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Application for Work Permit
to be completed by parent, guardian or legal custodian
(Please note: the minimum age to obtain a work permit is 14)
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* Indicates required question
Is this a duplicate request? (Has your student been issued a work permit from SCASD previously?)
*
Yes
No
Name of Minor
*
Your answer
SCASD student number (If not SCASD student, indicate current school)
*
Your answer
Sex
*
Male
Female
Prefer not to say
Color of Hair
*
Your answer
Color of Eyes
*
Your answer
Minor's Address ( Street, City, State & Zip Code)
*
Your answer
Student's PLACE OF BIRTH (City, State, and Country)
*
Your answer
Any Physical Work Restrictions (If yes, please explain)
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
I, the parent, guardian or legal custodian of the above named minor, request the issuance of an employment certificate. (Type name and address of parent, guardian, or legal custodian below)
*
Your answer
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