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

CLASSIFIED EMPLOYEE APPLICATION

Last Name/ First/ Middle Date

Present Address E-mail Address

City/State/Zip Home Phone

Mobile Phone

Position applied for Date available for work

EDUCATION
Name of High School & Location College/University & Area of Study

Circle Year Completed Circle Year Completed

9 10 11 12 1 2 3 4

EMPLOYMENT EXPERIENCE
Please list all experience of three months or longer. Begin with the most recent. Attach an extra sheet if needed.
Name of Business & Location Dates Inclusive Position Reason for Leaving

MAY WE CONTACT YOUR PRESENT EMPLOYER? YES NO

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REFERENCES
Please list three to five persons who can answer questions concerning your qualifications for the position you
seek. Include supervisors under whom you have worked. The district reserves the right to contact persons not
specified by you. Submission of an application to the district constitutes your permission and consent for the
district to contact any person(s) and discuss you, your qualifications, and other pertinent matters.

Name/Title Relationship Address Telephone Number

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 any other
information as is necessary to acquire a national criminal history background check. Are you willing to submit to
the necessary criminal and history background checks?

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 involuntarily terminated or asked to resign from any job? Yes No

2. 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

3. Have you ever been arrested for a felony? (Even if no contest or charges
dropped or pled down.) Yes No

4. Have you ever been charged with a felony? (Even if no contest or charges
dropped or pled down.) Yes No

5. Have you ever been convicted of a felony? (Even if no contest or charges

dropped or pled down.) Yes No

6. Have you ever been arrested for a sex-related offense? (Even if no contest or
charges dropped or pled down.) Yes No

7. Have you ever been charged with a sex-related offense? (Even if no contest or
charges dropped or pled down.) Yes No

8. Have you ever been convicted of a sex-related offense? (Even if no contest or

charges dropped or pled down.) Yes No

9. 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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10. Have you ever been charged of a drug-related offense? (Even if no contest or
charges dropped or pled down.) Yes No

11. Have you ever been convicted of a drug-related offense? (Even if no contest
or charges dropped or pled down.) Yes No

12. Have you ever been arrested for an act of violence, including domestic
violence? Yes No

13. Have you ever been charged for an act of violence, including domestic
violence? Yes No

14. Have you ever been convicted for an act of violence, including domestic
violence? Yes No

15. 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

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.

1. Please describe any professional or community activities, knowledge or skills you have which you think
would be helpful in this position.

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

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