STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST PDF

Name of Minor: Name of Employer: Business Address: Job Title and primary duties: Number of hours per day Minor is to be employed: The undersigned agrees to

Minor (Ages 14 -17) Employment Permit Process - Mass.gov

Doctor must complete. Certificate of. Health section of Work. Permit Application. Minor must obtain School Record from school they last attended. Form can.

workpermit.pdf

The minor may then begin work. 5. Employer must return a copy of the completed work permit to the department within seven (7)

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APPLICATION FOR MINOR WORK PERMIT. Name of Student / Applicant in full: Date Address of Student /Applicant's Place of Employment Job Site

Application for Work Permit (PDF)

To be completed by parent or guardian unless minor is a high school graduate (please attach proof of graduation). Signature of parent

Arkansas Department of Labor

NOTE: A WORK PERMIT IS NOT REQUIRED FOR A MINOR 16 YEARS OF AGE. HOWEVER REMINDER: Proof of age must be attached to application or permit will not be issued.

Completing an Employment Certificate (Youth Work Permit) for

Minor will access the minor application for a Youth Work Permit at this link: https://www.dol.state.ga.us/WS4-MW5/cics.jsp?TRANSID=WP17&FRMNAME=WP17. • The

PERMISSIBLE HOURS OF EMPLOYMENT FOR APPYING FOR A

Special permits may be issued to minors of any age to be employed as a model performer

PROCEDURES FOR OBTAINING A CHILD LABOR CERTIFICATE

Under the Hawaii Child Labor Law a child labor certificate or "work permit" is required for working minors until they reach 18 years of age. There is no

STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST

A “STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST FOR A WORK PERMIT–CERTIFICATE OF AGE” form (CDE Form B1-1) shall be completed in accordance with

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THE UNDERSIGNED HEREBY AGREES TO EMPLOY THE ABOVE NAMED CHILD IN ACCORDANCE WITH LAWS REGULATING THE. EMPLOYMENT OF MINORS. THE EMPLOYER FURTHER AGREES TO

Employment Permit Application for 14 through 17 Year-Olds

school official authorized to issue work permits do not need a signed work permit

statement of intent to employ a minor and request for work permit

STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST FOR WORK PERMIT–. CERTIFICATE OF AGE. CDE B1-1 (Rev. 07-10) Special rules apply to agricultural work.

Arkansas Department of Labor

APPLICATION FOR EMPLOYMENT OF A. MINOR. Mail To: Arkansas Dept of Labor and Licensing NOTE: A WORK PERMIT IS NOT REQUIRED FOR A MINOR 16 YEARS OF AGE.

PERMISSIBLE HOURS OF EMPLOYMENT FOR APPYING FOR A

Special permits may be issued to minors of any age to be employed as a model performer

Maine.gov

During summer school vacation minors may have two active work permits. Permits should not be submitted until minors have the promise of a job. Work permits do

APPLICATION FOR MINOR WORK PERMIT

APPLICATION FOR MINOR WORK PERMIT. 3331 02 ORC. 4109 02 ORC. STUDENT / APPLICANT INFORMATION. Name of Student / Applicant in full: Sex: Grade Level:.

workpermit.pdf

3 Employer verifies minor's age agrees to keep a copy of the Employer submits work permit to Wage and Hour office. 3. The approved duties are returned ...

PROCEDURES FOR OBTAINING A CHILD LABOR CERTIFICATE

Under the Hawaii Child Labor Law a child labor certificate or "work permit" is required for working minors until they reach 18 years.

General

STATE OF CALIFORNIA DEPARTMENT OF EDUCATION

STATEMENT OF INTENT TO EMPLOY

MINOR AND REQUEST FOR

WORK PERMIT

CERTIFICATE OF AGE CDE Form B1-1 (Rev. 02-14)

A "

STATEMENT OF INTENT

TO EMPLOY A MINOR AND REQUEST FOR

WORK PERMIT

CERTIFICATE OF AGE

form ( CDE Form B1

1) shall be completed in accordance with California

Education Code

49162 and 49163 as notification of intent to

employ a minor. This form is also a Certificate of Age pursuant to California

Education Code

49114.

(Print Information)

Minor's Information

Minor's Name (First and Last) Home Phone Grade

Home Address City Zip Code

Birth Date

School Information

Social Security Number

Age Student's Signature

School Name School Phone

School Address City Zip Code

To be filled in and signed by parent or legal guardian This minor is being employed at the place of work described with my full knowledge and consent.

I hereby certify that to the best of

my knowledge and belief, the information herein is correct and true. Parent's Name (Print First and Last) Parent's Signature Date

To be filled in and signed by employer

Business Name or Agency of

Placement

Business Phone Supervisor's Name

Business Address

City Zip Code

Employer"s Maximum Expected Work Hours: _________ hours per day ________ hours per week

Describe nature of work to be performed:

In compliance with California labor laws, this employee is covered by workers compensation insurance. T his business does not

discriminate unlawfully on the basis of race, ethnic background, religion, sex, sexual orientation, color, national origin, ancestry, age,

physical handicap, or medical condition. I hereby certify that, to the best of my knowledge, the information herein is correct and true. Employer's Name (Print First and Last) Employer's Signature Date

For authorized work permit issuer use ONLY

Maximum number of work hours when school is in session:

Mon Tues Wed Thur Fri Sat Sun Total

______________________________________________

Proof of Minor's

A ge (Evidence Type _____________________________________________

Verifying Authority's Name and Title

(Print) ______________________________________________

Verifying Authority's Signature

Maximum number of work hours when school is not in session:

Mon Tues Wed Thur Fri Sat Sun Total

Check Permit Type:

Full time

Restricted

Work Experience

Education, Vocational

Education, or Personal

Attendant

Workability

For more information about child labor laws, contact the U.S. Department of Labor at http://www.dol.gov/, and the State of

California Department of Industrial Relations, Division of Labor Standards E nforcement at http://www.dir.ca.gov/DLSE/dlse.htmlquotesdbs_dbs11.pdfusesText_17

[PDF] STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST

General

STATE OF CALIFORNIA DEPARTMENT OF EDUCATION

STATEMENT OF INTENT TO EMPLOY

MINOR AND REQUEST FOR

WORK PERMIT

CERTIFICATE OF AGE CDE Form B1-1 (Rev. 02-14)

STATEMENT OF INTENT

TO EMPLOY A MINOR AND REQUEST FOR

WORK PERMIT

CERTIFICATE OF AGE

1) shall be completed in accordance with California

Education Code

49162 and 49163 as notification of intent to

Education Code

49114.

Minor's Information

Minor's Name (First and Last) Home Phone Grade

Home Address City Zip Code

Birth Date

School Information

Social Security Number

Age Student's Signature

School Name School Phone

School Address City Zip Code

I hereby certify that to the best of

To be filled in and signed by employer

Business Name or Agency of

Placement

Business Phone Supervisor's Name

Business Address

City Zip Code

Describe nature of work to be performed:

For authorized work permit issuer use ONLY

Mon Tues Wed Thur Fri Sat Sun Total

Proof of Minor's

Verifying Authority's Name and Title

Verifying Authority's Signature

Mon Tues Wed Thur Fri Sat Sun Total

Check Permit Type:

Restricted

Work Experience

Education, Vocational

Education, or Personal

Attendant

Workability