Form Dlse 277 PDF Details

In the world of entertainment, young talents brighten the screen and the stage, but their involvement in such projects is regulated to ensure their welfare, safety, and education are not compromised. This is where the DLSE-277 form, an essential document for minors looking to work in the entertainment industry in California, comes into play. Parents and guardians stepping into this journey with their child are required to navigate the procedural aspects of obtaining this work permit, which involves providing detailed information about the child, such as personal identification and school records, and adhering to specific instructions related to school attendance and health criteria. The form mandates original signatures in ink and encloses a section that must be completed by the minor's school officials, ensuring the child's academic standing and health are satisfactory for the obligations of work in entertainment. Additionally, for the youngest of stars, those 15 days through kindergarten, a birth certificate or other listed documents must accompany the application to prove age and eligibility. Aside from the bureaucratic necessity, this process underscores the importance of maintaining a balance between a child's career aspirations in the entertainment sector and their overall well-being and development.

QuestionAnswer
Form NameForm Dlse 277
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdlseform277 california dlseform277

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STATE OF CALIFORNIA

THIS IS NOT A PERMIT

Division of Labor Standards Enforcement

 

NEW (never applied before)

RENEW

Permit No. ______________

APPLICATION FOR PERMISSION TO WORK IN THE ENTERTAINMENT INDUSTRY

PROCEDURES FOR OBTAINING WORK PERMIT

1.Complete the information required below.

2.School authorities must complete the “School Record” section below for minors in grades 1 thru 12.

3.For minors 15 days through kindergarten, please attach a photo copy of minor’s birth certificate. See reverse side for other documents that may be accepted.

4.All signatures MUST be in original ink. No fax or photo copies permitted.

5.Mail or present the completed application to any office of the Division of Labor Standards Enforcement for issuance of your work permit. Work permits will be issued within 3 business days and mailed to you.

6.Please provide a preaddressed, stamped envelope so the permit can be mailed back to you.

Name of Child

Professional Name (if applicable)

AKA:

Permanent Address

Number

Street

City

State

Zip Code

Home Phone Number

School Attending

Grade

Date of Birth

Age

Height

ft. in.

Weight

lbs.

Hair Color

Eye Color

Gender

Male

Female

STATEMENT OF PARENT OR GUARDIAN: It is my desire that an Entertainment Work Permit be issued to the above named child. I will read the rules governing such employment and will cooperate to the best of my ability in safeguarding his or her educational, moral and physical interest. I hereby certify, under penalty of perjury, that the foregoing statements are true and correct.

By submitting personal information about yourself and your minor child to DLSE in order to obtain an entertainment work permit for your child, you consent to DLSE’s use of that personal information for purposes authorized by Labor Code § 1308.5 and 1308.10, which provide for the issuance of such permits. Note that DLSE’s use of such personal information includes the disclosure of information about you and your minor child to third parties who want to verify a work permit.

Name of Parent or Guardian (print or type)

Signature

Daytime Phone Number

SCHOOL RECORD

Circle whether “SATISFACTORY” or “UNSATISFACTORY” for each

Attendance

Academics (Grades)

Health – Please indicate if the minor requires

 

 

 

medical approval to obtain a permit

SATISFACTORY / UNSATISFACTORY

SATISFACTORY / UNSATISFACTORY

SATISFACTORY / NEEDS MEDICAL APPROVAL

I CERTIFY THAT THE ABOVE-NAMED MINOR:

 

 

 

 

Meets the school district’s requirements with respect to age, school record, attendance and health.

 

 

Does not meet the district’s requirements and permit should not be issued.

 

 

 

 

 

 

 

Authorized School Official, Signature and Title

 

Date

 

 

 

 

 

 

 

School Address

 

School Phone Number

 

 

 

 

 

 

[School Seal, Stamp, Address Stamp or

 

 

 

 

Signed Letterhead] REQUIRED

 

HEALTH RECORD

 

 

Complete this Section if instructed to do so or if infant is under One Month of Age

Name of Doctor

Address

Phone Number

I certify that I am a licensed physician and surgeon who is Board Certified in pediatrics , and have carefully examined ___________________________

In my opinion, (please circle)

he / she

is / is not

than one month, infant is

/ is not at least 15 days old,

.

