Content Overview
Guide to Writing Statement of Intent to Employ Minor and Request for Work Permit
Completing the Statement of Intent to Employ Minor and Request for Work Permit form is an essential step in ensuring compliance with labor laws when hiring minors. Once the form is filled out accurately, it will be submitted to the appropriate authorities for review and approval. Following the instructions carefully will help streamline the process and ensure that all necessary information is provided.
- Begin by gathering the required information about the minor, including their full name, address, and date of birth.
- Next, provide details about the employer, including the business name, address, and contact information.
- Indicate the job title and a brief description of the duties the minor will be performing.
- Specify the expected hours of work, including the days of the week and the start and end times for each shift.
- Complete any sections related to parental consent, ensuring that a parent or guardian signs where indicated.
- Review the form for accuracy, checking all entries for completeness and correctness.
- Submit the completed form to the designated authority, ensuring that you retain a copy for your records.
Document Breakdown
| Fact Name | Description |
|---|---|
| Purpose | The Statement of Intent to Employ Minor and Request for Work Permit form is used to obtain permission for a minor to work legally. |
| Eligibility | This form is applicable to minors typically aged 14 to 17, depending on state regulations. |
| Governing Laws | Each state has its own labor laws that govern the employment of minors, such as the Fair Labor Standards Act (FLSA) and state-specific child labor laws. |
| Required Information | The form requires details about the minor, the employer, and the nature of the work to be performed. |
| Parental Consent | Parental or guardian consent is often required for the minor to apply for a work permit. |
| Submission Process | The completed form must be submitted to the appropriate state labor department or agency for approval. |
| Validity | Work permits for minors typically have an expiration date and may need to be renewed periodically. |
| Compliance | Employers must comply with all state regulations regarding minor employment, including hours worked and types of work allowed. |
FAQ
What is the Statement of Intent to Employ Minor and Request for Work Permit form?
The Statement of Intent to Employ Minor and Request for Work Permit form is a document that employers must complete when they intend to hire individuals under the age of 18. This form serves two main purposes: it indicates the employer's intention to hire a minor and requests the necessary work permit from the appropriate state authority. The form ensures that the employment complies with child labor laws, which are designed to protect minors in the workforce.
Who needs to fill out this form?
Employers who wish to hire minors must fill out this form. Additionally, the minor's parent or guardian may also need to provide information and consent. It is essential that both parties understand the working conditions and hours allowed for minors in their specific state. This form helps to ensure that the minor's rights are protected while allowing them to gain valuable work experience.
What information is required on the form?
The form typically requires several key pieces of information, including:
- The minor's full name and date of birth.
- The employer's name, address, and contact information.
- A description of the job the minor will be performing.
- The expected work hours and days of the week.
- Parental or guardian consent, if applicable.
Providing accurate and complete information is crucial, as it helps to expedite the approval process and ensures compliance with labor regulations.
How do I submit the form once it is completed?
After filling out the form, it should be submitted to the appropriate state agency that handles work permits for minors. This may vary by state, so it’s important to check local regulations for specific submission guidelines. Some states allow electronic submissions, while others may require a physical copy to be mailed or delivered in person. Always keep a copy of the completed form for your records, as it may be needed for future reference or inspections.
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Statement of Intent to Employ Minor and Request for Work Permit Example
Statement of Intent to Employ Minor and Request for Work Permit
Not a work permit
For Minor to Complete
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Write number in after printing |
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Minor’s name (last name first) |
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Social security number |
Date of birth |
Age |
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Street address |
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ZIP Code |
Home telephone |
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School name |
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Street address |
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ZIP Code |
School telephone |
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For Employer to Complete (Please review rules for employment of minors on reverse.)
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Name of business
Street address |
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ZIP Code |
Business telephone |
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Minor’s work duties |
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Hourly wage |
Maximum number of hours of employment when school is in session:
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Weekly = 0.00 |
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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 |
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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
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6.Radiation exposure
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9.Other mining
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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.