STATE OF CALIFORNIA DEPARTMENT OF EDUCATION
A “STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST FOR A WORK PERMIT–CERTIFICATE OF AGE” form (CDE Form B1-1) shall be completed in accordance with
Request for Work Permit - Work Experience (CA Dept of Education)
A “STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST FOR WORK PERMIT–CERTIFICATE OF AGE” form. (CDE B1-1) shall be completed in accordance with California
Request for Work Permit - Work Experience (CA Dept of Education)
STATE OF CALIFORNIA DEPARTMENT OF EDUCATION. STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST FOR A WORK PERMIT–CERTIFICATE OF AGE. CDE Form B1-1 (Rev.
IMM 5488 E : DOCUMENT CHECKLIST FOR A WORK PERMIT
FOR A WORK PERMIT (APPLIED OUTSIDE CANADA). IMM 5488 (02-2022) E. This document checklist is one of the forms that you need to submit with your application.
PERMIT TO EMPLOY AND WORK
STATE OF CALIFORNIA DEPARTMENT OF EDUCATION A work permit shall not be issued to a minor until the “STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST ...
Application with School Record DLSE277A
To make a request to access such records please contact the Entertainment Work Permit Unit by email EWP@dir.ca.gov or telephone. 818-901-5484. WATERMARK-277-A.
child labor laws 2 0 1 3
Emancipated minors are subject to all California's child labor laws except that they may apply for a work permit without their parents' permission. [FC 7050] (
Junior Permit Statement of Facts
CURRENT CA ID NUMBER. SECTION 2 — REASON(S) JUNIOR PERMIT REQUIRED. CHECK ALL THAT APPLY. I. Family Illness. II. School. III. To and From Work.
Work Permits During 2020-2021 The Santa Barbara Unified School
permit applications from scanned or e-signed documents at this time?. Additionally by law
State of Michigan Combined Offer of Employment and Work Permit
CA-7 for minors 16 and 17 years of age. Employer Information: • The employer must have a completed work permit form on file before a minor begins work.
General
STATE OF CALIFORNIA DEPARTMENT OF EDUCATION
STATEMENT OF INTENT TO EMPLOY
AMINOR AND REQUEST FOR
AWORK PERMIT
CERTIFICATE OF AGE CDE Form B1-1 (Rev. 02-14)
A "STATEMENT OF INTENT
TO EMPLOY A MINOR AND REQUEST FOR
AWORK PERMIT
CERTIFICATE OF AGE
form ( CDE Form B11) shall be completed in accordance with California
Education Code
49162 and 49163 as notification of intent to
employ a minor. This form is also a Certificate of Age pursuant to CaliforniaEducation Code
49114.
(Print Information)Minor's Information
Minor's Name (First and Last) Home Phone Grade
Home Address City Zip Code
Birth Date
School Information
Social Security Number
Age Student's Signature
School Name School Phone
School Address City Zip Code
To be filled in and signed by parent or legal guardian This minor is being employed at the place of work described with my full knowledge and consent.I hereby certify that to the best of
my knowledge and belief, the information herein is correct and true. Parent's Name (Print First and Last) Parent's Signature Date
To be filled in and signed by employer
Business Name or Agency of
Placement
Business Phone Supervisor's Name
Business Address
City Zip Code
Employer"s Maximum Expected Work Hours: _________ hours per day ________ hours per weekDescribe nature of work to be performed:
In compliance with California labor laws, this employee is covered by workers compensation insurance. T his business does notdiscriminate unlawfully on the basis of race, ethnic background, religion, sex, sexual orientation, color, national origin, ancestry, age,
physical handicap, or medical condition. I hereby certify that, to the best of my knowledge, the information herein is correct and true. Employer's Name (Print First and Last) Employer's Signature DateFor authorized work permit issuer use ONLY
Maximum number of work hours when school is in session:Mon Tues Wed Thur Fri Sat Sun Total
Proof of Minor's
A ge (Evidence TypeVerifying Authority's Name and Title
(Print)Verifying Authority's Signature
Maximum number of work hours when school is not in session:Mon Tues Wed Thur Fri Sat Sun Total
Check Permit Type:
Full timeRestricted
Work Experience
Education, Vocational
Education, or Personal
Attendant
Workability
For more information about child labor laws, contact the U.S. Department of Labor at http://www.dol.gov/, and the State of
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