Authorization for this form is provided under Section 103.70(1), Wisconsin Statutes. Completion of this form is voluntary. However, if you wish to create a work permit with the Equal Rights Division (ERD), you must submit a written document containing the information sought in this form, including payment of $10. Do not send cash. Personal information you provide may be used for secondary purposes (s. 15.04(1)(m), Wisconsin Statutes)


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