Dear Applicant:

This is to acknowledge the receipt of your inquiry concerning a teaching position in our
school district.

In order to complete your application file, we will need to receive the following:

1. Letter of Interest
2. Current Resumé
3. Current Placement Credentials or complete transcripts of your college or
university work (copies are acceptable for the screening process)
4. Three current letters of recommendation
5. Completed District Application (Four pages)

Please send all required materials to the address listed below. Our procedure is to
forward all application materials to the selection committee. They will review all
applications for the position and notify the candidates that have been selected for an
interview. Following the interviews, a recommendation is made to the Board of
Trustees.

We are pleased that you have expressed an interest in our school district. If there is
anything we can do to assist you in the application process, please do not hesitate to
call me at (307) 885-3811 or e-mail me at awelch@lcsd2.org.

Sincerely,
Amanda E. Welch
District Secretary

SEND COMPLETED APPLICATIONS TO:

Amanda Welch
Lincoln County School District #2
P.O. Box 219
Afton, WY 83110
 Lincoln County School District #2
222 E. 4th Avenue
P.O. Box 219
Afton, WY 83110
(307) 885-3811 ♦ Fax (307) 885-9562 ♦ www.lcsd2.org

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

9. Have you ever been charged of a drug-related offense? (Even if no contest or

charges dropped or pled down.) Yes No
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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 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