Instructions to Complete Student Working Papers

(for 14 to 17 years old)

A. Please print and complete the 2 forms below:

PHYSICAL FITNESS CERTIFICATION form

  1. Fill out the student’s name, address, and date of birth

  2. See the school nurse or your physician to fill out Part A (and Part B if necessary).

  3. The student's physical has to be within 12 months of the application to be valid.

APPLICATION FOR EMPLOYMENT CERTIFICATE form - Complete Part I only
(Parts II, III, IV, V, are not required for most applicants.)

  1. Fill out the date, student’s name, student’s age and home address.

  2. Check the appropriate employment certificate box.

  3. Sign as the parent/guardian of the student.

B. Student must return both completed forms to UEHS Main Office.

  1. The office staff will complete Part VI.

  2. The student must sign the Employment Certificate card in the presence of the issuing UEHS office staff.

  3. The student keeps the working card until an employer requests it to employ the student.

Students may also pick up a paper copy of the working paper forms in the UEHS Main Office.
Contact UEHS Main Office at (607) 757-2181 with any questions or concerns.