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Principal Dan Park
1717 Sylvan Avenue
Modesto, CA 95355
Hours: 7 a.m.-4 p.m.



  1. Print out the work permit application form (B1-1). Click Here
  2. Put your ID number in the top right hand corner. 
  3. Fill out the top section - Minor’s Information.  Make sure your phone number is correct in case I have to contact you and you provide your Social Security Number.  A work permit cannot be created without it.  This form will always be in a secure place once you send it to me.  
  4. Take the form to your employer.  Have the employer complete, sign and date the section – To be filled in and signed by the employer.
  5. Have a parent/legal guardian print their name, sign and date the section – To be filled and signed by parent or legal guardian.  
  6. If you have it printed and don’t know how to scan it, you can use CamScanner, Genius Scan or any other scanner from your app store on your phone.  Do not take a picture of it as it’s often too hard to read.  Make sure it is legible before you send it to me.
  7. Email the completed form to your OWN personal school email account first so I have your email address and I know who it is coming from.  This will speed up processing and ensure I know who I am emailing since there is secured information on it such as your Social Security Number.  
  8. Forward it to [email protected]
  9. A work permit will be processed, signed and emailed to you.
  10. Print, sign and date the work permit.
  11. Give the work permit to your employer.