ࡱ> c jbjbj ?WbWb xxxxx8H$<tl888{`lT;V;V;V;V;V;V;$=;@ z;Qx{{z;xx8;###Fx8xT;#T;##5 78h#9F 6@;;0<46GBGB( 7 7GBx47 Lg6#,*z;z;]!<GBB >: 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 PermitCertificate of age (CDE From 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 49130Check Permit Type:  FORMCHECKBOX  Full-time  FORMCHECKBOX  Workability  FORMCHECKBOX  Restricted  FORMCHECKBOX  General   FORMCHECKBOX  Work Experience Education, Vocational Cooperative Education, or Personal Attendant Date Minors Information FORMTEXT       FORMTEXT      Minor s Name (Print First and Last)Social Security Number FORMTEXT       FORMTEXT       FORMTEXT      Home PhoneAge at Time of Issuance Birth Date FORMTEXT       FORMTEXT       FORMTEXT      Home AddressCityZip CodeSchool Information FORMTEXT       FORMTEXT      School NameSchool Phone FORMTEXT       FORMTEXT       FORMTEXT      School AddressCityZip CodeMaximum Work Hours Permitted Maximum number of work hours on a school day FORMTEXT      Maximum number of work hours on a non-school day  FORMTEXT      Maximum weekly work hours while school is in session FORMTEXT      Maximum weekly work hours while school is not in session FORMTEXT       Remarks or Work Limitations: FORMTEXT       FORMTEXT       FORMTEXT      This permit is valid only at the business listed below:  FORMTEXT       FORMTEXT      Business NameBusiness A+,EFJOZ\^_`cο೤ueuuXuKhh0F;CJOJQJaJhc2;CJOJQJaJhW/Nh);CJOJQJaJhW/NhD{;CJOJQJaJhW/Nh:;CJOJQJaJhT~h]OCJOJQJaJhT~hLCJOJQJaJh*CJOJQJaJh*5;CJOJQJaJ"hT~h*5;CJOJQJaJhT~h*CJOJQJaJhT~h*;CJOJQJaJ,c  " ? 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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. 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N^2!xx BPermit to Employ and Work - Work Experience (CA Dept of Education)The permit to employ and work form must be completed and signed by appropriate persons before a minor can obtain an approved work permit. Work Permit AdministratorMansingh, Paul(       Oh+'0Lx     ,4<DDPermit to Employ and Work - Work Experience (CA Dept of Education)The permit to employ and work form must be completed and signed by appropriate persons before a minor can obtain an approved work permit.Administrator Work Permit Normal.dotmMansingh, Paul2Microsoft Office Word@F#@4D6E@^(#@^(#o, ՜.+,0D hp  #Calif. 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