Work Permit Grossmont Form – Fill Out and Use This PDF

The Work Permit Grossmont form serves as a Statement of Intent to Employ Minor and a Request for a Work Permit in the Grossmont Union High School District. It is a crucial step but not itself a work permit; it requires information from the employer, student, and parent or guardian, and after being fully completed, it must be processed by the district's designated authority. For those looking to navigate the employment of minors within this district, completing and submitting this form by following the outlined steps is the first action to take.

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Work Permit Grossmont Form PDF Details

Navigating the process of obtaining a work permit for high school students in the Grossmont Union High School District (GUHSD) involves completing the "Statement of Intent to Employ Minor and Request for Work Permit" form. This crucial document is the first step toward legal employment for minors, requiring detailed inputs from both the prospective employer and the student's parent or guardian. It's important to note that this application itself is not a work permit but rather a prerequisite for obtaining one. Once fully completed, the form must be submitted to a GUHSD authority for approval, a process that typically takes 48 hours. The form requires comprehensive information, including the student's identification details, the employer’s information, and a segment for parental consent. Equally essential is the emphasis on compliance with both state and federal labor laws, which are detailed on the reverse side of the form. These laws not only outline the permissible work duties and hours for minors but also emphasize the protections in place regarding the health and education of minor employees, alongside the requirements for work permits to be kept on record for inspection. Understanding these components is vital for ensuring a smooth and lawful employment experience for minors in the district.

Question	Answer
Form Name	Work Permit Grossmont Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	permit for essential worker in virginia, essential permit word, online work permit, work permit in saudi arabia

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GROSSMONT UNION HIGH SCHOOL DISTRICT

STATEMENT OF INTENT TO EMPLOY MINOR AND REQUEST FOR WORK PERMIT

This application is NOT A WORK PERMIT—PRINT all information, except signatures where required.

This application must be signed by the employer and the student’s (minor) parent/guardian. A work permit may be issued only after this form is fully completed, then approved and verified by a designated Grossmont Union High School District (GUHSD) authority.

Deliver this completed application in person to your school site. Processing time for work permit requests is 48-hours.

For Minor to Complete Student ID # ________ School _________________ District __________________

____________________________________			_____________________________				_____________	_______ ______		______
Student’s Last Name			First Name				Date of Birth	Age	Grade	Sex
__________________________________________________________						___________________		___________
Street Address						City		Zip Code
___________________________		________________________			________________________
Social Security Number		Home Telephone #			Student Cell #


	For Employer to Complete	(Please review rules for employment of minors on the reverse.)
________________________________________________					_______	______________________________________________
Business Name					Store #	Type of Business
_____________________________________________					___________________		____________	______________________
Business Address					City		Zip Code	Supervisor Phone
_________________________________________________					____________________		______________	________________________
Work Location Address (if different from above location)				City			Zip Code	Business Phone
________________________________________________________________________							______________	____________________
Minors Work Duties (Type of Work)							Date Hired	Hourly Wage
	In the Monday-Sunday spaces below, enter the maximum number of hours that you may be employing this student.
	The maximum number of hours that a student may work, according to age, is on the reverse side of this application.
		Do not use any words, such as “varies.” If applicable, indicate zero (0).
	Mon ______ Tues______ Wed ______ Thurs______			Fri ______ Sat ______		Sun _____	Weekly Total =

In compliance with California labor laws, this employee is covered by Worker’s Compensation Insurance. This business does not unlawfully discriminate on the basis of race, ethnic background, religion, sex, color, national origin, ancestry, age, physically handicap, or medical condition. I hereby certify, to the best of my knowledge, that the information herein is correct and true.

Supervisor’s Signature		Supervisor’s Name (print or type)	Date

	For the Parent to Complete	□ Mother □ Father □ 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, the information herein is correct and true. I request that a work permit be issued for this minor.

In addition to this employer, my child is working for: ________________________________________________________________________________

Name of Business

Parent/Guardian’s SignatureParent/Guardian Name (Printed)Date

For School/Office Use Only


Sector: □ Public □ Private		Grade Level: □ High School □ Middle School
School Type: □ Traditional		□ Continuation		□ Charter		□ Alt Ed	□ Community Day □ Spec Ed □ Graduate/Prof. Exam
Permit Type: □ Regular	□ Vacation		□ Restricted		Program Type: □ Traditional			□ WEE □ ROC/P □ Independent Study
Evidence of Age: □ District Census			□ Birth Cert		□ Perm DL/ID		□ Passport □ Military ID
Career Cluster: □ Ag	□ Auto □ Bus □ Food Service					□ Home Econ □ Indus		□ Print Arts □ Public Service
Denial Date: ____________		□ Attendance		□ Grades		□ Admin	□ HRO/FLSA
Date Received: ___________		Date Issued: ___________				Signature of Verifying Authority _________________________________

Adapted from the California Department of Education Form No. B1-1 (Revised 8/24/09 WPb11v3.4)

See reverse for important information.

General Summary of Minors’ Work Regulations

If federal laws, state laws and school district policies conflict, the more restrictive law (that which is most protective of the employee) prevails.

Generally, minors must attend school until age 18 unless they are 16 years or older and have graduated from high school or received a state Certificate of Proficiency.

