COMMUNITY SERVICE APPLICATION

RULES FOR COMMUNITY SERVICE

Community Service hours are Monday thru Friday 9am-4pm and Saturday 9:30am-12pm unless otherwise approved. You are expected to show up on time and stay the full time unless you have been approved to leave early by CSI staff. You are expected to work at least twice a month. Please do not return to your vehicle until you sign out. Parking is in the paved parking lot to the south of our building.
Saturday Community Service must be scheduled in advance. Call the office Monday thru Friday 9am-4pm to be approved to work on Saturday. You are expected to show up on time and stay from 9:30am-12pm. If you are unable to work the scheduled time, you must notify our office so that we may schedule someone else in your place. Failure to do so may result in not allowing you to work on Saturday.
If you are scheduled and unable to work, please call the CSI office as soon as possible. Failure to contact the CSI for a period of 15 consecutive days could result in dismissal.
Please be sure you record your hours in the time log before your departure each day. Sign in when you arrive and sign out when you leave. Failure to do so could result in a loss of time for that day.
Please come dressed appropriately to work. Preferred dress is shirt, jeans or slacks, and tennis shoes or comfortable work shoes. Please no tank tops, sleeveless, see-thru, or midriff shirts. No shorts, torn pants, overly baggy or sagging pants, or overly tight clothing. No open-toed shoes (flip flops or sandals). No bandannas or caps. No clothing advertising alcohol, tobacco, or bars. No visible earrings (males), nose rings or any other body piercings.
There will be no use or possession of drugs, alcohol, weapons, or pornographic material on CSI property. Horseplay, immoral attitudes or practices, and profanity will not be tolerated.
No shopping is allowed in B&B while you are completing your Community Service hours. Please DO NOT ask staff to hold items for you.
NO SMOKING OR TOBACCO USE IS ALLOWED AT ANY TIME ON CSI PROPERTY.
No phone calls except for emergencies. If you must bring your cellphone, please keep it off while you are here working.
Respect will be shown to everyone at all times. This includes following your supervisors' directions on each work detail, etc.
You are not to offer rides, give money, clothing, books, tapes, or any other items of any kind, place phone calls, relay messages, nor engage in any personal conversations or note exchanging with Liberty Ministries students. Violation of this rule WILL result in termination of your community service with loss of any/all hours completed.
CSI staff should be notified immediately if you are approached by anyone seeking, money, jobs, etc.
Community service workers are responsible for delivering their completed paperwork to the appropriate court or caseworker.
ALL minors must be accompanied by a parent or guardian when signing up for Community Service.

COMMUNITY SERVICE WORK RECORD

BASIC INFORMATION

First Name

Last Name

Last 4 Digits of SSN#

Birthday

Address

City

State

Zip Code

Phone

REASON FOR YOUR COMMUNITY SERVICE: (circle correct agency or organization)

Name of agency we report hours to

Name of person we report hours to

Phone number of person we report hours to

Hours required

Date to be completed

Emergency Contact

Emergency Contact's relation to you

Emergency Contact phone number

ARE YOU A MINOR (17 years old or under)

Yes

ARE YOU ATTENDING WITH YOUR PARENT(S) OR GUARDIAN(S)

Yes

Medical Condition(s)

Any Med(s)

NOTES

GENERAL RELEASE
(CHRISTIAN SERVICES, INC. OF AMERICA)

AND FOR SAID CONSIDERATION, the undersigned jointly and severally hereby forever release, discharge, acquit, and forgive CHRISTIAN SERVICES, INC. of AMERICA, from any and all claims, actions, suits, demands and/or agreements, and each of them, if more than one, and liabilities, judgment, and proceedings both at law and in equity arising from the beginning of time to the date these presents.
This release in general, full and complete and shall be binding upon and inure to the benefit of the parties, their successors, assigns and personal representatives.

Date

Signed on today's date

SECTION FOR MINORS ONLY (17 years old or under)

Minor's Name

Parent's Name

Minor's Phone

Parent's Phone

SECTION FOR ADULTS ONLY (18 years old or older)

Releaser's Name

Releaser's Phone

SIGNATURE

I AGREE TO AND WILL ADHERE TO THE ABOVE RULES. I UNDERSTAND THAT BREAKING ANY OF THE ABOVE RULES MAY BE GROUNDS FOR DISMISSAL, WITH LOSS OF ALL TIME COMPLETED.

Signature

Date

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