in the listed system/agency and all required background checks have been completed;

To exempt the applicant from the certification fee in some cases; and

To request a Permit, International Exchange, Waiver, or non-renewable type certificate.

CERTIFICATE FIELD CODES

TEACHING FIELDS

Elementary Fields

Birth Through Kindergarten 870

Elementary Education (P-5) 808

SpEd Gen Curriculum/Elementary Education (P-5)

708

Middle Grades (4-8):

Language Arts - 853

Mathematics - 851

Reading - 855

Science - 852

Social Science - 854

Secondary Fields (6-12)

Agriculture788

Behavioral Science 766

Biology 750

Business 783

Chemistry 752

Earth/Space Science 753

Economics 757

Engineering and Technology 769

English 730

Family/Consumer Science 790

Geography 759

Healthcare Science 619

History 755

JROTC: Air Force 643

JROTC: Army 641

JROTC: Marine Corps 644

JROTC: Navy 642

Marketing 792

Mathematics 743

Physics 751

Political Science 756

Science (Broad Field) 748

Speech 733

Trade & Industrial Education:

Architectural Drawing and Design 658

Audio/Video Technology & Film 652

Automotive Service Tech 650

Aviation 830

Barbering 613

Collision Repair 653

Computer Animation 678

Construction - 656

Cosmetology 525

Culinary Arts - 669

Distribution & Logistics654

Electronics Technology 657

Esthetics 614

Government & Public Administration680

Granite Technology 659

Graphic Communications & Design 660

IT/Info Services & Support 662

IT/Network Systems - 663

IT/Programming & Software Dev. 664

IT/Cybersecurity 676

Manufacturing & Engineering Sciences 667

Marine Service Technology 618

Nails 615

Precision Machine Technology 668

Law, Public Safety, Corrections & Security 670

Sheet Metal 671

Welding Technology 673

Foreign Languages (P-12)

American Sign Lang.

832

Arabic

845

Chinese (Mandarin)

834

Farsi

848

French

836

German

838

Greek (Classical)

842

Hebrew

841

Hindi

843

Italian

840

Japanese

831

Korean

846

Latin

835

Portuguese

844

Russian

839

Spanish

837

Swahili

847

Turkish

850

Urdu

849

Special Education (P-12) Consultative Sp Ed Adapted Curriculum 805 Behavior Disorders 778

Deaf Education 797

Sp Ed General Curriculum 798

SpEd General Curriculum/Elementary Education (P-5 only) 708

Learning Disabilities 777 Physical & Health Disabilities 768 Sp Ed Preschool (ages 3-5) 799 Visual Impairment 722

Sp Ed Academic Content Concentrations:

 

P-5

4-8

6-12

Language Arts

930

931

932

Mathematics

910

911

912

Reading

950

951

952

Science

920

921

922

Social Science

940

941

942

P-12 Fields

Art 764

Computer Science 789

Dance 820

Drama 821

Eng. To Speakers of Other Lang. (ESOL) 885

Gifted (P-12) Consultative 780

Gifted Concentrations:

Language Arts 963

Mathematics 961

Reading 965

Science 962

Social Science 964

Health Education - 760

Health and Physical Education 761

Music 767

Reading 732

SERVICE FIELDS (P-12)

Audiology 801

Media Specialist 813

School Counseling - 709

School Nutrition Director 729

School Psychology711

School Social Work 715

Speech and Language Pathology 802

Curriculum & Instruction 902

Instructional Technology 903

Teacher Leadership 904

LEADERSHIP FIELDS (P-12)

Educational Leadership-Tier I --700

Educational Leadership- Tier II -- 710

ENDORSEMENTS

Teaching Endorsements: Agriculture Education (P-5) 892 Autism 877

Birth Through Five 871

Career Exploration (PECE) 749 Career Technical Instruction (CTI) 810 Coaching Endorsement 980 Computer Science 882

Coordinated Career Academic Ed (CCAE) -770 Culinary Arts 884

Dramatic Writing Micro-Endorsement 350 Dual Immersion Elementary Education 863 ESOL 825