 

 

physically fit to be employed in the production of motion pictures and television. If less was / was not carried to full term, and is / is not physically able to perform.

Signature ____________________________________________________ M.D. Date ________________________

Remarks

*PLEASE USE DOCTOR’S OFFICE STAMP ON APPLICATION TO ENSURE AUTHENTICITY.*

DLSE- 277 (Rev. 03/12)

Application for Permission to Work in Entertainment Industry English

Information covering California’s child labor laws applicable to the entertainment industry can be found at http://www.dir.ca.gov/dlse/DLSE-CL.htm.

PROCEDURE FOR OBTAINING AN “ENTERTAINMENT PERMIT”

NEW

 

 

1.)

Application Form

Obtain from any of the Division of Labor Standards Enforcement offices or

 

 

from the website:

www.dir.ca.gov/dlse/DLSEform277.pdf

2.)

Parent/Guardian

Complete all requested information on the front of the application.

 

 

Please print and sign your name in original ink.

3.)

School Record Information

To be completely filled out by authorized school official in original ink for

 

 

minors in grades 1 thru 12.

A PREADDRESSED, STAMPED ENVELOPE MUST ACCOMPANY THE APPLICATION

REQUIREMENTS FOR NON-SCHOOL AGE CHILDREN (15 days through kindergarten)

A PHOTO COPY OF ONE OF THE FOLLOWING:

1.) Certified Birth Certificate

2.) Baptismal Certificate

3.) Official letter from hospital where born

4.) Passport

Every infant under one month of age must have a certification from a licensed physician and surgeon who is Board Certified in pediatrics certifying that the infant is at least 15 days old, was carried to full term, and is physically able to endure the stresses of a television or movie set.

REQUIREMENTS FOR SCHOOL AGE CHILDREN (Grades 1 through 12)

PUBLIC / PRIVATE SCHOOL, ON-LINE / VIRTUAL ACADEMY AND OUT OF STATE RESIDENTS:

When school is IN session, the application must be completed and dated during the current school session by an authorized school official.

When school is NOT in session (i.e., school break, vacations, holidays), either the minor’s recent report card or letter from the school principal on school letterhead indicating that the minor is “satisfactory” in all academic subjects, health and attendance is required.

HOMESCHOOLED:

If minor is homeschooled, the application must be completed by the parent/guardian and attached to either a current private school affidavit, or written verification indicating that the minor is “satisfactory” in all academic subjects, health and attendance from either the local school district, county office of education or state board of education where the minor lives.

RENEWAL

1.) Complete application form (all questions)

2.) Send a copy of the old permit with the application.

3.) Enclose a self addressed, stamped envelope for return.

4.) If school is not in session, see above instructions.

5.) If school is in session, have school official complete and sign the “school record” section of the application form for minors in grades 1 through 12.

THERE IS NO FEE

SOCIAL SECURITY NUMBER IS NOT REQUIRED

APPLICATION CANNOT BE PROCESSED VIA FAX

DEPARTMENT OF INDUSTRIAL RELATIONS

Division of Labor Standards Enforcement

DLSE- 277 (Rev. 03/12)

Application for Permission to Work in Entertainment Industry

 

English

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Step # 1 of filling in Form Dlse 277

2. Once your current task is complete, take the next step – fill out all of these fields - STATEMENT OF PARENT OR GUARDIAN It, Name of Parent or Guardian print, Signature, Daytime Phone Number, Circle whether SATISFACTORY or, SCHOOL RECORD, Attendance, SATISFACTORY UNSATISFACTORY I, Academics Grades, SATISFACTORY UNSATISFACTORY, Health Please indicate if the, Meets the school districts, Authorized School Official, School Address, and Date School Phone Number with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Meets the school districts, Attendance, and Circle whether SATISFACTORY or of Form Dlse 277

It is easy to get it wrong while completing the Meets the school districts, so make sure you take another look before you send it in.

3. This step is going to be straightforward - fill in all of the form fields in Information covering Californias, PROCEDURE FOR OBTAINING AN, NEW Application Form, Obtain from any of the Division of, wwwdircagovdlseDLSEformpdf, REQUIREMENTS FOR NONSCHOOL AGE, A PHOTO COPY OF ONE OF THE, and Certified Birth Certificate in order to complete this part.

Form Dlse 277 writing process outlined (part 3)

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