Statement of Intent to Employ Minor and Request for Work Permit Template

Statement of Intent to Employ Minor and Request for Work Permit Template

The Statement of Intent to Employ Minor and Request for Work Permit form is a crucial document that employers must submit to obtain permission to hire minors for work. This form not only outlines the employer's intent but also helps ensure compliance with child labor laws, providing protections for young workers. It's important for both employers and minors to understand the requirements involved in this process.

To start the application process, fill out the form by clicking the button below.

Content Overview

The journey of a young person entering the workforce can be both exciting and daunting, highlighting the importance of proper documentation to safeguard their rights and well-being. One essential form that plays a crucial role in this process is the Statement of Intent to Employ Minor and Request for Work Permit. Designed specifically for employers, this form establishes a formal request to hire a minor, ensuring compliance with both federal and state labor laws. It requires information about the employer, the minor's details, and the nature of the work to be performed. By completing this form, employers signal their dedication to providing a safe working environment while also outlining the minor's rights. Additionally, the form emphasizes the need for parental consent, underscoring the collaborative effort between families and businesses to support youth employment. Understanding the significance of this document is key for both aspiring young workers and potential employers navigating the landscape of youth employment regulations.

Statement of Intent to Employ Minor and Request for Work Permit Sample

Statement of Intent to Employ Minor and Request for Work Permit

Not a work permit —Print all information except signatures

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

Year-Round

Signature of verifying authority

Work Experience Education

Other (specify)

CALIFORNIA DEPARTMENT OF EDUCATION FORM B1-1 (revised 6/03)

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 B1-1) for the school district of attendance for each such minor.

Employers must retain a “Permit to Employ and Work” (form B1-4) for each such minor.

Work permits (B1-4) must be retained for three years and be available for inspection by sanctioned authorities at all times.

A work permit (B1-4) must be revoked whenever the issuing authority determines the employment is illegal or is impairing the health or education of the minor.

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.Power-driven woodworking machines

6.Radiation exposure

7.Power-driven hoists/forklifts

8.Power-driven metal forming, punching, and shearing machines

9.Other mining

10.Power-driven meat slicing/processing machines

11.Power-baking machines

12.Power-driven paper products/paper bailing machines

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 baby-sitting, or in private homes where the minor is not regularly employed.

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 non-school day or on any day that precedes a non-school day. May be permitted to work up to 48 hours per week. Students in Work Experience Education or cooperative vocational education programs may be permitted to work a maximum of 8 hours on a school day.

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 non-school days may work 8 hours. Weekly maximum of 18 hours. Students in Work Experience Education and career exploration programs may work up to 23 hours per week.

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 Attributes

Fact Name Details
Purpose The form is used to request legal permission for a minor to work.
Eligibility Minors typically need to be at least 14 years old, depending on state laws.
Consent Parental or guardian consent is usually required for minors to work.
State Compliance Each state has unique requirements for the work permit process.
Governing Laws The Fair Labor Standards Act (FLSA) governs child labor at the federal level; state laws may vary.
Submission The completed form must be submitted to the appropriate state agency.
Work Conditions The form may outline specific work conditions and hours permitted for minors.
Employer Responsibilities Employers must ensure compliance with both federal and state labor laws.
Expiration The work permit may have an expiration date, after which renewal is necessary.

Statement of Intent to Employ Minor and Request for Work Permit: Usage Instruction

After gathering the necessary information and documentation, the next step involves completing the Statement of Intent to Employ Minor and Request for Work Permit form. This process requires attention to detail, ensuring that all required fields are accurately filled out. Make sure to have all pertinent information at hand before you begin.

  1. Obtain the form from the relevant state or local labor department's website or office.
  2. Read through any instructions or guidelines provided with the form to understand the requirements.
  3. Enter the minor’s full name in the designated section.
  4. Fill in the minor’s date of birth, ensuring it is accurate.
  5. Provide the minor's address including city, state, and zip code.
  6. Indicate the name of the business or organization that intends to employ the minor.
  7. Include the business address in the specified section, including city, state, and zip code.
  8. Fill in the name of the person completing the form on behalf of the employer.
  9. Provide the title or position of the person completing the form.
  10. Specify the nature of the work or job responsibilities the minor will be performing.
  11. State the expected hours of work and any special conditions related to the job.
  12. Review the form for accuracy and completeness before signing it.
  13. Submit the completed form to the appropriate labor department along with any required documentation or fees.

Once you have submitted the form, it will be processed by the relevant authorities. They will review the information provided and determine whether to issue the work permit for the minor. You may need to follow up if additional information is requested.

Frequently Asked Questions

  1. What is the Statement of Intent to Employ Minor and Request for Work Permit form?

    This form is required when an employer wishes to hire a minor, typically defined as someone under 18 years of age. The form serves two purposes: it indicates the employer’s intent to employ the minor and requests a work permit from the appropriate state authority. This process helps ensure that the minor's work adheres to labor laws designed to protect young workers.

  2. Who needs to fill out this form?

    The employer must complete the form. Additionally, a parent or guardian of the minor will need to provide their consent. The completed form must be submitted to the state agency responsible for issuing work permits in order for the minor to legally work.

  3. What information is required on the form?

    The form generally requires details like the name, address, and contact information of both the employer and the minor, including the minor's date of birth. You'll also need to specify the type of work the minor will be doing and the hours they will work. Consent from a parent or guardian, along with their signature, is also necessary.

  4. How does a minor apply for a work permit?

    To apply for a work permit, the minor should have the completed Statement of Intent to Employ Minor and Request for Work Permit form ready. This form, along with any required identification and parental consent, must then be submitted to the appropriate state agency. This process may vary slightly depending on your state, so it’s advisable to check local guidelines.

  5. Are there age restrictions on the type of work minors can do?

    Yes, there are specific age restrictions related to the type of work minors can engage in. For example, younger minors may be restricted from working in hazardous environments or performing certain tasks. Employers should familiarize themselves with both federal and state labor laws to ensure compliance and to protect the welfare of the minor.

  6. What is the process after the form is submitted?

    After submission, the relevant state agency will review the Statement of Intent to Employ Minor and Request for Work Permit form. Once approved, the agency will issue a work permit. It’s important for the employer and minor to keep a copy of this permit, as it serves as proof that the minor is legally allowed to work.

  7. Can the work permit be revoked? If so, under what circumstances?

    Yes, a work permit can be revoked. This may happen if the employer violates labor laws, if the minor is found to be working in unsafe conditions, or if the minor fails to maintain acceptable school attendance, among other reasons. Continuous monitoring of compliance with labor laws helps ensure the minor's rights and safety are protected during their employment.

Common mistakes

Filling out the Statement of Intent to Employ Minor and Request for Work Permit form can be a straightforward process, but many make common mistakes that can delay approval or create confusion. One significant error occurs when the employer forgets to provide accurate identification information. This includes details such as the legal name of the business, the physical address, and the correct Employer Identification Number (EIN). Without this information, the form may be considered incomplete, causing unnecessary delays in processing.

Another frequent mistake involves the minor's personal information. Parents or guardians often overlook the accuracy of the minor's date of birth or social security number. Providing incorrect or mismatched information can lead to complications, as these details are crucial for verifying the minor's eligibility to work. It is essential to double-check that each piece of information aligns with official documents to avoid issues down the line.

Inadequate signatures also pose a significant problem. The form requires signatures from both the employer and the minor’s parent or guardian. Missing or illegible signatures can result in the form being rejected. It is important to ensure that all signatures are clear and match the names printed in the relevant sections, enhancing clarity and reducing the chance of misinterpretation.

Additionally, failing to specify the exact nature of the job and the hours of work can lead to misunderstandings. The form must detail the job responsibilities and the proposed work hours, including any limitations. Providing this information is vital since there are regulations regarding the types of work minors can engage in, as well as the permissible hours they can work. Skipping this information can lead to delays as the employer may need to provide additional explanations or documentation.

Lastly, neglecting to attach any required supporting documents is another pitfall that applicants commonly encounter. This may include proof of age or parental consent, which are often mandatory. Without these documents, the application may be stalled, requiring resubmission of the form along with the missing attachments. To streamline the process, ensure that all necessary documentation is included and organized before submission.

Documents used along the form

In the process of employing a minor, various documents are essential to ensure compliance with labor laws and regulations. Each of these forms serves a specific purpose, facilitating a smooth application process for obtaining permission to hire individuals under the age of 18. Here’s a list of common documents associated with the Statement of Intent to Employ Minor and Request for Work Permit form.

  • Parental Consent Form: This document requires the signature of a parent or legal guardian, granting permission for the minor to work. It confirms that the guardian agrees to the employment terms and is aware of the work hours and conditions.
  • Application for Employment: This form is typically completed by the minor, providing personal information, work preferences, and any previous work experience. It helps potential employers assess the candidate’s suitability for a position.
  • Minor’s Work Schedule: Employers must outline a detailed work schedule for the minor, specifying the hours and days they will work. This form ensures that the employment adheres to the regulations regarding permissible work hours for minors.
  • Health and Safety Agreement: This agreement emphasizes the importance of a safe working environment. It ensures that both employer and employee understand health and safety regulations, specifically tailored for minors.
  • Verification of Age Document: Employers may need to provide proof of the minor’s age, often in the form of a birth certificate or a government-issued identification card. This helps confirm that the individual is eligible for the position based on age-related regulations.
  • Job Description: A clear outline of the job responsibilities and expectations is crucial. This document helps minors understand their roles and the scope of work involved, ensuring that the tasks align with legal guidelines for youth employment.

