Georgia Psc Employer Assurance Form PDF Details

In the realm of Georgia's education sector, the Georgia PSC Employer Assurance Form emerges as a pivotal document, updated recently in June 2021, tailored primarily for educators who are either currently employed or aspire to be part of Georgia's educational landscape. This form, which should not be mailed but submitted electronically via www.gapsc.org for public school employers, while others can fill it out for applicants to upload via MyPSC, serves multiple critical functions. It acts as a verification tool for current employment within Georgian educational systems, ensures that all necessary background checks are duly conducted, and helps in reporting any violations related to the Georgia Code of Ethics for Educators. Moreover, it facilitates various transactions on behalf of the applicant, such as the acquisition of first Georgia certificates, renewals, and additions of new fields among others, tailored to the specific needs of educators seeking to enhance or kick-start their professional journey. Additionally, it offers a comprehensive list of certificate field codes, covering a wide range of educational disciplines from early childhood to specialized subjects, thereby supporting educators in finding their precise niche. This form not only streamlines the certification process but also underscores Georgia’s commitment to maintaining high standards of professionalism and ethics in education.

QuestionAnswer
Form NameGeorgia Psc Employer Assurance Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesEmployerAssuran ce_20120701 gapsc form

Form Preview Example

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)

Agriculture– 788

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 & Logistics– 654

Electronics Technology – 657

Esthetics – 614

Government & Public Administration– 680

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 Psychology– 711

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 Grades– 859 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

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