Application for Permission to Work in the Entertainment Industry

Summary

Application for Permission to Work in the Entertainment Industry

Text

APPLICATION FOR PERMISSION TO WORK 
IN THE ENTERTAINMENT INDUSTRY 
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Name of Minor:  Stage Name: 
Address City State Zip Home Phone Number 
School:  Grade Level: 
Date of Birth Height Weight Hair Color Eye Color Gender 
SCHOOL RECORD 
** Please CHECK the best description of the minor for each ** 
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Name of Minor: 
Attendance Academics (Grades) Health 
SATISFACTORY 
UNSATISFACTORY 
SATISFACTORY 
UNSATISFACTORY 
Please indicate if the minor requires medical 
approval to obtain a permit 
REQUIRED  NOT NEEDED 
Certification: 
I certify that the above-named minor meets the 
school district's requirements with respect to age, 
school record and health 
AGREE 
DISAGREE 
Signature and Title of Authorized 
School Official 
Date Signed 
School Address 
Daytime Phone 
[School Seal/Stamp or Address Stamp](REQUIRED) 
** All Areas Must state SATISFACTORY for issuance of permit ** 
** Any alterations or falsifications may void this application ** 
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STATEMENTOF PARENT OR GUARDIAN: It is my desire that a 6 Month Entertainment Work Permit be issued to the above 
named minor. I will read the rules governing such employment and will cooperate to the best of my ability in safeguarding the above 
named minor's educational, moral and physical interest. 
I declare that the School Record section of the Application for Permission to Work in the Entertainment Industry submitted herein, is 
a true, accurate and complete copy of the original signed by the school official, whose name and title appears on the application. 
Under penalty of perjury under the laws of the State of California, I declare that I have read the foregoing Application for Permission 
to Work in the Entertainment Industry and the facts as stated on this application are true. 
Name of Parent or Guardian (print or type) Signature 
Name of Minor (print or type) 
WATERMARK-277-A  Rev. 3/2023 Page 1 of 2

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E https://www.dir.ca.gov/dlse/Entertainment-Industry-Sexual-Harassment-Prevention-Training-Requirements.htmlC 
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AB 3175 Certification of Compliance Acknowledgment THIS IS NOT A TRAINING CERTIFICATE 
For 14-17 year old minors only, (with exception for 13½ year olds) 
I hereby certify that the below named minor completed the training in sexual harassment prevention, retaliation, and reporting resources using 
the online training course made available on the internet website of the Civil Rights Department (CRD) pursuant to Section 12950.1 of the 
Government Code on the date contained in the CRD’s Certificate of Completion submitted herewith.  I also hereby certify that I 
accompanied the below named minor during said training.  I verify under penalty of perjury that the foregoing is true and correct. 
Name of Parent or Guardian (print or type) Signature 
Name of Minor (print or type) 
Information covering California’s child labor laws applicable to the entertainment industry can be found at 
http://www.dir.ca.gov/dlse/DLSE-CL.htm.
REQUIREMENTS FOR NON-SCHOOL AGE MINORS  (15 days through kindergarten) 
A PHOTO COPY OF ONE OF THE FOLLOWING: 
1.Certified Birth Certificate
2.Baptismal Certificate
3.Official letter from hospital where born
4.Passport
* Every infant under one month of age must have a certification from a licensed physician and surgeon who is Board Certified in either pediatrics
or family medicine, certifying that the infant is at least 15 days old, was carried to full term, and is physically able to endure the stresses of
working in the entertainment industry.
REQUIREMENTS FOR SCHOOL AGE MINORS (Grades 1 through 12) 
PUBLIC / PRIVATE SCHOOL, ON-LINE and VIRTUAL ACADEMY: 
When school is IN session, the application must be completed and dated during the current school session by an authorized school 
official. 
When school is NOT in session (i.e., school break, vacations, holidays), either the minor’s recent report card or letter from the school 
principal on school letterhead indicating that the minor is “satisfactory” in all academic subjects, health and attendance is required. 
HOMESCHOOL (ON-LINE and VIRTUAL ACADEMY see above): 
If minor is homeschooled, the application must be completed by the parent/guardian and attached to either a current private school 
affidavit, or written verification indicating that the minor is “satisfactory” in all academic subjects, health and attendance from either the 
local school district, county office of education or state board of education where the minor lives. 
INFORMATION PRACTICES ACT NOTICE (California Civil Code Section 1798.17) 
1. The information on this application is being requested by the Department of Industrial Relations, Division of Labor Standards Enforcement.
2. The information in this application is collected and maintained pursuant to California Labor Code sections 1308.5, 1308.10 and Title 8
California Code of Regulations section 11753.
3. If you fail to provide all or any part of the information requested in this application, the Labor Commissioner may deny issuance / renewal of an
Entertainment Work Permit for minors under 18 years of age.
4. The principal purposes within the Division of Labor Standards Enforcement for which the information on this application will be used are: (1)
administration of the registration for the employment of minors in the entertainment industry, and (2) enforcement of the California child labor
laws.
5. The following are known or foreseeable disclosures of the information contained herein which may be made pursuant to subdivision (e) or (f)
of Section 1798.24 of the California Civil Code by the Division of Labor Standards Enforcement. Response to a request under the California
Public Records Act.
6. You have the right to access records containing your personal information that are maintained by the Division of Labor Standards Enforcement.
To make a request to access such records, please contact the Entertainment Work Permit Unit by email [email protected] or telephone
818-901-5484.
WATERMARK-277-A  Rev 3/2023 Page 2 of 2

Retrieval chunks

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  APPLICATION FOR PERMISSION TO WORK IN THE ENTERTAINMENT INDUSTRY S E C T I O N A Name of Minor:  Stage Name: Address City State Zip Home Phone Number School:  Grade Level: Date of Birth Height Weight Hair Color Eye Color Gender SCHOOL RECORD ** Please CHECK the best description of the minor for each ** …

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  the online training course made available on the internet website of the Civil Rights Department (CRD) pursuant to Section 12950.1 of the Government Code on the date contained in the CRD’s Certificate of Completion submitted herewith.  I also hereby certify that I accompanied the below named minor during said traini…

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  2. The information in this application is collected and maintained pursuant to California Labor Code sections 1308.5, 1308.10 and Title 8 California Code of Regulations section 11753. 3. If you fail to provide all or any part of the information requested in this application, the Labor Commissioner may deny issuance …