Employee Certificate of Experience

							                                     FORSYTH COUNTY SCHOOLS
                                          APPLICATION FOR
                                       iAchieve Virtual Academy
DO NOT complete this application unless you are currently employed in FCS as a 50%-100% teacher or a cleared substitute
teacher for FCS, and certified and highly qualified.

If you are interested in teaching for iAchieve Virtual Academy, please complete this application and e-mail to Glenda Vis, in
Human Resources at gvis@forsyth.k12.ga.us. Contact the Academies of Creative Education Principal, Mr. Brad Smith, by
e-mail at basmith@forsyth.k12.ga.us, if you have questions regarding the program. Applications will be screened and
you will be notified by the Principal or his designee if you are to be employed.



Full Name :                                                                                                           _______

Social Security Number:                                                Employee I.D. #:                               ______

Mailing Address:                                                                                               ______________

Home Phone Number:                                            _______ Cell Number:

Emergency Contact Person:                                              Emergency Number:

School Site 2009-10:                                                   Position:                               ______________

School Site 2010-11: _______________________________________           Position:_______________________________________

FCS Substitute Teacher: ______Yes       ______No


Georgia Certification Fields:

Please answer the following questions:

Please describe your experience using the Angel/Blackboard Learning Management System:
    Basic              Moderate          Advanced
Have you taken one or more of the professional development courses offered in using Angel /Blackboard (please indicate
which course(s)?
    Level I            Level II          Level III
Have you completed or are you currently working on the PSC On-line Teaching endorsement?
                             If yes, what is your anticipated
    Yes           No
                             completion date:
Do you have any experience in teaching a virtual class?
    Yes              No         If yes, please describe:
Have you taken a graduate class related to the development and delivery of on-line content?
    Yes              No




                                INFORMATION BELOW IS FOR HUMAN RESOURCES USE ONLY

          Employee #:                       Certificate Level/Years:                 Certificate Expiration Date:

          Direct Deposit:                   Certificate Field(s):

          Approved by HR to be screened and considered by ACE Principal:           yes    _   no