Form H - Verification Of Employment printable pdf download

Form H - Verification Of Employment

FORM H COVER SHEET

Directions for Completing

Form H

Form H should only be completed by those Fellows who are currently employed in a low-performing school

(API of 5 or less). Fellows who meet this criterion should complete the top (address) portion of the form.

Please fill in this information completely. If you have changed any part of your contact information, please check

the box to alert our staff to update your records.

Once you have completed the top portion, please give the form to the Director of Human Resources for your

school district to complete. IMPORTANT: The form instructs the Human Resource personnel to fill in the date

you were initially hired at your current school. For example, if you were hired initially in the 2006-07 school

year and are continuing employment in this same school for the 2008-09 school year, the initial hire date would

be in the fall of 2006. Only if you have changed schools for the current school year (or the 2009-10 school year is

your first year of teaching service) would you have a fall 2008 hire date.

After completing Form H, the Human Resources Director should place it in a sealed district envelope that she or

he has signed across the back of the sealed envelope. The form should be mailed to the following address:

Governor’s Teaching Fellowship Program

P.O. Box 1590

Long Beach, CA 90802-1590

The envelope must be postmarked no later than 5:00 p.m. on November 8, 2013.

Note: Schools may change their API rankings from year to year. The API ranking for your school must be 5 or

less at the time you were hired in order for your employment there to be counted toward satisfying your four

year GTF teaching obligation. If, in a subsequent year, your school’s API score rises above 5, that school will

still count as a qualifying school. However, if you have been employed in a school that has had and continues

to have an API ranking of greater than 5 since your time of hire, you should not complete Form H.

Instead, complete the Status Update Form.

Form H - Verification Of Employment