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Get and Sign Work Permit California 2013-2022 Form
Information)
Minor’s Information
Minor’s Name (First and Last)
Home Phone
Birth Date
Social Security Number
Grade
Home Address
Age
City
Zip Code
School Information
Kings Christian High School
(559) 924-8301
School Name
School Phone
900 East D Street
Lemoore
93245
School Address
City
Zip Code
To be filled in and signed by employer. (Please review the General Summary of Minors’ Work Regulations on reverse)
Business Name or Agency of Placement
Supervisor’s Name
Business...
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