Extended Hours Program Application Email:office@extendedhoursprogram.com Phone:970-241-3603

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? *


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.


Days Available *
Shift availability:
AM - 6:10-8:45am
PM (M-TH) 3:30-6:15
PM(Fri) 1:30 - 6:15
Full Day Shifts on non-school days: 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?


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. *
Powered byFormsite