AB 3175 Certification of Compliance

Summary

AB 3175 Certification of Compliance

Text

STATE OF CALIFORNIA   Gavin Newsom, Governor 
DEPARTMENT OF INDUSTRIAL RELATIONS 
Division of Labor Standards Enforcement 
Entertainment Work Permit Unit 
6150 Van Nuys Blvd., Room 100 
Van Nuys, CA  91401 
Tel: (818) 901-5484 
AB 3175 Certification of Compliance for Parents or Legal Guardians 
I _______________________________, parent/legal guardian of 
         (parent/guardian’s legal name) 
_______________________________, hereby certify that on ____________________, 
   (minor’s legal name)              (month/day/year) 
_______________________________ completed the training in sexual harassment, prevention,  
            (minor’s legal name) 
retaliation, and reporting resources using the online training course made available on the internet  
website of the Department of Fair Employment and Housing (DFEH) pursuant to Section 12950.1 of 
the Government Code.  
I also hereby certify that I accompanied ______________________________ during said training. 
     (minor’s legal name) 
I verify under penalty of perjury that the foregoing is true and correct. 
_______________________
      (month/day/year) 
_________________________________________ 
(parent/guardian’s signature)
________________________________________ 
(print name of parent/guardian) 
Note: You must submit the DFEH’s Certificate of Completion with this form, or your 
application will be considered incomplete, and we will not be able to issue your minor an 
entertainment work permit.

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  STATE OF CALIFORNIA Gavin Newsom, Governor DEPARTMENT OF INDUSTRIAL RELATIONS Division of Labor Standards Enforcement Entertainment Work Permit Unit 6150 Van Nuys Blvd., Room 100 Van Nuys, CA 91401 Tel: (818) 901-5484 AB 3175 Certification of Compliance for Parents or Legal Guardians I _____________________…