Being familiar with these forms not only aids in adhering to the law but also promotes a responsible and supportive work environment for minors. Employing young individuals can provide invaluable experience, and understanding the necessary paperwork eases the overall process for employers and guardians alike.

Similar forms

  • Parental Consent Form: This document requires the signature of a parent or guardian, granting permission for a minor to work. Similar to the Statement of Intent to Employ Minor, it ensures that a parent or guardian is informed and agrees to the employment arrangement.
  • Youth Employment Certificate: This certificate is often issued by a school or a state agency. It verifies that a minor meets the age requirements for employment and is thus related to verifying eligibility for work.
  • Employment Application: This document collects personal information, work history, and references for a potential employer to evaluate a candidate. Like the Statement of Intent, it is essential for establishing the minor's qualifications and intentions to work.
  • Job Offer Letter: The letter outlines the terms of employment and is provided by the employer once they decide to hire the minor. Similar to the Statement of Intent to Employ Minor, it formalizes the employment arrangement between the employer and the minor.

Dos and Don'ts

When filling out the Statement of Intent to Employ Minor and Request for Work Permit form, careful attention is crucial to ensure compliance with legal requirements and to expedite the processing of the work permit. Here are some important guidelines:

  • Do provide accurate personal information for both the minor and the employer.
  • Do include the correct job title and description of the work the minor will perform.
  • Do ensure that the hours and days the minor will work are clearly stated.
  • Do sign and date the form to validate the request.
  • Don't use vague or misleading language in job descriptions or duties.
  • Don't overlook the need for parental consent, if applicable, when the minor is under age.
  • Don't forget to check for specific state laws that may influence the process.
  • Don't assume incomplete forms will be accepted; ensure all fields are correctly filled out.

Misconceptions

Below are some common misconceptions about the Statement of Intent to Employ Minor and Request for Work Permit form. Understanding the facts can help clarify the process and requirements for employing minors.

  • Misconception 1: The form is only necessary if the minor works full-time.
  • In truth, the form is required for any employment of minors, regardless of whether it is full-time or part-time.

  • Misconception 2: Employers can skip the form if they have a verbal agreement with the minor and their parent.
  • Employers must complete the form to comply with the law, even if a verbal agreement is in place.

  • Misconception 3: All minors are eligible for a work permit automatically.
  • Not all minors qualify for a work permit. Eligibility varies based on age, type of work, and other conditions.

  • Misconception 4: The form can be submitted after the minor starts working.
  • The form must be submitted and approved before the minor begins employment.

  • Misconception 5: Completing the form guarantees that a work permit will be issued.
  • Filling out the form does not guarantee approval. The application is subject to review by the appropriate authorities.

  • Misconception 6: There are no restrictions on the type of work minors can do.
  • Certain jobs are off-limits for minors. Specific regulations dictate what types of work are acceptable based on age.

  • Misconception 7: Only state forms are needed with no additional documentation required.
  • Employers may need to provide other documents based on local laws or specific requirements for certain industries.

  • Misconception 8: Once approved, the work permit does not need to be renewed.
  • Work permits for minors often have an expiration date and may need to be renewed periodically.

  • Misconception 9: The parent’s signature is optional.
  • The parent's or guardian's signature is a mandatory part of the form and must be included for the application to be valid.

Key takeaways

Filling out the Statement of Intent to Employ Minor and Request for Work Permit form can seem daunting, but understanding the key points can make the process smoother. Here are some important takeaways:

  • Know the age requirements: Ensure the minor meets the age criteria for employment in your state. Different rules may apply depending on the minor’s age.
  • Gather necessary information: Collect all relevant details about the minor, the job, and the employer before starting the form.
  • Obtain consent: Make sure to get written permission from a parent or legal guardian, as this is often a requirement.
  • Be clear about job duties: Describe the work the minor will perform. Clarity helps in understanding the responsibilities involved.
  • Compliance with labor laws: Ensure that the job complies with local, state, and federal labor laws regarding minors.
  • Submit on time: Pay attention to deadlines for submitting the form. Timely submission is crucial for the minor to start work.
  • Keep copies: Retain copies of the completed form and any supporting documents for your records.
  • Track the permit approval: After submission, check the status of the permit to ensure it has been processed.

With these takeaways in mind, you can navigate the process of employing a minor more effectively and responsibly.

More PDF Forms