Application for Work Permit
TO BE COMPLETED BY PARENT/GUARDIAN.  
Once application has been accepted, an appointment will be made available to you and sent via email. 

Per the State of Pennsylvania, the minor MUST BE AT LEAST 14 YEARS OF AGE to be eligible for a Work Permit. 

Parent/Guardian MUST ACCOMPANY minor to the appointment. The in-person appointment will occur at the High School Main Office. Our summer office hours are Monday - Thursday, from 8:00AM - 4:00PM.  Instructions will be included in the appointment email to follow.  Please allow 3-5 business days for a response with your appointment date and time. *If your student already has a position and requires the permit prior to the scheduled appointment, please email sroam@nazarethasd.org and accommodations will be made.
 
**IF YOU HAVE ALREADY COMPLETED AN APPLICATION, BUT MISSED YOUR APPOINTMENT, PLEASE DO NOT COMPLETE ANOTHER APPLICATION, SIMPLY SEND AN EMAIL TO: sroam@nazarethasd.org AND YOUR APPOINTMENT WILL BE RESCHEDULED.
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Email *
Date of Application *
MM
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DD
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First Name (of Minor ) *
Middle Name (of Minor) *
Last Name (of Minor) *
Sex *
Color of Hair *
Color of Eyes *
Any Physical Work Restrictions *
Street Address *
City *
State *
Zip Code *
Place of Birth  (Facility) *
City and State of Birth *
Date of Birth of Minor *
MM
/
DD
/
YYYY
Current Age of Minor *
Evidence of Age Accepted and filed. (Evidence is  required at time of physical signature) *
Name of Parent/Legal Guardian *
Email Address of Parent/Legal Guardian *
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