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The Wyoming Certified Application form plays a crucial role in the hiring process for educators seeking employment within the state's school districts. This comprehensive document not only serves as a means for applicants to present their qualifications but also outlines essential requirements that must be met for successful certification. Key sections of the form include personal information, educational background, teaching experience, and references. Applicants are required to provide their social security number, addresses, and contact information, ensuring that school districts can reach them easily. Furthermore, the form asks for detailed educational history, including degrees earned and relevant coursework, which must be expressed in semester hours. It also inquires about the subjects and grade levels for which the applicant is endorsed to teach, reflecting the diverse educational needs of Wyoming's students. Additionally, candidates must disclose their availability for work and indicate their willingness to consider positions in rural schools, which may be located far from urban centers. This aspect highlights the commitment to meeting the staffing needs of all districts. The application also addresses the legal and ethical responsibilities of applicants, requiring them to affirm their ability to perform essential job functions and disclose any past criminal convictions that may impact their employment eligibility. By encompassing these various elements, the Wyoming Certified Application form not only facilitates a thorough evaluation of candidates but also underscores the importance of transparency and accountability in the educational profession.

Preview - Wyoming Certified Application Form

Wyoming Statewide Certified Application

Note: Applications which are submitted to a school district will remain active at that district for one year. The district will normally keep the application on file for two years. Contact individual districts about procedures for reactivating an application that is more than one year old. Individual school districts may require additional information other than that asked for on this application.

Information

Last Name, First, Middle

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Permanent Address

 

 

 

 

 

 

 

 

 

 

 

 

Other Phone

 

 

 

 

Present Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

City/State/Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone

 

 

 

Personal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When will you be available to begin work?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please indicate 1st, 2nd and 3rd choice in the level(s) for which you are applying. Teachers and coaches must

 

possess or be eligible for Wyoming Certification - with supporting course work and endorsement in each teaching

 

assignment area. The applicant is responsible for securing all appropriate certifications and endorsements.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Elementary

K-3

 

4-6

 

 

K-6

 

Subject Area(s): (PE, Art, Music)

 

 

 

 

Endorsements

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Some districts have small rural schools located some distance from a population center. Do you wish to be

 

 

considered for vacancies in those schools?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle School

Subjects endorsed to teach:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Secondary

7-9

 

10-12

7-12

 

Indicate subjects you are endorsed to teach below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

 

 

 

 

 

 

 

(2)

 

 

 

 

 

 

 

 

(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Teaching

Special Education/Related Services

 

K-6

 

7-9

 

 

10-12

 

K-12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Area(s) of endorsements:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exams and Highly Qualified Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List the Praxis exams which you have passed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List the subject areas for which you are considered “highly qualified” in Wyoming:

 

 

 

 

 

 

 

Duties

Check the extra duties for which you are certified by the State of Wyoming and/or are willing to sponsor. Blacken

the box of any sport in which you are certified by the State of Wyoming to serve as head coach.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Extra

Basketball

Football

 

Golf

Cross-Country

Volleyball

Ski

Swim

Tennis

Other

Speech

 

Drama

Track

 

Soccer

Cheerleading

 

 

 

 

Wrestling

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Dates

Degree

Major

Minor

# of Sem. Hrs.

Inclusive

Major

Minor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Student

Teaching

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.

Name of School/Business

From-To

Position

Reason for

& Location

Leaving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

Name/Title

Address/City

Email

Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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:

 

Yes

No

Do you have, or have you had, continuing contract status in any other Wyoming

 

 

school district? If yes, list dates and with which district:

 

 

 

Yes

No

Are you legally authorized to work in the United States?

 

 

 

Yes

No

Will you, now or in the future, require sponsorship for employment status (e.g. H-1B

 

 

visa status)?

Yes

No

Wyoming school districts do not discriminate on the basis of race, color, national origin, sex, age, disability, political affiliation, religion or belief in relation to admission, treatment of students, access to programs and activities, or terms and conditions of employment. Any person who feels that discriminatory conditions exist concerning Title VI, Title IX or Section 504 of the Rehabilitation Act of 1973 may contact the district's coordinator or the Wyoming Department of Education, Office for Civil Rights Coordinator, 2nd Floor, Hathaway Building, Cheyenne, Wyoming 82002-0050, 307/777-6198; or the Office for Civil Rights, Region VIII, U.S. Department of Education, Federal Office Building, Suite 310, 1244 Speer Boulevard, Denver, Colorado 80204-3582, 303/844-5695, TDD 303/844-3417.

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

your application information to these other institutions?

Yes

No

A photocopy of this release shall be effective as the original. Electronic submission shall be interpreted as authorization of the above information.

Signature

Date
▼ Wyoming Certified Application File

Document Characteristics

Fact Name Description
Application Validity Applications submitted to a school district remain active for one year.
File Retention The school district typically keeps applications on file for two years.
Certification Requirement Teachers and coaches must possess or be eligible for Wyoming Certification.
Endorsement Responsibility The applicant is responsible for securing all necessary certifications and endorsements.
Extra Duties Applicants can check extra duties they are certified for, such as coaching various sports.
Criminal Background Disclosure Applicants must disclose any felony convictions or moral turpitude offenses.
Non-Discrimination Policy Wyoming school districts do not discriminate based on race, color, national origin, and other factors.
Authorization for Information Release Applicants authorize school districts to obtain information about their criminal records.
Governing Law This application is governed by the laws of the State of Wyoming.
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