Isaiah Perkins


 CASA COLINA 
 Hospital and Centers for Healthcare 
 CASA COLINA MEAL PERIOD AGREEMENT 
 This will certify that I am an employee regularly scheduled to work an eight or ten 
 hour shift (ten hours under a certified alternative work week schedule), and that should 
 a time arise when my shift exceeds 10 hours, I wish to waive my entitlement to a 
 second meal period. I understand that I am entitled to have this meal period under 
 California Law. However, I hereby voluntarily agree to waive one- of the two meal 
 periods. 
 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 receive. 
 I also understand that I or the hospital may revoke this "Meal Period Waiver" at 
 any time by providing at least one day's advance notice in writing of the decision to do 
 so. This waiver will remain in effect until 1 exercise, or the hospital exercises, the option 
 to revoke it. 
 The decision not to waive one on-duty meal break will result in an additional 
 unpaid meal period of thirty (30) minutes and the extension of my workday by the same 
 thirty (30) minutes. 
 I acknowledge that I have read this waiver, understand it, and voluntarily agree to 
 its provisions. 
 In addition, I understand that while it is my employer's obligation to make the 
 meal period and rest periods available to me, it is my responsibility to ensure 1 take 
 them. 
 (Please reference HR Policy C2-302 Hours of Work for additional details) 
 aim 
 Signature 
 Luis Romero
 Print Name 
 19-11-2016
 Date 
 Updated: 11-12-2021 (file located In: S Drive/Human Resources/Forms/Meal Period Agreement)
