Orrin PARENT/SCHOOL AUTHORIZATION Labor & Industries For parents or legal g Employment Standards Program a minor employee to work a PO Box 44510 ‘and within the limits of the child labor regulations. Olympia WA 98504-4510 yuardians and school officials to indicate approval for .ccording to the terms listed by the employer Phone (866) 219-7321 FAX (380) 902-5300 Email feensafely@L.niwa.aov or Web page: www. TeenWorkers,Lniwa.gov, This is not a Minor Work Permit Employers must have a minor work permit endorsement on their Business License for each work location with employees under age 18 and renew it each year. See http:/fbls.dor.wa,gov/minorworkpermit. aspx Do not mail this form to L&I. This form is to be kept on file by the available for department audit. A copy should also be maintained by the employer must renew this parent/school authorization by September 30, of each ‘employer at the minor’s workplace and be the minor's school representative. Additionally, year or when work schedule changes. Employee Information nest Empbree Tina Da Te won| Eanes "b._ Nelson (ut be secompaied by prot 264 Mom_| and PUB ave cb, |Powencanre [INA aOR BROCE -14 06 Employee School Information ‘Name of Employee School (If home schooled, please note) RR ORO Wine ences PPO REY IS C368” BAAR Ce Tonoma Wow Pnple. Vanes |W ose Employer Information Employer Business Name Phone Number ‘Dit UBI for Business Location | Expraion Date of Minor Casal Enterprises, Inc. __| 206-915-5549 602-406-771 O971375020 ‘Adaress of Minors Work Location Gi State cz 23225 Maple Valley - Black Diamond Rd SE Maple Valley _|WA 98038 ‘Wage per hour. | Number of days per week: | List Job Duties: Tg minor employed at any other job? Weekly maximum: 20 ‘School/parent may adjust limit as needed, ¥¢S 13.50 School woakc 5 Customer service, cleaning & food | yes [Ino ifanswered as "es", 313.50 preparation Row many hours per week 'Non-Schoo! week: 5. Maximum number of work hours during School year Start and Quit ime during Schoo! year ‘Maximum hours to be worked Per Day: Earliest start time: Circle One Monday-Thursday 4 Monday-Thursday 7 am. AM PM Friday-Sunday 8 Friday-Sunday 7am AM PM ‘Schooliparent may adjust limits as needed: Yes Latest quit time Circle One ‘Maximum hours to be worked Per Week Sunday Thursday 102M ce AM PM Friday-Saturday Midnight ‘School/parent may adjust quit time as needed: ‘Maximum number of work hours during Non- School year Start and Quit time during Non-School yé a ‘Weekly maximum: 40 Parent may adjust mit as needed, Yes Z| Maximum hours t be worked Per Day: Earliest start ime: Cirale One Monday-Sunday 8 Monday-Sunday S.am__ AM_PM Parent may adjust limits as needed, Yes Latest quit ime Circle One Maximum hours to be worked Per Week Monday - Sunday Midnight AM PM Parent may adjust quit time as needed: Yes 700-002-000 Parent School Authorization 01-2014