Place of birth (Name of Hospital that the minor was born, City, State of Hospital)
Date of birth – Month Day Year
Name and address of parent, guardian or legal custodian
Attach one of any required documents, such as a proof of age document, to the completed application and submit it to the High School.
If applying electronically, the student may attach digital copies, such as a scan or digital photograph.
If an applicant is unable to provide a required document with their application, they can present it to the High School issuing officer at the next stage of the process.
Finally, provide this information in the email:
Request a meeting at Lower Dauphin High School (Entrance 1)
Minor and Parent (or Legal Guardian) must be in attendance
The purpose of the appointment is to enable the applicant to "appear before" the issuing officer, in accordance with the Child Labor Act, while following social distancing guidelines. It also enables the issuing officer to verify a proof of age document if one is required but the student was not able to provide a copy with the application.
The school district issuing officer ensures that all the documents required by law have been examined, approved and filed, and all conditions and requirements for issuing a permit have been fulfilled, and then provides or mails to the minor a wallet-sized, paper work permit bearing a number, the date of issuance, and signature of the issuing officer.
The student signs the work permit when received and shows it to the employer, who makes a copy for their records. The student retains the original work permit.