Please complete the form below to confirm your status of compliance with the required “Hours of Operation”.

Today's Date

MM

DD

YYYY

Business Name

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Line

Compliance Status

If yes, do not complete the remainder of the form.

Reason(s) for non-compliance

Action(s) Taken

Please provide a list of actions taken to reach compliance

Job Posting

If non-compliance is related to hiring, have you requested that the open position be posted on the Seaport Village website?

Yes

No

Date Submitted

If yes, please provide the date the posting was submitted

MM

DD

YYYY