Fillable Adjunct Professional Application 2 (Eastern Wyoming College)

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Adjunct Professional Application 2 (Eastern Wyoming College)

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Eastern Wyoming College APPLICATION FOR EMPLOYMENT
3200 WEST C STREET TORRINGTON, WY 82240 ADJUNCT PROFESSIONAL
(307) 532-8200 FAX (307) 532-8329
Eastern Wyoming College is committed to providing equal opportunity for access to and participation in college programs of
instruction, services, and activities. It is the policy of the college to neither favor nor disfavor any individual on the basis of race,
color, creed, religion, sex, disability, or national origin. The college is subject to and complies with the regulations of Title VII of the
Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973 and
Americans with Disabilities Act. Inquiries regarding compliance may be directed to the Director of Human Resources, Eastern
Wyoming College, Torrington, WY, 82240 or phone (307) 532-8330, or the Wyoming Department of Education, Office for Civil
Rights Coordinator, 2nd Floor, Hathaway Building, Cheyenne, WY 82002-0050, or (307) 777-6218.
P
ERSONAL DATA
Name ________________________________________________________________________________________________
(Last) (First) (Initial) (Maiden)
Address ________________________________________________________________________________________________
(Street) (City) (State) (Zip)
Telephone Number ____________________________________________________________________________
(Home) (Work)
Have you ever been convicted of a misdemeanor or felony? _________
Explain: ___________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
EDUCATIONAL BACKGROUND (Submit copies of college transcript(s) with the application form)
College or University Attendance
Name of Institution City and State From – To Degree Received
COURSES REQUESTING TO TEACH (If Applicable, List EWC Locat
ion, Dept., Course Number and Course Title)
TEACHING EXPERIENCE AND WORK EXPERIENCE
(List in chronological order beginning with the most recent experience)
Name of Employer & Previous Supervisor Duties Dates
REFERENCES
List three former
supervisors who we may contact. Other references may include those who are not related to you and who have
definite knowledge of your qualifications and fitness for the position for which you are applying and whom we may contact.
________________________________________________________________________________________________________
MISCELLANEOUS
List below any of your outside interests, skills, and/or activities that you feel will support your application to teach the
specific courses which you requested to teach.
________________________________________________________________
Applicant’s Signature Date
(Return completed application to the Director of Human Resources)
◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊◊
(For Office Use Only)
INTERVIEWER’S COMMENTS
________________________________________________________
Interviewer’s Signature Date
APPROVED T
O TEACH – Division/Department Chair –
Revised 3/1/14
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Adjunct Professional Application 2 (Eastern Wyoming College)

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Completed 24 July 2020

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