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Community Service Verification
Form
1. Worker’s Name:
2. Supervisor’s Name:
3. Description of Duties
Performed:
Date Worked
Hours Worked
Supervisor’s
Name
Supervisor
’s
Signature
Boynton Beach Community Church
9515 Boynton Beach Blvd., Boynton Beach, FL 33472
www.bbcconline.com + Office: (561) 733-‐9400