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Employer assurance form 2026

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  1. Click ‘Get Form’ to open the employer assurance form in the editor.
  2. Begin by filling out the Applicant Information section. Enter the title, last name, first name, middle name, GaPSC Certification ID number, and date of birth in the specified fields.
  3. Proceed to Employment Verification. Here, ensure that all required background checks are confirmed as completed. Specify the applicant's certification field and the start date of employment.
  4. In the Transaction Request section, check all applicable transactions for the applicant. This may include requests for a first GA certificate or renewal.
  5. Complete the Employer Information section by providing details such as the name of the superintendent or authorized designee, their signature (note that eSignatures are not accepted), title, date, phone number, and email address.
  6. If applicable, initial to confirm if this is a virtual school based outside of Georgia and certify that the applicant will be working with Georgia students.

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VersionsForm popularityFillable & printable
20214.8 Satisfied (91 Votes)
20204.3 Satisfied (142 Votes)
20194.4 Satisfied (173 Votes)
20154 Satisfied (38 Votes)
20104 Satisfied (56 Votes)

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Related links

Employer resources - Texas Department of Insurance

Certified self insurance Employer coverage forms and notices. Questions? Call 800-252-7031, option 1

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7 CCR 1104-1-3-4 - Employer Assurance Form | State Regulations

In addition to the Employer Petition Form, an employer shall sign and submit an Employer Assurance Form. The employers signature on the form signifies

Learn more
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