Extended Hours Program Application Email:office@extendedhoursprogram.com Phone:970-241-3606

Personal Information

What position are you applying for? *

Are you currently CPR/1st Aid Certified? *

Are you legally authorized to work in the United States? *
Have you ever been convicted of a felony? *

Education

Did you Graduate?
Did you Graduate?
What year are you?
If you are currently attending college, please indicate if your residence is on campus or off campus.


Availability

Days Available *
Shift availability: AM - 6:15-8:45, PM (M-R) 3:30-6:15, PM (Fri) 1:30 - 6:15, Full Day Ex. 6:15-1:00pm or 1-6:15pm *

Employment History

Employer 1
 +
 +
May we contact? *
 
 
 
Employer 2
 +
 +
May we contact? *
 
 
 
Employer 3
 +
 +
May we contact? *

References

Reference 1

 
 
Reference 2

 
 
Reference 3

Additional Skills



I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. *
clear
Powered byFormsite