Fill and Sign the Public Housekeeping Industry California Department of Form

Basic form © James R. McDade (ver: 04-23-04) 209-667-2300 ON-DUTY MEAL PERIOD AGREEMENT(Pursuant to Section 11 of the California Wage Orders) Note: Employers use this form if the employee cannot leave the premises during lunch breaks because of the nature of the employee’s work. By entering into this Agreement, the one hour penalty for not having a duty-free lunch break does not need to be paid. Seek legal counsel if you do not know the wage and hour rules. (Delete this note prior to use.)On-Duty Meal Break: Because the undersigned Employee [describe reason a duty-free meal break cannot be given, such as> is the only employee present at the store during meal and rest breaks and cannot leave the premises,] the Employee and the Company agree that the nature of the Employee's work prevents the Employee from being relieved of all duties during the Employee's meal break. Therefore, the Employee hereby agrees that he or she will take a paid on-duty meal period. To the extent possible, the Employee should rest and eat for up to thirty minutes as required by the applicable California Wage Order. The Employee shall be paid during the on-duty meal period. The paid on-duty meal period shall count toward hours worked for overtime purposes.Revocation of Agreement. The employee is free, at any time, to revoke this agreement by providing written notice to the Company. ______________________________ ____________________EmployeeDate__________________________________________________EmployerDate