Community Service Application
This application is for individuals who need court ordered community service. Filling out this application does not guarantee that you will be able to complete your community service hours at HHHS. A form of identification will also be required if you are moved forward with community service.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Home Phone
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Have you ever been charged with animal cruelty or neglect?
Yes
No
How many hours need to be completed?
When do the hours need to be completed by?
-
Month
-
Day
Year
Date
Additional questions or comments
Submit
Should be Empty: