Work Permits



(Work Permit Form)


Instructions to student:

1. Fill out form B1-1 Statement to Employ

a. Full legal name (as printed on your social security card)

b. Home Address, City, Zip Code

c. Date of Birth, Social Security Number, Age

d. Student signs form

e. Fill out your school information

(Name, telephone number, address, city and zip code)


Parents/Guardian’s section:

2. Print First and Last Name, sign and date


Employer’s section:

3. Business Name, Business Phone, Supervisor’s Name, Business Address,

City, Zip Code, Expected Work hours per day/week; employer will describe your duties

Employer Name (name of person who will sign form), signature and date.

Completed form must be emailed to:


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  • Please allow 24 hours turn-a-round time for the issuance of your work permit
  • Incomplete Forms cannot be processed
  • Work permits will only be issued to current AUHSD Students