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Last name

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Phone

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Email address

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Questionnaire

By typing your full name, you are acknowledging to the terms and conditions of York Habitat's Court Ordered Community Service Policy.

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The number of hours to be completed:

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The date hours are due:

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Reason for court ordered community service

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Have you ever been convicted for theft?

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Have you ever been convicted of a sexual offense?

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Are you a registered sex offender?

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Have you ever been convicted of a violent offense?

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If you answered "yes" to the previous question, please explain:

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Please share the name and contact information of your Probation Officer:

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Is there any other information you would like to share?

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