WORK PERMIT REQUEST
Date:
RE: (minor’s name)
To whom it may concern:
The above referenced minor will be employed on a part-time basis by the University of Wisconsin –
Green Bay. Following are the specifics of this employment.
Department:
Position:
Duties:
Work Schedule:
Dates of Employment:
Supervisor:
Contact Phone Number:
If you have any questions regarding this employment, please contact the supervisor at the above
number.
Supervisor Signature
Date
Parent/Guardian Consent
Date
UW Green Bay - Office of Human Resources
2420 Nicolet Drive • Green Bay, WI 54115-7001
(920) 465-2390 • hr@uwgb.edu • www.uwgb.edu/hr/