Employee: AlyssaWright 3TiptonFarmRoad CandlerNC28715 828-337-4270 Age:16DOB:10/14/1995Sex:Female ProposedJob:Cashier

Employer: KerrDrug(KerrDrug,Inc) 1124PattonAvenue AshevilleNC28806 BuncombeCounty 828-236-1519 ABCon-premisespermit:N Business:Services

EMPLOYERMUSTVERIFYAGEANDCOMPLYWITHRESTRICTIONSBELOW NOONEUNDER14MAYWORKINANYJOBINTHISINDUSTRY. NOONEUNDER16MAY:

--operatepower-drivenequipmenttoincludelawnmowers,weedeatersandgolfcarts --workinanestablishmentwithan"onpremises"ABCpermitexceptonthe"outsidegrounds"withparentalpermission,includinggolf courses,swimmingpools,countryclubs,baseballparksandamusement/recreationalparks. --workinawarehouseinanyoccupation. --workinthemeatdepartmentofagrocerystore. --assemblemotorcyclesorothervehiclesinpreparationforfirstsale

NOONEUNDER18MAY:
--operateanamusementride. --clean,repairoroperatepower-drivencircularsaws,bandsawsandgrindingorslicingmachines. --operateorunloadscrappaperbailersandpaperboxcompactors. --clean,repairoroperate"platen-type"printingpresses. --prepare,dispense,serveorsellalcoholicbeveragesincludingbeer,wineandmixedbeverages. --workinthestorageofexplosives;excludingretailammunitionsales,trap/skeetranges,andpolicestations. --workwherethereisariskoffallingadistanceof10feetormore,includingtheuseofladdersandscaffolds. --havedrivingastheirmainoccupation,includingdeliveryofparts,prescriptiondrugs,flowersandfood. --operate"most"power-drivenhoistingapparatussuchasforklifts,bobcatsandcranes,freightelevatorsandhighlifttrucks. --operateahoistingapparatusexceptpneumaticliftsusedingaragesandservicestations --takeX-rays,orbeintheworkroomwhileX-raysarebeingtaken.Thisincludesallformsofionizingradiation. Hours Restrictions (14-15 years olds):Onlybetween7amand7pm(exceptuntil9pmduringthesummerwhenschoolisnotinsession);only outsideschoolhours;nomorethan3hoursperdayor18hoursperweekwhenschoolisinsession;and,nomorethan8hoursperdayor40 hoursperweekwhenschoolisnotinsession. Hours Restrictions (16-17 year olds):Ifregularlyenrolledingrades12orlower,cannotbeemployedbetween11pmand5amwhenthereis schoolthenextdayfortheyouthunlesstheemployerreceiveswrittenpermissionfromtheparent/guardianandtheprincipalorprincipals designee.ThisrestrictiondoesnotapplytoyouthenrolledinGEDprogramsorwhohavedroppedoutofschool. The undersigned individuals certify that the above information is correct; that the youth will not be employed in a hazardous, prohibited, or detrimental occupation; will only be employed during legal hours; and, will be employed only in a permitted occupation. Employer'sSignature:________________________________________________________________________ Parent/Guardian/Custodian'sSignature:__________________________________________________________ Youth'sSignature:___________________________________________________________________________ IssuingOfficer:NorthCarolinaDepartmentofLabor,April8,2012Certificate:S120408093330W