NURSE

Years Of Experience

• Years worked in this district
• Years worked in other WY school districts
• Years worked in other states
• How many years were part-time?

Conditions of Employment

• Are you legally eligible for employment in the United States?
• I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I understand that my application will be on file for one (1) calendar year. I understand that it is my responsibility to keep data on my application current during that calendar year.

In the event of my employment, I understand that false or misleading information given in my application and / or application documents or in my interview may result in discharge.

I also understand that I am required to abide by all rules and regulations of the employer. I authorize Sublette County School District #1 to obtain information about any criminal records I may have.

I also authorize all governmental agencies to provide information to Sublette County School District #1 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 Sublette County School District #1 will be sufficient cause for this application not to be considered by Sublette County School District #1 or for dismissal, if I have been employed.

I authorize Sublette County School District #1 to check my references, to obtain information from my prior employers and educational institutions, 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 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, educational institutions, and anyone else who has information about my work history, education, qualifications, or fitness, to provide such information to Sublette County School District #1.

I release Sublette County School District #1 and all persons providing information to Sublette County School District #1 from any liability whatsoever for obtaining and providing that information.

I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time.

I understand as "Employment at Will" as a legal doctrine, which allows employees to end their employment with Sublette County School District #1 at any time.

Likewise, Sublette County School District #1 may discharge the employment of an employee at time. I understand that answering yes confirms that I acknowledge and agree to the authorization statement listed above.

General Questions

• Why do you want to work for Sublette County School District #1 and live in Pinedale, Wyoming?
• Please complete the self-assessment on the following standard. Include justification of your response in question 3. RECEPTIVITY TO FEEDBACK : Developing - Accepts, with some reluctance, feedback on performance from both supervisors and colleagues.

Rarely implements changes to practice. Acknowledges personal and organizational failures when confronted with evidence. Proficient - Accepts feedback from supervisors or colleagues, but changes in practice may be limited or inconsistent.

Accomplished - Welcomes feedback form supervisors and / or colleagues when the opportunities arise through professional collaboration.

Readily acknowledges personal and organizational failures and offers clear suggestions for personal learning. Distinguished - Seeks out feedback on performance from both supervisors and colleagues.

Offers frank acknowledgement of prior personal and organizational failures and clear suggestions for both personal and system learning resulting from those lessons.

• Justification for Receptivity to Feedback.
• Please complete the self-assessment on the following standard. Include justification of your response in question 5. INCREASING EXPERTISE : Developing - Participates in professional activities to a limited extent.

Proficient - Is prepared and engaged in appropriate professional learning opportunities. May participate in professional learning within the school, but inconsistently applies beneficial strategies.

Accomplished - Is consistently prepared and highly engaged in professional learning opportunities. Actively seeks professional learning activities within the school, district, and / or other organizations and implements the learning from these opportunities.

Distinguished - Contributes to a culture of inquiry by both seeking and sharing effective strategies or professional literature, conducting action research and engaging in collaborative inquiry around problems of practice.

• Justification for Increasing Expertise.
• Please complete the self-assessment on the following standard. Include justification of your response in question 7. RELATIONSHIPS WITH COLLEAGUES : Developing - Relationships with some colleagues lack collegiality and exhibit minimum to fulfill duties that the school or district requires.

Proficient - Maintains professional relationships with colleagues through respectful interactions. Accomplished - Relationships with colleagues are characterized by collaboration, cooperation, and willingness to learn from others.

Open to all perspectives when addressing concerns. Distinguished - Relationships demonstrate strong support for others and initiative in addressing issues of concern.

Initiates and facilitates collaboration to resolve concerns and further team and school goals.

• Justification for Relationships with Colleagues.
• Please complete the self-assessment on the following standard. Include justification of your response in question 9. INTEGRITY : Developing - Meets explicit written commitments, sometimes requiring follow up from supervisors.

Verbal statements lack the weight of a commitment. Proficient - Meets written commitments and generally fulfills verbal commitments.

Seeks clarification appropriately. Clearly communicates obstacles to meeting commitments in a timely fashion. Accomplished - Meets commitments or negotiates where the commitment cannot be met.

Verbal commitments have the same weight as written commitments. Distinguished - Meets commitments - verbal, written, and implied, or negotiates exceptions where the commitment cannot be met.

Commitments to all students and staff have the same weight as commitments to superiors, board members, or other people with visibility and / or authority.

