Navigation
Document Sample
Statement of Intent to Employ Minor and Request for Work Permit
Not a work permit
For Minor to Complete
• |
|
Write number in after printing |
|
|
|
|
|
|
|
|
|
Minor’s name (last name first) |
|
Social security number |
Date of birth |
Age |
Grade |
|
|
|
|
|
|
Street address |
City |
ZIP Code |
Home telephone |
|
|
|
|
|
|
|
|
School name |
|
|
|
|
|
|
|
|
|
|
|
Street address |
City |
ZIP Code |
School telephone |
|
|
For Employer to Complete (Please review rules for employment of minors on reverse.)
•
Name of business
Street address |
City |
ZIP Code |
Business telephone |
|
|
|
|
Minor’s work duties |
|
|
Hourly wage |
Maximum number of hours of employment when school is in session:
Mon. |
|
Tues. |
|
Wed. |
|
Thurs. |
|
Fri. |
|
Sat. |
|
Sun. |
|
Weekly = 0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
In compliance with California labor laws, this employee is covered by worker’s compensation insurance. This 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.
Supervisor’s signature |
Supervisor’s name (print or type) |
For Parent or Guardian to Complete
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, the information herein is correct and true. I request that a work permit be issued.
In addition to this employer, my child is working for:
Name of business
Signature of parent or legal guardian |
Date |
|
|
For School to Complete
Type: Regular
Evidence of minor’s age
Vacation
Signature of verifying authority
Work Experience Education
Other (specify)
CALIFORNIA DEPARTMENT OF EDUCATION FORM |
IMPORTANT: See reverse side for additional information. |
General Summary of Minors’ Work Regulations
•If federal laws, state laws and school district policies conflict, the more restrictive law (the one most protective of the employee) prevails.
•Generally, minors must attend school until age 18 unless they are 16 years or older and have graduated from high school or received a state Certificate of Proficiency.
•Employers of minors required to attend school must complete a “Statement of Intent to Employ Minor and Request for Work Permit” (form
•Employers must retain a “Permit to Employ and Work” (form
•Work permits
•A work permit
Minors under the age of 18 may not work in environments declared hazardous or dangerous for young workers as listed below:
1.Explosive exposure
2.Motor vehicle driving/outside helper
3.Coal mining
4.Logging and sawmilling
5.
6.Radiation exposure
7.
8.
9.Other mining
10.
11.
12.
13.Manufacturing brick, tile products
14.Power saws and shears
15.Wrecking, demolition
16.Roofing
17.Excavation operation
For more complete information about hazardous occupations, contact the U.S. Department of Labor (Child Labor Bulletins 101 and 102) and the California Department of Industrial Relations, Division of Labor Standards Enforcement. Regional offices are located in several California cities. They are listed in the “Government Listings” sections of telephone directories.
•Minors younger than 16 years are allowed to work only in limited, specified occupations that exclude baking, manufacturing, processing, construction, warehouse, and transportation occupations.
•In addition to safety regulations, labor laws applicable to adult employees also generally apply to minor employees, including workers’ compensation insurance requirements.
•Child labor laws do not generally apply to minors who deliver newspapers or work at odd jobs, such as yard
work and
•A day of rest from work is required if the total hours worked per week exceed 30 or if more than 6 hours are worked on any one day during the week.
Ages |
Hours of Work |
16 – 17 When school is in session: Daily maximum of 4 hours, Monday through Thursday. May work up to 8 hours on any
When school not in session: May work up to 48 hours per week but no more than 8 hours in any one day.
Work must be performed no earlier than 5 a.m. or later than 10 p.m. except that work may extend to 12:30 a.m. on nights preceding non- school days. Students in Work Experience Education or cooperative vocational education programs may be authorized to work until 12:30 a.m. on nights preceding school days with specified written permission.
14 – 15 When school is in session: On school days daily maximum 3 hours. On
When school is not in session: Daily maximum 8 hours and weekly maximum 40 hours.
May not work during public school hours except students in Work Experience Education or career exploration programs.
Work must be performed no earlier than 7 a.m. nor later than 7 p.m. any day of the week. From June 1 to Labor Day work hours may be extended to 9 p.m.
