Lincoln County School District #2
222 E. 4th Avenue
P.O. Box 219
Afton, WY 83110
(307) 885-3811 ♦ Fax (307) 885-9562 ♦ [Link]
CERTIFIED EMPLOYEE APPLICATION
Last Name/ First/ Middle Date
Present Address E-mail Address
City/State/Zip Home Phone
Permanent Address Mobile Phone
City/State/Zip Date available for work
Indicate area of certification:
Elementary Middle School High School
Indicate preference of teaching location:
Star Valley Cokeville Any
ELEMENTARY- Indicate 1st and 2nd choice in the level for which you are interested.
K-3 4-6 Any
Subject Area (Elem. Ed., P.E. Art, Music, etc):
MIDDLE SCHOOL
Subject Area (Science, Math, P.E. Art, Music, etc):
SECONDARY SCHOOLS
7-8 9-12 7-12
Subject Area (Science, Math, P.E. Art, Music, etc):
COACHING
Please check the activities for which you are certified by the State of Wyoming and/or are willing to coach.
Basketball Football Golf Volleyball Wrestling
Track Speech Drama Other:
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Pursuant to definition of “highly qualified” by the No Child Left Behind Act, do you possess “highly qualified”
status? _____ Yes _____ No.
If “yes” please list by which state and attach evidence. ______________________________________________
If “no” , please state your plan for becoming highly qualified. __________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Pursuant to the provisions of W.S. 21-7-401, any employee who is to be hired by the school board on or after July
1, 1996, who may have access to minors, is required to submit to fingerprinting and to provide such other
information as is necessary to acquire a national criminal history background check. Although a criminal history
background check may have been done by the Wyoming Professional Teaching Standards Board, the school
district may, at its option, conduct a separate criminal history background check. In addition, if you are not
required to be certified by the Wyoming Professional Teaching Standards Board, or if you have not had a criminal
history background check conducted by the Wyoming Professional Teaching Standards Board within the last 12
months, the school district may require you to submit to a criminal history background check.
Have you provided the necessary information to the Professional Teaching
Standards Board to allow it to conduct a criminal history background check? Yes No
Conviction of a crime is not an automatic bar to employment. The district will consider the nature of the offense,
the date of the offense, and the relationship between the offense and the position for which you are applying.
1. Have you ever been convicted of an offense other than a minor traffic violation?
(DUI and DWI convictions are not considered minor and must be reported.) Yes No
2. Have you ever been arrested for a felony? (Even if no contest or charges
dropped or pled down.) Yes No
3. Have you ever been charged with a felony? (Even if no contest or charges
dropped or pled down.) Yes No
4. Have you ever been convicted of a felony? (Even if no contest or charges
dropped or pled down.) Yes No
5. Have you ever been arrested for a sex-related offense? (Even if no contest or
charges dropped or pled down.) Yes No
6. Have you ever been charged with a sex-related offense? (Even if no contest or
charges dropped or pled down.) Yes No
7. Have you ever been convicted of a sex-related offense? (Even if no contest or
charges dropped or pled down.) Yes No
8. Have you ever been arrested for a drug-related offense? (Even if no contest or
charges dropped or pled down.) Yes No
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9. Have you ever been charged of a drug-related offense? (Even if no contest or
charges dropped or pled down.) Yes No
10. Have you ever been convicted of a drug-related offense? (Even if no contest
or charges dropped or pled down.) Yes No
11. Have you ever been arrested for an act of violence, including domestic
violence? Yes No
12. Have you ever been charged for an act of violence, including domestic
violence? Yes No
13. Have you ever been convicted for an act of violence, including domestic
violence? Yes No
14. Are you prevented from being lawfully employed in this country because of
visa or immigration status? Proof of status will be required if employed. Yes No
15. Has your professional license ever been revoked?
Yes No
16. Have you ever been discharged or separated from a position with a school
district or been asked to resign a licensed arrangement? Yes No
17. Have you ever been the subject of an investigation by a school district or any
other employer? Yes No
18. Have you ever had sanctions placed on your teaching certificate for any
reason? Yes No
19. Have you ever been denied a teaching certificate anywhere? Yes No
20. Is disciplinary action currently pending anywhere against your certificate Yes No
If you answered yes to any of the above questions, and/or have any pending charges, as well as pleas of nolo
contendre, please attach explanation on a separate sheet.
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1. Please describe any professional or community activities, knowledge or skills you have which you think
would be helpful in this position.
2. Please list the instructional techniques you plan to use in your teaching.
I authorize Lincoln County School District #2 to obtain information about any criminal records I may have. I also
authorize all governmental agencies to provide information to Lincoln County School District #2 about any criminal
record I may have. I verify that all information on this employment application is true and complete. I understand
that any misrepresentation, falsification, or omission on this application or other documents submitted to Lincoln
County School District #2 will be sufficient cause for this application not to be considered by the School District or
for dismissal if I have been employed.
I authorize Lincoln County School District #2 to check my references, to obtain information from my prior
employers and educational institutions, and to take other actions to investigate any information provided in my
application employment, and to obtain information relevant to evaluating my qualifications and fitness for a
teaching position. I authorize the release of any and all information or records maintained by the Wyoming
Department of Family Services. I authorize my listed references, past employers and educational institutions, and
anyone else who has information about my work history, education, qualifications, or fitness, to provide such
information to Lincoln County School District #2. I release Lincoln County School District #2 and all persons
providing information to the school district from any liability whatsoever for obtaining and providing that
information.
A photocopy of this release shall be as effective as the original.
Signature Date
Applicants for admission and employment, students, parents, persons with disabilities, employees, and all unions or professional organizations holding collective bargaining or professional
agreements with Lincoln County School District #2 are hereby notified that this school district does not discriminate on the basis of race, sex, color, national origin, age, religion, or
disability, in admission or access to, or treatment or employment in, its programs and activities. Any person having inquiries concerning the school’s compliance with the regulations
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implementing Title VI, Title IX, The Americans with Disabilities Act (ADA) or Section 504 is directed to contact the following individual who has been designated to coordinate efforts to comply
with the regulations regarding nondiscrimination- Mark Taylor, PO Box 219, 222 E. 4th Avenue, Afton, WY 83110, (307) 885-3811. TTY- 1-800-877-9965
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