COURT APPOINTED COMMUNITY SERVICE APPLICATION:

Court-mandated Community Service workers who are looking to volunteer at HVCC, please contact Faith at (860) 872-7727 ext. 2923 for more information. Complete form below, or you can fill out form in house.

THIS IS FOR COURT APPOINTED COMMUNITY SERVICE ONLY!

Name *
Name
Date of Birth:
Date of Birth:
Address
Address
Phone
Phone
HOME
Phone 1
Phone 1
WORK
Phone 2
Phone 2
CELL
Emergency Contact Name:
Emergency Contact Name:
Emergency Contact:
Emergency Contact:
Parole Officer Name:
Parole Officer Name:
Parole Officer Number:
Parole Officer Number:
Start Date:
Start Date:
Deadline for Completing Hours:
Availability
How Often Per Week:
Are you employed:
If yes, Name, Address and Phone Number of Employer:
Do you have relatives currently working at HVCC:
If yes, Name of employee:
Any Past convictions for felonies and /or misdemeanors:
If yes, Give nature of offense and date:
INTERNAL USE ONLY:
JUD.
If yes state charge:
SO.
If yes state charge:
DOC,
If yes state charge:
CITRIX.
If yes state charge:
Letter of completion sent:
If no Reason why:
If yes Date of Letter and Name of person who it was sent to: