Public Land Corps Participant Work Hours Verification

Public Lands Corps Participant Work Hours Verification
Participant Name: _______________________________ Last Four SSN: ________________________________
Primary Organization: _______________________________ Address: ________________________________
Phone Number: _______________________________ ________________________________
Start and End Dates of Project |Organization |Organization Phone Number |PLC?
Yes/No |Location of Project |Project Type |Project Duties |Performance Satisfactory?
Yes/No (notes) |Total Hours |Supervisor’s Signature | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
I certify that these hours accurately represent the work I I certify that these hours accurately represent the work the participant
conducted on the listed projects. conducted on the listed projects
Participant Signature Date Certifier Signature Date
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