Community Service Work Declaration

508 Haigler Street Abbeville, SC 29620
Monday - Thursday: 7:30 a.m. EST - 4:30 p.m. EST
Friday: 7:30 a.m. EST - Noon
Tel: 864.366.4549
Fax: 864.366.4341

Each participating agency must complete the following information and return it to the family member who has done the community service work. The family member shall be responsible for returning this information to their Community Manager.

[{"type":"text","label":"Worker's First Name","name":"Workers-First-Name","className":"col-md-6","subtype":"text"},{"type":"text","label":"Worker's Last Name","name":"Workers-Last-Name","className":"col-md-6","subtype":"text"},{"type":"text","label":"Participating Agency Street Address","name":"Participating-Agency-Street-Address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Participating Agency City","name":"Participating-Agency-City","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Participating Agency State","name":"Participating-Agency-State","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Participating Agency Zip Code","name":"Participating-Agency-Zip-Code","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Contact Person First Name","name":"Contact-Person-First-Name","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Contact Person Last Name","name":"Contact-Person-Last-Name","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Contact Person Phone Number","name":"Contact-Person-Phone-Number","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"1. Work Performed","name":"1-Work-Performed","className":"col-md-6","subtype":"text"},{"type":"text","label":"1. Date of Work","name":"1-Date-of-Work","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"1. Hours Worked","name":"1-Hours-Worked","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"2. Work Performed","name":"2-Work-Performed","className":"col-md-6","subtype":"text"},{"type":"text","label":"2. Date of Work","name":"2-Date-of-Work","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"2. Hours Worked","name":"2-Hours-Worked","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"3. Work Performed","name":"3-Work-Performed","className":"col-md-6","subtype":"text"},{"type":"text","label":"3. Date of Work","name":"3-Date-of-Work","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"3. Hours Worked","name":"3-Hours-Worked","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"4. Work Performed","name":"4-Work-Performed","className":"col-md-6","subtype":"text"},{"type":"text","label":"4. Date of Work","name":"4-Date-of-Work","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"4. Hours Worked","name":"4-Hours-Worked","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"5. Work Performed","name":"5-Work-Performed","className":"col-md-6","subtype":"text"},{"type":"text","label":"5. Date of Work","name":"5-Date-of-Work","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"5. Hours Worked","name":"5-Hours-Worked","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"6. Work Performed","name":"6-Work-Performed","className":"col-md-6","subtype":"text"},{"type":"text","label":"6. Date of Work","name":"6-Date-of-Work","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"6. Hours Worked","name":"6-Hours-Worked","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"7. Work Performed","name":"7-Work-Performed","className":"col-md-6","subtype":"text"},{"type":"text","label":"7. Date of Work","name":"7-Date-of-Work","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"7. Hours Worked","name":"7-Hours-Worked","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"8. Work Performed","name":"8-Work-Performed","className":"col-md-6","subtype":"text"},{"type":"text","label":"8. Date of Work","name":"8-Date-of-Work","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"8. Hours Worked","name":"8-Hours-Worked","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Total Hours Worked","name":"Total-Hours-Worked","className":"d-block","subtype":"text"},{"type":"checkbox-group","label":"I hereby certify, as an authorized agent of the above listed Participating Agency, that the above information given is a true and accurate account of the dates and hours that the above named person has performed community service work for this agency. ","name":"I-hereby-certify-as-an-authorized-agent-of-the-above-listed-Agency-that-the-above-information-given-is-true-and-accurate-account-of-the-dates-and-hours-that-the-above-named-person-has-performed-community-service-work-for-this-agency","className":"d-block","values":[{"label":"I Certify","value":"I Certify"}]},{"type":"text","label":"Name (Printed)","name":"Name-Printed","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Signature","name":"Signature","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Title","name":"Title","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Date of Signature","name":"Date-of-Signature","className":"col-md-6 col-lg-3","subtype":"text"}]

Community Service Work Declaration

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