Gifted In-Field 881 Intervention Specialist 887 K-5 Mathematics 970 K-5 Science 971 Middle Grades859 On-Line Teaching 898 Personalized Learning 889

Positive Behavior Intervention and Supports (PBIS) 189

Reading 833

Safety & Driver Education 763 Sp Ed Deaf Education 874

Sp Ed Physical & Health Disabilities 875 Sp Ed Preschool (ages 3-5) 826

Sp Ed Transition Specialist 873

Sp Ed Visual Impairment 876 STEM Education 186 Urban Education 891 Work-Based Learning 793

Service Endorsements:

Student Support Team Coordinator 888 Teacher Support and Coaching 712

Leadership Endorsements:

Teacher Leader 774

File Specifics

Fact Name Details
Form Purpose This form verifies current employment for applicants seeking certification as Georgia educators.
Submission Method Public school employers must submit the form electronically through their GaPSC account. Other employers can complete it for the applicant to upload via MyPSC.
Governing Laws The form operates under the Georgia Code of Ethics for Educators and relevant Georgia educational statutes.
Background Checks Employers must certify that all required background checks have been completed for the applicant.
Certification Fee Exemption In certain cases, the form can exempt the applicant from the certification fee.
Completion Requirements Sections 2, 3, and 4 must be filled out by the employer, and the form must be completed in dark ink or typed.

How to Use Georgia Psc Employer Assurance

Completing the Georgia PSC Employer Assurance form is an important step in verifying an applicant's employment as a Georgia educator. After filling out this form, it should be submitted electronically through the appropriate channels, depending on whether the applicant is associated with a public school or another type of educational institution. Following these steps will help ensure that the process runs smoothly.

  1. Gather necessary information about the applicant, including their full name, date of birth, and GaPSC Certification ID number.
  2. Use dark ink to fill out the form clearly and legibly.
  3. In the Applicant Information section, enter the title, last name, first name, middle name, GaPSC Certification ID number, and date of birth (formatted as MM/DD/YY).
  4. Move to the Employment Verification section. Certify that all required background checks have been completed and that any violations of the Georgia Code of Ethics for Educators have been reported to the GaPSC.
  5. Indicate the employment status of the applicant, specifying whether they are employed or will be employed within the local unit of administration (LUA).
  6. Fill in the employment certification field and the start date of employment in the designated areas.
  7. In the Transaction Request section, check all applicable boxes for the type of transaction being requested on behalf of the applicant.
  8. Complete the Employer Information section by providing the name and title of the superintendent or authorized designee, along with their signature, date, phone number, and email address.
  9. Specify the name of the Local Unit of Administration (School System/Agency/Private School/Institution).
  10. If applicable, initial the section indicating that the applicant will be working with Georgia students while based in a virtual school outside of Georgia.

Your Questions, Answered

What is the purpose of the Georgia PSC Employer Assurance Form?

The Georgia PSC Employer Assurance Form is used to verify the current employment status of an applicant who is seeking certification as a Georgia educator. It ensures that all required background checks have been completed and any violations of the Georgia Code of Ethics for Educators have been reported. Additionally, it may exempt the applicant from certification fees in certain situations.

Who is required to submit this form?

Public school employers in Georgia must submit the form electronically through their account on www.gapsc.org. Other employers in Georgia can complete the form for applicants to upload via MyPSC. This includes private schools and educational agencies.

What information is needed from the applicant?

The applicant must provide their personal information, including:

  • Title (Mr., Ms., Dr.)
  • Last name
  • First name
  • Middle name
  • GaPSC Certification ID number
  • Date of birth

It's important to fill out this section clearly, using dark ink or typing.

What does the employer need to certify?

Employers must certify that:

  1. All required background checks for the applicant have been completed.
  2. Any violations of the Georgia Code of Ethics for Educators have been reported to the GaPSC.
  3. The applicant will be employed in a position that requires GaPSC certification.

This certification is crucial for ensuring the integrity of the hiring process.

What types of transactions can be requested using this form?

