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May 20, 2012

970 Route 146, Clifton Park, NY 12065

518-881-0310

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Application for Employment Certificate (Working Card)

Application

Click here for the application for high school students (PDF)

Click here for the application for middle school students who want to sell newspapers, work on farms, etc. (PDF)

 

Instructions for filling out the application

Part I

Parental Consent: Please fill in student’s name, age and address. Parent/legal guardian must sign this section.

Part II

Evidence of Age: Student will need to bring proof of age (i.e. copy of birth certificate, passport, driver’s license, etc.).

Part III

Certificate of Physical Fitness: Student will need to take application to the school nurse for verification of a physical exam. Said exam must have been given within the last twelve months. The school nurse will verify and sign Part III. If you do not have a physical exam on file, the nurse will be unable to complete this section until one is provided. *Note: When school is not in session, attach a copy of the physical exam signed by your physician or a Certificate of Physical Fitness form from your physician’s office to the application form.

Parts IV, V, VI – Leave these parts blank.

 

Once the application is complete...

Once Part 1 is completed and Part 3 signed by the school nurse, bring the application form, along with evidence of age, to the Counseling Center for processing. Completed applications dropped off before noon may be picked up at the end of the day. Applications dropped off after noon may be picked up at the end of the following day.

*NOTE: During the summer, completed applications may be dropped off at the Counseling Center between 8:00 A.M. and 12:00 noon Monday through Friday. Please allow 24 hours for your application to be processed.