• Justification for Integrity.
• Please complete the self-assessment on the following standard. Include justification of your response in question 11. SELF CONTROL : Developing - Occasionally exhibits aggressive, dismissive, or demeaning behaviors leading to a climate in which people are reluctant to raise sensitive issues.
• Proficient - Is able to keep his / her emotions in check; shows a level of restraint in difficult or challenging situations;
• demonstrates empathy and respect. Accomplished - Deals with sensitive subjects and / or conflict with dignity and self-control;

consistently demonstrates empathy and respect. Distinguished - Consistently demonstrates self-control, even in the most difficult and confrontational situations.

Defuses confrontational situations with empathy and respect.

• Justification for Self Control.
• Please complete the self-assessment on the following standard. Include justification of your response in question 13. RESPECT FOR OTHERS : Developing - Can be dismissive of the importance of the roles or work of others.

Generally arrives on time and is prepared, participates fully, and is ready to listen and respect others in meetings, with periodic exceptions.

Diverse opinions are sometimes welcomed, but this occurs inconsistently. Proficient - Demonstrates respect for each person in the organization and the work he or she does.

Arrives on time and is prepared, participates fully, and is ready to listen and respect others in meetings. Accomplished - "Demonstrates respect for each person in the organization and the work he or she does.

Arrives on time and is prepared, participates fully, and is ready to listen and respect others in meetings. Diverse opinions are consistently encouraged, welcomed, and recognized, even when such opinions differ from those of the staff member.

Distinguished - Demonstrates respect for each person in the organization and the work he or she does. Effectively manages time and meetings by engaging others in the process, achieving meeting objectives, and beginning and ending on time.

Models respect for others by arriving early to all meetings, and consistently encourages, welcomes, and recognizes diverse opinionseven when such opinions differ from those of the leader.

• Justification for Respect for Others
• Please complete the self-assessment on the following standard. Include justification of your response in question 15. ORGANIZATIONAL COMMITMENT : Developing - Requires some guidance regarding the rules, policies, and procedures established by the district and / or sometimes challenges administrative and policy leadership without bringing those concerns to appropriate administrator or policy authorities.

Sometimes avoids or circumvents unpopular policies or directives, or performs them in a perfunctory manner. Proficient - Accepts and implements leadership and policy with fidelity.

Addressed concerns through the proper chain of command. Accomplished - Actively acquires knowledge of and adheres to the rules, policies, and procedures established by the district.

Accepts and implements leadership and policy with fidelity. Proactively brings concerns to his or her immediate supervisor by articulating disagreements and points of view in the interest of the organization.

Distinguished - Proactively brings concerns to his or her immediate supervisor by articulating disagreements and points of view in the interest of the organization, but once the decision is made, fully supports and effectively implements organizational policy and leadership decisions.

• Justification for Organizational Commitment.
• 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 in question 17.

• If you answered "NO" to the previous question, please explain.
• 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.

Moral turpitude is an act of baseness, vileness or depravity in the private and social duties which a person owes another member of society, or society in general, and which is contrary to the accepted rule of right and duty between persons, including but not limited to, theft, attempted theft, attempted murder, murder, rape, swindling, and indecency with a minor.

Have you ever been convicted of a felony or any offense involving moral turpitude or has any court received a plea of guilty or a plea of nolo contendere from you?

If "YES", please explain in the next question.

• If you answered "YES" to the previous question, please explain.
• 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 in question 21.

• If you answered "YES" to question 20, please explain.
• Have you ever been dismissed or asked to resign from any job? If "Yes", please explain in question 23.
• If you answered "YES" to the previous question, please explain.
• Pursuant to the provisions of W.S. 21-7-401, any person who is hired by Sublette County School District #1 is required to submit to fingerprinting and to provide such other information as is necessary to acquire a national criminal history background check.

Even though you may have submitted to a background check with PTSB, the district will require you to submit to an additional background check for the district.

Will you give the school district your consent to conduct this criminal history background check?

• Are you prevented from being lawfully employed in this country because of visa or immigration status? Proof of citizenship or immigration status will be required upon employment.
• List professional and community activities with which you participate.
• List honors you have received as a professional.
• List other honors you have received.
• List other information about yourself that you would like us to consider.

Attachments

Letter of Recommendation 1

Letter of Recommendation 2

Letter of Recommendation 3

References

Support Reference : 3 of 5 external references required.

Sublette County School District No. 1 does not discriminate on the basis of race, color, national origin, sex, age, disability, or religion in its programs or activities.

Inquiries concerning Title VI, Title IX, Section 504, and ADA may be referred to Sublette County School District No. 1, Civil Rights Coordinator, 665 N Tyler, Pinedale, Wyoming 82941, 307-367-2139, or the Office for Civil Rights, Region VIII, U.

S. Department of Education, Federal Building, Suite 310, 1244 Speer Blvd., Denver, Colorado 80204-03582, 303-844-5695 or TDD 303-844-3417, [email protected].