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

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

What position are you applying for? *

Program Aid - At least 16 years of age. Prior experience appreciated but not required.

Program Leader - At least 18 years of age. Minimum of 460 hours in a formal childcare or school age setting. Letter of experience required.

Site Director- At least 21 years of age. Either 2 year college training with a minimum of 910 hours in a formal childcare or school age setting, or 4 year degree in a major such as; recreation, education, or subject in human service field. Letter of experience required.

What starting wage are you hoping to earn? *

Letter of Experience: Will need to be obtained from previous employer. Should include; Letter head of facility where experience was obtained, name of employee, name of facility, position title, total hours, specific age groups you worked with.

Examples of qualifying experience are coaching with children 5-12 years of age, volunteer hours or employment with a professional program that involves school-aged children.

Are you currently CPR/1st Aid Certified? *

Yes

If yes, please upload a copy of your CPR/1st Aid Certificate

Are you legally authorized to work in the United States? *

Yes

If no, please explain.

Education

High School:

Did you Graduate?

Yes

College:

Did you Graduate?

Yes

Currently Enrolled

Major:

What year are you?

Freshman

Sophomore

Junior

Senior

If you are currently attending college, please indicate if your residence is on campus or off campus.

On campus

Off campus

Current Transcripts

Diploma- High School or College

Availability

Additional schedule notes

Employment History

Employer 1

Company Name

Address

Phone

Start Date +

End Date +

Position

Supervisor/Manager

Reason for Leaving

May we contact?

Yes

Phone Number

Employer 2

Company Name

Address

Phone

Start Date +

End Date +

Position

Supervisor/Manager

Reason for Leaving

May we contact?

Yes

Phone Number

Employer 3

Company Name

Address

Phone

Start Date +

End Date +

Position

Supervisor/Manager

Reason for Leaving

May we contact?

Yes

Phone Number

References

Were you recommended to apply to this job? If so, who recommended you? *

Reference 1

Name

Title

Email Address

Phone

Reference Letter

Reference 2

Name

Title

Email Address

Phone

Reference Letter

Reference 3

Name

Title

Email Address

Phone

Reference Letter

Additional Skills

List any additional skills that you would like to mention.

Can you speak fluently in a language other than English? If so, what language?

Please submit a copy of your resume.

Cover Letter

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. *

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