Employers of minors required to attend school must complete a “Statement of Intent to Employ Minor and Request for Work Permit” (form B1-1) for the school district of attendance for each such minor.

Employers must retain a “Permit to Employ and Work” (form B1- 4) for each such minor.

Work permits (B1- 4) must be retained for three years and open at all times for inspection by sanctioned authorities.

A work permit (B1- 4) must be revoked whenever the issuing authority determines the employment is illegal or is impairing the health or education of the minor.

Minors under the age of 18 may not work in occupations declared hazardous for young workers as listed below:

1.Explosives

2.Motor vehicle driving/outside helper

3.Coal mining

4.Logging and saw milling

5.Power-driven woodworking machines

6.Radiation exposure

7.Power-driven hoists/forklifts

8.Power-driven metal forming, punching, and shearing machines

9.Other mining

10.Power-driven meat slicing/processing machines

11.Power baking machines

12.Power-driven paper products/paper bailing machines

13.Manufacturing brick, tile products

14.Power saws

15.Wrecking, demolition

16.Roofing

17.Excavation operation

For more complete information about hazardous occupations, contact the U.S. Department of Labor (Child Labor Bulletins 101 and 102) and the California Department of Industrial Relations, Division of Labor

Standards Enforcement. Regional offices are located in several California cities. They are listed in the “Government Listings” sections of telephone directories.

Minors younger than 16 years are allowed to work only in limited, specified occupations, which exclude baking, manufacturing,

processing, construction, warehouse, and transportation occupations.

In addition to safety regulations, labor laws applicable to adult employees are also generally applicable to minor employees, including workers’ compensation insurance requirements.

Child labor laws do not generally apply to minors who deliver newspapers or work at odd jobs, such as yard work and baby- sitting, or in private homes where the minor is not regularly employed.

A day of rest from work is required if the total hours worked per week exceed 30 or if more than 6 hours are worked on any one- day during the week.

Hours of Work

16 – 17 When school is in session: Daily maximum 4 hours, Monday through Thursday. May work up to 8 hours on any non- school day or on any day that precedes a non-school day. May be permitted to work up to 36 hours per week.

Students in Work Experience Education or cooperative vocational education programs may be permitted to work a maximum of 8 hours on a school day.

When school not in session: May work up to 36 hours per week but no more than 8 hours in any one day.

Work must be performed no earlier than 5:00 a.m. nor later than 10:00 p.m. except that work may extend to 12:30 a.m. on nights preceding non-school days. Students in Work Experience Education or cooperative vocational education programs may be authorized to work until 12:30 a.m. on nights preceding school days with specified written permission.

14 – 15 When school is in session: Daily maximum 3 hours, Monday through Friday. On non-schooldays may work 8 hours. Weekly maximum 18 hours. Students in Work Experience Education and career exploration programs may work up to 23 hours per week.

When school not in session: May work up to 36 hours per week but nor more than 8 hours in any one day.

May not work during public school hours except students in Work Experience Education or career exploration programs. Work must be performed no earlier than 7:00 a.m. nor later than 7:00 p.m. any day of the week. From June 1 to Labor Day work hours may be extended to 9:00 p.m.

Younger than 14:		Labor laws generally prohibit non-farm
		employment of children younger than 14.
		Special rules apply to agricultural work, domestic
		work and the entertainment industry.

	MAXIMUM HOURS MINORS ARE ALLOWED TO WORK
			WHEN SCHOOL IS IN SESSION
							School VACATION /
AGE	MON-THUR		FRI	SAT	SUN		HOLIDAY Periods

Age 12-13	Employment is PROHIBITED under Federal Labor Laws
Age 12-13			(Fair Labor Standards Act)
			(Fair Labor Standards Act)
Age 14-15							8 Hrs /Max
18Hrs/Wk	3 Hrs /Max		3 Hrs /Max	8 Hrs /Max	8 Hrs /Max		7am - 7pm
Maximum	7am - 7pm		7am - 7pm	7am - 7pm	7am - 7pm		36 Hrs/Wk MAX
Age 16-17			8 Hrs/Max	8 Hrs/Max	8 Hrs/Max		8 Hrs/Max
36Hrs/Wk	4 Hrs/Max		5am -	5am -	5am -		5am - 12:30am
Maximum	5am - 10pm		12:30am	12:30am	10:00pm		36 Hrs/Wk MAX

Work Experience Work Permits: Maximum Hours Minors Enrolled In WORK
	EXPERIENCE are ALLOWED to work when school is in session
							School VACATION /
AGE	MON-THUR		FRI	SAT	SUN		HOLIDAY Periods

Age 16-17	8 Hrs/Max		8 Hrs/Max	8 Hrs/Max	8 Hrs/Max		8 Hrs /Max
36Hrs/Wk	5am –		5am -	5am -	5am –		5am –12:30am
Maximum	12:30am		12:30am	12:30am	12:30am		36 Hrs/Wk MAX
	Work Experience students may work until 12:30 a.m. on any day with approval.
Students may never work more than 8 hours on one day. Students must have at least one day per week off.
(Please Sign Below- Acknowledgment of Information Above)

Parent Signature						Date

Student Signature						Date
							REV. 8/17/10

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