State Form 48409 (R3/3-00)
Written Parental Permission for Additional Work Hours for 16 & 17 Year Olds
I am the parent or legal guardian of: Name of Child As parent or guardian, I give the above named child permission to: if 16 years of age, work until midnight on nights not followed by a school day.
(Initial)
if 17 years of age, work until 11:30 p.m. on nights followed by a school day.
(Initial)
if 17 years of age, work until 1:00 a.m. on two non-consecutive school nights per week.
(Initial)
if 16 or 17 years of age, work up to 9 hours on a day not followed by a school day.
(Initial)
if 16 or 17 years of age, work up to 40 hours during a school week.
(Initial)
if 16 or 17 years of age, work up to 48 hours during a non-school week.
(Initial)
Printed Name of Parent or Guardian Signature of Parent or Guardian Date
State Form 48409 (R3 / 12-99)
Written Parental Permission for Additional Work Hours for 16 & 17 Year Olds
I am the parent or legal guardian of: Name of Child As parent or guardian, I give the above named child permission to: if 16 years of age, work until midnight on nights not followed by a school day.
(Initial)
if 17 years of age, work until 11:30 p.m. on nights followed by a school day.
(Initial)
if 17 years of age, work until 1:00 a.m. on two non-consecutive school nights per week.
(Initial)
if 16 or 17 years of age, work up to 9 hours on a day not followed by a school day.
(Initial)
if 16 or 17 years of age, work up to 40 hours during a school week.
(Initial)
if 16 or 17 years of age, work up to 48 hours during a non-school week.
(Initial)
Printed Name of Parent or Guardian Signature of Parent or Guardian Date
State Form 48409 (R3 / 12-99)
Written Parental Permission for Additional Work Hours for 16 & 17 Year Olds
I am the parent or legal guardian of: Name of Child As parent or guardian, I give the above named child permission to: if 16 years of age, work until midnight on nights not followed by a school day.
(Initial)
if 17 years of age, work until 11:30 p.m. on nights followed by a school day.
(Initial)
if 17 years of age, work until 1:00 a.m. on two non-consecutive school nights per week.
(Initial)
if 16 or 17 years of age, work up to 9 hours on a day not followed by a school day.
(Initial)
if 16 or 17 years of age, work up to 40 hours during a school week.
(Initial)
if 16 or 17 years of age, work up to 48 hours during a non-school week.
(Initial)
Printed Name of Parent or Guardian Signature of Parent or Guardian Date