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BROWN COUNTY PROBATION DEPARTMENT Courthouse, First Floor P.O. Box 85 Nashville, IN 47448 (812) 988-5505 Fax (812) 988-5506 COMMUNITY SERVICE PROGRAM Probationer's instructions: This form is to be presented to the supervisor on the first scheduled workday. The supervisor will record and evaluate your work and will return this form to the Probation Department. You are expected to report to work and be dressed appropriately. Name: No.: Charge: Number of hours assigned: Date to be completed: Agency WORK SCHEDULE: Date Time/Hours completed Verification of completion Probationer's attitude: ___Poor ___Fair ___Good ___Excellent Quality of work: ___Poor ___Fair ___Good ___Excellent Supervisor’s Name (Print): Phone: Supervisor's signature: Date: Please return immediately following completion of work or when deadline has expired to: Probation Officer’s Name: BROWN COUNTY PROBATION DEPARTMENT P.O. BOX 85 NASHVILLE, IN 47448 (812) 988-5505 Fax (812) 988-5506 [EMAIL REDACTED]