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Application For Work Permit

This document is an application for a work permit. It requests information such as the applicant's name, sex, hair and eye color, date and place of birth, school district, and place of residence. It also requires evidence of the applicant's age to be submitted, such as a birth certificate, baptismal certificate, passport, or affidavit from a parent or guardian. The application must be signed by a parent, guardian or legal custodian unless the applicant has graduated high school, in which case proof of graduation must be attached.

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Eca Mahendra
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147 views1 page

Application For Work Permit

This document is an application for a work permit. It requests information such as the applicant's name, sex, hair and eye color, date and place of birth, school district, and place of residence. It also requires evidence of the applicant's age to be submitted, such as a birth certificate, baptismal certificate, passport, or affidavit from a parent or guardian. The application must be signed by a parent, guardian or legal custodian unless the applicant has graduated high school, in which case proof of graduation must be attached.

Uploaded by

Eca Mahendra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPLICATION FOR WORK PERMIT Date of application ______________________________________

Certificate/Permit number ________________________________


PDE‐4565 (1/13) Date issued _____________________________________________

A. To be completed by the applicant


Name of minor Sex_____________________________ Signature of issuing officer
Color of hair _____________________
Color of eyes ____________________
Any physical work restrictions School district ‐ name and address

Place of residence Place of birth

Date of birth Evidence of age accepted and filed. Evidence shall be required in the order designated. Check the accepted evidence.
Month Day Year a. Transcript of birth certificate b. Baptismal certificate or transcript c. Passport
d. Other documentary evidence e. Affidavit of parent or guardian accompanied by
physician's statement of opinion as to the age of the minor
B. To be completed by parent or guardian, unless minor is a high school graduate (please attach proof of graduation)
Signature of parent, guardian or legal custodian* Name and address of parent, guardian or legal custodian

Ministry of Business, Innovation & Employment ‐ Department of Education

*In lieu of signature under clause (B), the applicant may execute a statement before a notary public or other person authorized
to administer oaths attesting to the accuracy of the facts set forth in the application on a form prescribed by the department.
The statement shall be attached to the application.

NZ17
NEW ZEALAND IMMIGRATION
NEW ZEALAND

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