Wyoming Certified Application Form – Fill Out and Use This PDF

Academic Preparation

Include all college and university preparation. Express college credits in semester hours. Multiply quarter hours by 2/3 to change to semester hours. Attach an extra sheet if needed.

Name of School & Location Subject/Grade Dates

Supervisor

Phone

Experience

List all teaching experience and non-teaching experience of three months or longer. Begin with the most recent position. Attach an extra sheet if needed.

References

Please list three to five persons who can answer questions concerning your qualifications for the position you seek. Include superintendents, principals and other 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.

Personal Information

Are you able to perform the essential functions required of the position for which you are making application, with or without accommodations? If no, please explain:

Yes No

Have you ever been convicted of a felony or any offense involving moral turpitude (e.g., theft, attempted theft, murder, rape, swindling, and indecency with a minor) or has any court received a plea of guilty or a plea of nolo contendre from you? If yes, please explain:

Yes No

Have you ever been convicted of any felony or sentenced or received a deferred prosecution or probation for any charge including any crime relating to child abuse or neglect, or any crime relating to sexual abuse of a minor? If yes, please explain:

Yes No

Have you ever been dismissed or asked to resign from any job? If yes, please give details:

General Information

1.List any honors you received in college:

2.List any honors you have received as a professional:

3.List your professional and community activities.

4.What instructional techniques do you plan to use in your teaching? (Please use complete sentences.)

5.What will you do to ensure your students learn? (Please use complete sentences.)

Authorization

I authorize any school district to which this application is submitted to obtain information about any criminal records I may have. I also authorize all governmental agencies to provide information to the school district 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 the school district 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 any Wyoming school district for which I have completed an employment application 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 employment application, 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, qualification or fitness, to provide such information to any Wyoming school district. I release the school district and all persons providing information to the school district from any liability whatsoever for obtaining and providing that information.

Upon occasion, school districts are asked by other educational institutions, such as other districts, to provide names of candidates for areas in which they have vacancies. Do you consent to the release of