Fillable Date PERMIT TO EMPLOY AND WORK CDE Form (California)

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Date PERMIT TO EMPLOY AND WORK CDE Form (California)

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The Date PERMIT TO EMPLOY AND WORK CDE Form (California) form is 1 page long and contains:

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  • 31 other fields

Country of origin: US
File type: PDF

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Full-time
STATE OF CALIFORNIA DEPARTMENT OF EDUCATION
PERMIT TO EMPLOY AND WORK CDE Form B1-4 (REV. 02-14)
A work permit shall not be issued to a minor until the “STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST FOR
A WORK PERMIT–CERTIFICATE OF AGE” (CDE Form B1-1) form has been signed by the parent or guardian, foster parent,
caregiver, or residential shelter service provider and filed with the issuing authority. California Education Code (EC) 49110(c)
(Print Information)
Permit Expiration Date
Work permits shall expire five days after the opening of the next
succeeding school year. Full-time exempt work permits issued to 14
& 15 year olds shall expire no later than the end of the current school
year. EC 49118 and 49130
Date
Check Permit Type:
Workability
Restricted
General
Work Experience Education,
Vo
cational Cooperative
Education, or Personal Attendant
Minor’s Information
Minor’s Name (Print First and Last)
Home Phone
Birth Date
Home Address
School Information
City
Zip Code
School Name
School Phone
School Address City Zip Code
Maximum Work Hours Permitted
1. Maximum number of work hours on a school day
2. Maximum number of work hours on a non-school day
3. Maximum weekly work hours while school is in session
4. Maximum weekly work hours while school is not in session
Remarks or Work Limitations:
This permit is valid only at the business listed below:
Business Name
Business Address
To be signed by minor
Minor’s Signature
Date
Certification
I hereby certify that, to the best of my knowledge, the information herein is correct and true. I hereby certify that I have a working
knowledge of child labor laws and all laws pertaining to the issuance of work permits in California. EC 49110
Issuing Authority’s Name and Title (Print) Issuing Authority’s Signature Date
Copy–District or County Superintendent; Parent or Legal Guardian; Employer
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Date PERMIT TO EMPLOY AND WORK CDE Form (California)

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Completed 1 April 2021

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