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The Georgia PSC Employer Assurance Form should accompany all applications for certification when the applicant is employed or will be employed in a Georgia public or private school system/agency. Georgia PSC Employer Assurance Form Two Peachtree Street Suite 6000 Atlanta Georgia 30303-3141 Please Use Black Ink or Type Title Last Name Mr Ms First Name Middle or Maiden Name Social Security Number - Date of Birth MM/DD/YY / I.

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How to fill out the Assurance Form online

Completing the Assurance Form online is a straightforward process that ensures the verification of an applicant's employment status and the certification request. This guide provides step-by-step instructions to help users navigate the form efficiently.

Follow the steps to successfully complete the Assurance Form.

  1. Click the ‘Get Form’ button to access the Assurance Form and open it for online completion.
  2. Begin by entering your title and name in the designated fields. Use black ink or type to ensure clarity. Include your last name, first name, and middle or maiden name as required.
  3. Input your social security number and date of birth in the specified formats to maintain accuracy.
  4. Navigate to the Employment Verification section. Here, check the appropriate transaction option that applies to the applicant. Ensure to fill in the employing school system or agency code.
  5. Indicate the applicant's employment start date in the correct format to confirm their current or past employment.
  6. In the Request for Non-Renewable Certificate Type section, choose the type of certificate requested by checking all that apply. Enter the beginning validity date for processing.
  7. Provide the applicant's specific field of employment and any additional required information regarding Trade & Industrial Education if applicable.
  8. Complete the Authorization section by entering the name of the superintendent or central office designee. Sign the form to verify that a background check has been initiated, and include their title and contact information.
  9. Review the entire form for accuracy before finalizing your submission. Once everything is complete, you can save changes, download, print, or share the completed form as needed.

Complete the Assurance Form online today to ensure a smooth certification process.

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The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants, loans, contracts, property, discounts or other Federal financial assistance from the U.S. Department of Health and Human Services.

Through the assurance of compliance, an institution commits to HHS that it will comply with the requirements set forth in the regulations for the protection of human subjects at 45 CFR part 46.

Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of disability in any program or activity receiving Federal financial assistance.

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