Employers can request various transactions on behalf of the applicant, such as:

  • First Georgia certificate
  • Renewal of certification
  • Addition of a new field
  • Conversion or extension of certification
  • Upgrade of certification
  • Montessori certificate
  • Educational Interpreter certificate
  • Non-renewable type certificates
  • Other unlisted transactions

Be sure to check all applicable options when submitting the form.

How should the form be submitted?

The form should not be mailed. Instead, it must be submitted electronically through the appropriate channels, either via the employer’s account on the GaPSC website or uploaded by the applicant through MyPSC. This helps streamline the certification process.

What happens if the form is incomplete?

Submitting an incomplete form can lead to delays in processing the applicant's certification. It is essential to fill out all sections legibly and accurately. Double-check that all required information is provided before submission to avoid unnecessary complications.

Common mistakes

  1. Using the wrong ink color. The form specifically requires dark ink, so using any other color can lead to issues.

  2. Failing to complete all sections. Sections 2, 3, and 4 must be filled out by the employer. Omitting any of these can delay processing.

  3. Not certifying background checks. Employers must certify that all required background checks have been completed for the applicant. Missing this step can cause the application to be rejected.

  4. Incorrectly reporting employment details. It is crucial to accurately state the applicant's employment status and the position requiring GaPSC certification. Errors can lead to misunderstandings.

  5. Neglecting to provide a signature. The form requires a signature from the superintendent or authorized designee. An unsigned form will not be accepted.

  6. Submitting the form by mail. The instructions clearly state DO NOT MAIL. Forms must be submitted electronically, or they will not be processed.

  7. Overlooking the certification field code. Each applicant's certification field must be accurately noted. Failing to include the correct code can result in delays or denials.

Documents used along the form

The Georgia PSC Employer Assurance Form is a critical document for verifying the employment status of educators in Georgia. It serves as a means for public and private school systems to confirm that applicants meet the necessary requirements for certification. Alongside this form, several other documents may also be required to facilitate the certification process. Below is a list of these additional forms and documents, each serving a specific purpose in the certification journey.

  • GaPSC Certification Application - This is the primary application form that educators must complete to apply for certification. It includes personal information, educational background, and details about the certification sought.
  • Background Check Authorization Form - This document allows the Georgia Professional Standards Commission (GaPSC) to conduct a criminal background check on the applicant. It is essential for ensuring the safety of students and compliance with state regulations.
  • Transcripts from Educational Institutions - Official transcripts are required to verify that the applicant has completed the necessary coursework and degree requirements for the certification being sought.
  • Proof of Teaching Experience - This document outlines the applicant's previous teaching experience, including the duration and type of positions held. It is crucial for applicants seeking to demonstrate their qualifications.
  • Recommendation Letters - Letters from previous employers or mentors can provide insight into the applicant's teaching abilities and character. These letters are often required to support the application for certification.
  • Professional Development Documentation - Evidence of completed professional development courses or workshops may be necessary to show ongoing commitment to professional growth and compliance with GaPSC requirements.
  • Certificate Field Codes Documentation - This document lists the specific certificate field codes that correspond to the applicant's area of expertise. It helps ensure that the applicant is applying for the correct certification based on their qualifications.

Each of these documents plays a vital role in the certification process, ensuring that educators in Georgia are qualified and prepared to provide quality education. Understanding the purpose and requirements of each form can streamline the application process and enhance the chances of successful certification.

Similar forms

The Georgia PSC Employer Assurance Form shares similarities with the Employment Verification Form used in various states. Like the Georgia form, this document serves to confirm an educator's employment status, ensuring that all necessary background checks have been conducted. It typically requires the employer's certification that the applicant meets all qualifications and ethical standards required for teaching. Both forms aim to facilitate the certification process, allowing educators to demonstrate their eligibility for teaching positions within their respective states.

Another comparable document is the Teacher Certification Application. This application often includes sections for employment verification, similar to the Georgia PSC Employer Assurance Form. It requires applicants to provide details about their current employment and any relevant background checks. Both documents are essential in confirming that an applicant is qualified to receive a teaching certificate, ensuring that they meet the educational and ethical standards set forth by the governing body.

