Meal Period Waiver

  • This will certify that I regularly work a shift in excess of eight hours and wish to waive one of the two meal periods I would otherwise be entitled to receive under California law. In accordance with the requirements of state law, I hereby voluntarily agree to waive one meal period each day. I understand that, as a result of this waiver, I will receive only one meal period during each day of work and will be paid for all working time, but not for the one duty-free meal period I receive. I also understand that I, or Agency, may revoke this "Meal Period Waiver" at any time by providing at least one day's notice in writing of the decision to do so. This waiver will remain in effect until I exercise, or Agency exercises the option to revoke it.
  • I acknowledge that I have read this waiver, understand and voluntarily agree to its provisions.
  • (please type full name)
  • MM slash DD slash YYYY