Meal Break Waiver

Meal Break Waiver – Employee Shift 6 Hours or Less

I am scheduled to work a shift of 6 hours or less on:

From the hours of a.m./p.m. (circle one) to a.m./p.m. (circle one).
I understand that:
1. I may waive my 30-minute unpaid meal break only when my work and/or scheduled shift will be completed in
6 hours or less in one workday.
2. In order for this waiver to be valid, an authorized company official must also authorize the waiver in writing by
signing below.
3. I may revoke this agreement to waive, in writing, my meal break at any time by signing this form as indicated

Employee Signature :

REVOCATION: I hereby revoke this waiver.

Employee Signature :

For Employer Use Only:

Check One :

Your meal break waiver request has been approved and submitted.
Your meal break waiver request has been denied.

Employer Signature :

Please Print Name
Pistachio Hair Studio LLC

Pistachio Hair Cut & Color Bar
Phone: 760.230.4880
cash, credit card
6965 El Camino Real, Suite 206, Carlsbad, CA 92009
Carlsbad , California 92009