8/2019
Meal Break Waiver Form
Please Prin
t
Employee Name:_____________________________ ID Number: A_____________________
Department: ________________________________ Effective Date: ____________________
I understand that under California l
aw, after a work period of 5 hours, I am entitled to receive an
unpaid meal break of not less than 30 minutes during which I am relieved of all duties.
I give my voluntary consent to Taft College that 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.
I understand that if my shift exceeds 6 hours, I am required to take an unpaid meal break of at
least 30 minutes.
I understand that I may revoke this agreement at any time by providing written notice of my
request to revoke to Human Resources. This agreement will remain valid for a period of 12
months unless revoked.
In order for this waiver to be valid, my supervisor must also authorize the waiver in writing by
signing below and forwarding the original signed document to Human Resources. Waivers not
on file in Human Resources will be invalid.
Employee Authorization
Employee Signature: ____________________________ Date: ______________________
Supervisor Authorization
Supervisor Signature: ___________________________ Date: ______________________
Return the completed, original Meal Break Waiver Form to the Human Resources office. A
copy may be kept for your department records.
For HR/Payroll Use Only:
Date received by HR: ____________ Received by: ____________ Expiration Date: ____________
Date payroll notified: ____________ Revoked on: _____________
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
