This is a document that is filled by a person in authority, allowing an individual to look for work. The employment form can be specific and address a certain employer or can be addressed to whoever it may concern, showing that the individual, who can be a student, a minor or an alien is permitted to seek paid employment in the state or country.
Work Authorization Form
EMPLOYEE INFORMATION (Filled by the individual seeking work authorization)
Full Name: ___________________ Gender __________ Date of Birth: ________________
Social Security Number: _________________________ Nationality ___________________
Phone: _________________________________ Email: ____________________________
Address: ________________________________ Town: ____________________________
Zip: ______________________________ State: ____________________________
Veterans Status: None _____ Disabled Veteran ______ Other Veteran _____ (Specify)
Ethnic Group ______
African American (Non-Hispanic origin) ______ Hispanic ______ White (Non-Hispanic origin) ____ Asian/Pacific Islander ______ Native American or Alaska Native
Marital Status: Single ______Married ______
Voluntary Disclosure of Disability _____________________________________________
Is any work accommodation requested? ________________________________________
REVIEW PROCESS (This section is to be filled by the employment coordinator)
Employment form
Work permit completed and attached ____ Date_____/____/_____
OR
Employee Data Form duly completed and attached Date_____/____/_____
AUTHORIZATION TO WORK
I certify that the above student person is approved to work as follows:
Position Title: ______________________________________________________________
Department: ______________________________________________________________
Signature ______________________________ Date ________________________