Younger Labor laws generally prohibit nonfarm than 14 employment of children younger than 14.
Special rules apply to agricultural work, domestic work and the entertainment industry.
Document Information
| Fact Name | Description |
|---|---|
| Purpose | The Statement of Intent to Employ Minor and Request for Work Permit form is designed to ensure that minors can work legally and safely. |
| Eligibility | This form is required for minors under the age of 18 who seek employment in various industries. |
| Parental Consent | Parental or guardian consent is typically required to complete the form, ensuring that the minor's interests are protected. |
| State Variations | Each state may have its own version of the form, reflecting specific laws and regulations governing minor employment. |
| Governing Laws | In many states, the governing laws include child labor laws that dictate the hours and types of work permitted for minors. |
| Submission Process | The completed form must often be submitted to the appropriate state agency or school district for approval. |
| Validity Period | The work permit issued is generally valid for a specific period, after which a renewal may be necessary. |
| Employer Responsibilities | Employers must comply with all applicable labor laws and maintain records of work permits for minors they employ. |
Statement of Intent to Employ Minor and Request for Work Permit - Usage Guidelines
Filling out the Statement of Intent to Employ Minor and Request for Work Permit form is an important step in ensuring compliance with labor laws when hiring a minor. Once you complete this form, you will submit it to the appropriate authority to obtain the necessary work permit for the minor you intend to employ.
- Begin by gathering the minor's personal information, including their full name, date of birth, and address.
- Provide the employer's details, such as the business name, address, and contact information.
- Indicate the job title and a brief description of the work the minor will perform.
- Specify the hours and days the minor will work, ensuring they comply with state regulations.
- Include any additional information required by your state, such as parental consent or school information.
- Review the completed form for accuracy and completeness.
- Sign and date the form where indicated.
- Submit the form to the appropriate local or state agency for processing.
Common PDF Forms
Prescription Label Requirements by State - The form generally includes the pharmacy’s name and address for easy reference.
When engaging in the sale or purchase of a mobile home, it is crucial to utilize a proper legal document, such as the Utah Mobile Home Bill of Sale, to clarify ownership transfer. For those unfamiliar with this form, detailed information can be found at mobilehomebillofsale.com/blank-utah-mobile-home-bill-of-sale/, which outlines the necessary components and requirements to ensure a seamless transaction in Utah.
Uscis I864 - The I-864 is a key component in demonstrating financial capability.
Dos and Don'ts
When filling out the Statement of Intent to Employ Minor and Request for Work Permit form, it’s important to follow certain guidelines to ensure the process goes smoothly. Here’s a helpful list of what to do and what to avoid:
- Do: Ensure all information is accurate and complete. Double-check names, dates, and signatures.
- Do: Provide the required documentation, such as proof of age and parental consent, if necessary.
- Do: Submit the form well in advance of the intended start date for the minor’s employment.
- Do: Keep a copy of the completed form for your records.
- Don't: Leave any sections blank. Incomplete forms may be rejected.
- Don't: Use white-out or make alterations to the form. Corrections should be made with a clear strike-through and initialed.
- Don't: Submit the form without the necessary signatures from both the employer and the minor’s parent or guardian.
- Don't: Wait until the last minute to submit the form. Allow time for processing and any potential issues.
Common mistakes
-
Incomplete Information: Failing to fill out all required fields can lead to delays. Each section must be completed accurately.
-
Incorrect Personal Details: Providing wrong names, addresses, or dates of birth can result in the rejection of the application. Double-check these details.
-
Missing Signatures: Both the employer and the minor's parent or guardian must sign the form. Omitting a signature can halt the process.
-
Failure to Provide Documentation: Not attaching necessary identification or proof of age can lead to complications. Ensure all supporting documents are included.
-
Ignoring Local Laws: Each state has specific regulations regarding minor employment. Familiarize yourself with these rules to avoid non-compliance.
-
Submitting Late: Timeliness is crucial. Delaying the submission may cause the minor to miss out on job opportunities.
-
Not Keeping Copies: Failing to retain copies of the submitted form and supporting documents can create issues later. Always keep a record for your files.
-
Overlooking Employer Responsibilities: Employers must understand their obligations regarding minor workers. This includes adhering to work hour restrictions and safety regulations.