SECOND MEAL PERIOD WAIVER



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MEAL PERIOD WAIVER (IN EXCESS OF 10 HOURS)

This will certify that I regularly or occasionally work a shift in excess of ten hours at Community Medical Centers, and that on the days I work a shift in excess of ten hours, I hereby waive one of the two meal periods I would otherwise be entitled to receive each workday under California law. I understand that if I do not provide direct patient care or work in a clinical or medical department and I work a shift in excess of ten hours but less than twelve hours, I may waive my second meal period only, and therefore must take my first meal period before the start of my sixth hour of work.

I understand that as a result of this waiver I will receive only one unpaid meal period during each day of work, and that I will be paid for all working time, but not for the one duty-free meal period that I receive each workday.

I understand that CMC or I may revoke this Meal Period Waiver at any time by providing at least one day's advance notice in writing of the decision to revoke this waiver. This waiver will remain in effect until such time as CMC or I exercise the option to revoke it. I also understand that once this waiver is revoked, I will not be permitted to waive any meal periods unless CMC and I both sign a new Meal Period Waiver form.

I acknowledge that I have read this waiver, that I understand it, and that I voluntarily agree to its terms.

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Employee signature Employee ID # Date

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Supervisor signature Supervisor ID # Date

FORWARD SIGNED FORM TO YOUR FACILITY HUMAN RESOURCES DEPARTMENT

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