Community Service Registration

Court Services Community Service Registration

Step 1 of 6

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Name*
First Middle Last
Case Worker*
Date of Birth*
MM
DD
YYYY
Address*
Street Address City State ZIP
Cell Phone*
Work Phone
Email
Probation/Parole Officer Name*
Discharge Date

Employment
Are you employed?*
- Yes
- No
How long have you been employed?
Type
- Full Time
- Part Time
Present Employer Name
Position or Type of Work*
Current Work Schedule
List your normal work hours for each day of the week.
MON TUES WED THUR FRI SAT SUN

Education
Level of Education
- GED
- Some High School
- High School Graduate
- Some College
- College Graduate
- Post Graduate
Are you currently attending school?
- Yes
- No
Name of School Currently Attending
Field of Study
Current School Schedule
List your normal school hours for each day of the week.
MON TUES WED THUR FRI SAT SUN

Availability
Best Times and Days to do Community Service*
Enter hours you are available.
MON TUES WED THUR FRI SAT SUN

In Case of Emergency
Emergency Contact Name*
Emergency Contact Phone*
Relation to Emergency Contact*

Work Assignment Questionnaire
The type of community service work assignment will depend on many factors. To help us find the most suitable community service site for you, please complete the following.
Number of Hours to be Completed*
Have you done community service before?*
- Yes
- No
Did you finish the hours?
- Yes
- No
Where were you assigned?
Do you already know of an organization where you would like to be assigned?
- Yes
- No
Which organization?
Which is most important in choosing a work site?
- Location
- Schedule
- Type of Work
Do you have any medically documented physical limitations, restrictions or conditions that would interfere with your ability to do the Community Service hours?*
- Yes
- No
Describe*
How will you get to Community Service?*
- Own Vehicle
- Ride
- Bike
- Bus
- Walk
For which offense were you ordered to do Community Service, please give details of the offense:*
Have you had any prior convictions?*
- Yes
- No
List criminal history below:
List any misdemeanor convictions with dates below:
List any felony convictions with dates below:
I am experienced in the following areas:
Check as many as you wish.
- Janitorial
- Maintenance
- Construction
- Painting
- Carpentry
- Filing
- Typing
- Sales
- Food Services
- Computers
Other experience, training, or certification:
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Name
This field is for validation purposes and should be left unchanged.