Work Permit

CONSENT FOR WORK PERMIT BY PARENT OR GUARDIAN

I, _________tin pa_________________________________ hereby state to the Honorable Second Judicial District Court of (Name of the Parent or Guardian)

the State of Nevada; in and for the County of Washoe, or the Court’s designee, that I am the_________pa tin________________ of (Mother, Father or Guardian) kj _________________________________ who is presently_____19____ years of age born on _____dec 12 1992_______________________. (Minor’s Name) (Age) (Month, Day and Year)

I hereby consent that my minor child may be employed by ________________________________________________ at (Name of Employer) (A new work permit is required every time there is a job change)

___________________________________________________ during hours which will not conflict with the schooling of my (Employer’s Address)

child, and during the summer vacations. My child will be employed to ____________________________________________. (Type of Work)

Having given this consent freely and voluntarily, it is my request that the District Judge of the Second Judicial District Court

or the Court’s designee issue a WORK PERMIT for the above-named minor child.

DATED this __________ day of _________________, 20______.

__________________________________________________ (Signature of Parent or Guardian and Relationship to Juvenile)

__________________________________________________ (Address of Parent or Guardian)

Based on the above Application, pursuant to NRS 609.245 and good cause appearing, ______________________