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Get CA CDE B1-4 2010

STATE OF CALIFORNIA DEPARTMENT OF EDUCATION PERMIT TO EMPLOY AND WORK CDE B1-4 REV. 03-10 A work permit shall not be issued to a minor until the Statement of Intent to Employ Minor and Request for Work Permit CDE 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 Non full-time work permits shall expire five days after the opening of the next succeeding school year. Full-time work permits shall expire no later than the end of the current school year. EC 49118 49130 Date Check Permit Type 1. Full-time 2. Work Experience Education Vocational Personal Attendant Workability Restricted Minor s Information Minor s Name Print First and Last Social Security Number Home Phone Age at Time of Issuance Birth Date City Zip Code Home Address School Information School Name School Phone School Address Maximum Work Hours Permitted 1. Total number of work hours on a school day Remarks or Work Limitations This permit is valid only at the business listed below Business Name To be signed by minor Minor s Signature Certification I hereby certify that to the best of my knowledge the information herein is correct and true. California* EC 49110 Issuing Authority s Name and Title Print Copy District or County Superintendent Parent or Legal Guardian Employer. California Education Code EC 49110 c Print Information Permit Expiration Date Non full-time work permits shall expire five days after the opening of the next succeeding school year. Full-time work permits shall expire no later than the end of the current school year. EC 49118 49130 Date Check Permit Type 1. Full-time work permits shall expire no later than the end of the current school year. EC 49118 49130 Date Check Permit Type 1. Full-time 2. Work Experience Education Vocational Personal Attendant Workability Restricted Minor s Information Minor s Name Print First and Last Social Security Number Home Phone Age at Time of Issuance Birth Date City Zip Code Home Address School Information School Name School Phone School Address Maximum Work Hours Permitted 1. Full-time 2. Work Experience Education Vocational Personal Attendant Workability Restricted Minor s Information Minor s Name Print First and Last Social Security Number Home Phone Age at Time of Issuance Birth Date City Zip Code Home Address School Information School Name School Phone School Address Maximum Work Hours Permitted 1. Total number of work hours on a school day Remarks or Work Limitations This permit is valid only at the business listed below Business Name To be signed by minor Minor s Signature Certification I hereby certify that to the best of my knowledge the information herein is correct and true. Total number of work hours on a school day Remarks or Work Limitations This permit is valid only at the business listed below Business Name To be signed by minor Minor s Signature Certification I hereby certify that to the best of my knowledge the information herein is correct and true. California* EC 49110 Issuing Authority s Name and Title Print Copy District or County Superintendent Parent or Legal Guardian Employer. .

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