Work Permits

Parent and student must complete this section in full with the exception of the Superintendent/Office box.

• Address needs to include street address, city, state, and zip code.
• Proof of Age can be birth certificate, driver’s license, temporary driver’s license, or passport. You must provide a photocopy of one of the listed documents for us to keep.
• School District should state “Lakota Local” and Building should state the actual school building that the applicant attends daily.

The employer must complete this section in full.  All sections are mandatory to process the permit.  

• Please provide full address of employer (Including city, state, and zip code).
• Specific nature of Work – This should state exactly what you will be doing.  For Example: Cashier, server, bagger, childcare attendant, hostess, lifeguard, etc. (Do NOT put the business type such as retail or restaurant).
• Employer’s Tax ID Number.
• Number of Days Per Week/Hours Per Day- Please list a number that represents the most days per week and hours per day that the applicant will work.
• Starting/Quitting time should list the earliest/latest time that the applicant would start and quit any particular shift.  DO NOT WRITE “VARIES” OR “REPRESENTATIVE”.

• The parent/guardian & physician must complete the top section in full.
• Physician must complete both portions of the bottom section.
• The form MUST be signed AND stamped by the physician’s office.
• You may use a current sport physical if it is not over a year old.  You must provide a copy of it with the application.