The Credential Verification Form is also akin to the Georgia PSC Employer Assurance Form. This form is utilized to verify an educator's credentials and employment history. Employers must attest to the accuracy of the information provided, similar to the assurances required in Georgia's form. Both documents play a crucial role in the certification process, ensuring that only qualified individuals are granted teaching credentials.

Lastly, the Background Check Authorization Form aligns with the Georgia PSC Employer Assurance Form in purpose and function. This document is essential for obtaining consent to conduct background checks on potential educators. While the Georgia form certifies that background checks have already been completed, the Background Check Authorization Form initiates that process. Both forms emphasize the importance of ensuring that educators meet safety and ethical standards before being allowed to work with students.

Dos and Don'ts

When filling out the Georgia PSC Employer Assurance form, there are several important considerations to keep in mind. Below is a list of things you should and should not do to ensure the process runs smoothly.

  • Do submit the form electronically through the appropriate channels, as mailing is not permitted.
  • Do use dark ink or type the information clearly to ensure legibility.
  • Do complete all required sections of the form, especially those pertaining to the applicant's employment verification.
  • Do ensure that all background checks for the applicant have been completed prior to submission.
  • Do include accurate contact information for the superintendent or authorized designee.
  • Don't leave any sections of the form blank; incomplete forms may delay processing.
  • Don't use an eSignature, as it is not accepted on this form.
  • Don't forget to check all applicable transaction requests for the applicant.
  • Don't submit the form if the applicant has not been verified for employment in the required certification field.

By adhering to these guidelines, you can facilitate a more efficient processing of the Georgia PSC Employer Assurance form.

Misconceptions

Understanding the Georgia PSC Employer Assurance Form is essential for both employers and applicants. However, several misconceptions can lead to confusion. Here are nine common misconceptions about this form:

  • It can be mailed to the Georgia PSC. The form must be submitted electronically through the appropriate channels. Mailing the form is not permitted.
  • Only public school employers can use this form. While it is primarily for public schools, all Georgia employers can complete the form for applicants to upload via MyPSC.
  • The form is optional for current employees. The form is necessary to verify employment and must be completed for applicants currently employed or about to be employed.
  • Any ink can be used on the form. The instructions specify that the form must be completed in dark ink, preferably black.
  • Electronic submission eliminates the need for a signature. A physical signature from the superintendent or authorized designee is required; eSignatures are not accepted.
  • Background checks are not the employer's responsibility. Employers must certify that all required background checks have been completed for the applicant.
  • All transactions can be requested on the form. The form allows specific transaction requests, and not all types may be applicable to every applicant.
  • The form is only for new applicants. It can also be used for current employees seeking renewal or upgrades of their certifications.
  • There is no deadline for submitting the form. Timeliness is crucial. Delays in submission can affect the applicant's certification process.

Addressing these misconceptions can help streamline the certification process for educators in Georgia.

Key takeaways

Key Takeaways for Filling Out the Georgia PSC Employer Assurance Form

  1. The form must be submitted electronically through the employer's account on www.gapsc.org for public school employers.
  2. Other Georgia employers can complete the form for the applicant to upload via MyPSC.
  3. Use dark ink or type the information clearly to ensure legibility.
  4. Sections 2, 3, and 4 require completion by the employer, confirming the applicant's employment status.
  5. Employers must certify that all background checks for the applicant have been completed.
  6. Indicate if any violations of the Georgia Code of Ethics for Educators have been reported to the GaPSC.
  7. Specify the certification field and the start date of employment in that field.
  8. Employers can request multiple transactions on behalf of the applicant, such as a first GA certificate or renewal.
  9. Include the name and title of the superintendent or authorized designee along with their signature.
  10. Ensure the form is completed accurately to avoid delays in the certification process.

This form is essential for verifying employment and facilitating the certification process for Georgia educators. Proper completion is crucial for a smooth submission and approval.