Free Statement of Intent to Employ Minor and Request for Work Permit PDF Form Prepare Document Here

Free Statement of Intent to Employ Minor and Request for Work Permit PDF Form

The Statement of Intent to Employ Minor and Request for Work Permit form is a crucial document in the United States, designed to ensure the lawful employment of minors by detailing the nature of the work, hours, and conditions under which the minor will be employed. This form acts as a protective measure, safeguarding the rights and well-being of young workers across the country. To learn more about how to properly fill out this form and ensure compliance with child labor laws, click the button below.

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Content Overview

Entering the workforce as a minor comes with its own set of rules and regulations, designed to ensure the safety and well-being of young workers. At the heart of navigating these rules is the essential document known as the Statement of Intent to Employ Minor and Request for Work Permit. This form serves multiple vital functions: it officially documents a minor's intention to work, it requires the approval of both a parent or guardian and the prospective employer, and it necessitates an evaluation by the minor's school to ensure that employment does not negatively impact academic performance. Moreover, the form acts as a safeguard, setting forth the conditions under which the minor is permitted to work, including hours and types of work allowed, thereby protecting young workers from exploitation and ensuring that their work experience is both safe and enriching. Understanding and correctly completing this form is a crucial step for any minor eager to explore the workforce, as well as for employers who are dedicated to fostering a legally compliant and nurturing work environment for their youngest employees.

Example - Statement of Intent to Employ Minor and Request for Work Permit Form

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.

Form Data

Fact Name Description
Form Purpose This form is used to formally request a work permit for a minor. It demonstrates the minor's intent to work and the employer's agreement to hire them under the conditions set by local law.
Involved Parties The form typically requires information and signatures from three key parties: the minor seeking employment, the employer offering the job, and the minor's school or educational institution.
State-Specific Variations Requirements for the form can vary significantly from one state to another, reflecting differences in state laws governing the employment of minors.
Governing Laws While specifics vary, all states' forms are governed by federal and state laws aimed at protecting minors in the workplace, including restrictions on hours, types of work, and working conditions.

How to Fill Out Statement of Intent to Employ Minor and Request for Work Permit

Filling out the Statement of Intent to Employ Minor and Request for Work Permit form is a crucial step for young individuals seeking employment opportunities. This process not only aligns with legal requirements but also ensures the protection of minors in the workforce. The completion of this form is a collaborative effort between the employer, the minor, and, if applicable, the minor’s parents or guardians. Following these detailed steps will simplify the process, ensuring accuracy and compliance with state laws and regulations.

  1. Gather necessary information, including the minor's personal information (full name, date of birth, and address), the employer's details (business name, address, and supervisor's name), and the job description (including hours and duties).
  2. Begin by filling out the minor's section with the requested personal information. It is essential that this information is accurate to avoid any legal issues or delays.
  3. The employer is required to complete their section next. This includes providing detailed information about the job offer, such as the nature of work, hours per week, and salary. The employer must assure that the work conditions comply with state labor laws regarding minors.
  4. Parents or guardians, if applicable, should review the form next. Their role is to provide consent for the minor to be employed, ensuring they have no objections to the job specifications and conditions.
  5. The form should then be submitted to the school district or the authority responsible for issuing work permits in your area. This may involve bringing the form to the minor's school or sending it to a designated office.
  6. Wait for the processing of the work permit. The issuing authority will review the form for completeness and compliance with labor laws before granting a work permit.

Upon receiving the work permit, it's important for all parties involved to understand that this document is not merely a formality. It represents a commitment to uphold the terms agreed upon, with the well-being and safety of the minor being of paramount importance. The permit facilitates an opportunity for young individuals to gain valuable work experience, while simultaneously ensuring that their rights are protected and that their employment does not interfere with their education or well-being. Proper adherence to the steps outlined ensures a smooth and lawful transition into the workforce for minors.

FAQ

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

This form is a legal document that is required in many states for minors (individuals under the age of 18) who seek to work. It serves two main purposes: to declare an employer's intention to hire a minor and to request a work permit on the minor's behalf. The form ensures that the employment complies with state labor laws, particularly those concerning the safety and education of minors.

Who needs to complete the Statement of Intent to Employ Minor and Request for Work Permit form?

The employer who intends to hire a minor must fill out this form. Additionally, the minor and their parent or guardian are often required to provide information and signatures to confirm their consent to the employment arrangement. Once completed, it typically needs to be submitted to and approved by the minor's school or a designated issuing officer before the minor can legally begin work.

What information is required on this form?

The form usually asks for details about the minor, such as their name, age, and school information. It will also require information about the employer, including the business name, job description, and work hours. Essential to the form is the nature of the work to be performed and the hours the minor will work, to ensure they do not interfere with their education and comply with child labor laws. Signatures from the minor, their parent or guardian, and the employer affirm the accuracy of the information and compliance with labor regulations.

Where do I submit the completed form?

Once filled out, the form should be submitted to the minor's school or to the designated issuing officer who is responsible for approving work permits for minors. The specific office or individual can vary by state or school district, so it is advisable to check with the minor’s school or state labor department to find out where the form should be sent. After review and approval, the school or issuing officer will issue a work permit to the minor.

Is there a deadline for submitting the Statement of Intent to Employ Minor and Request for Work Permit form?

While there isn't a universal deadline applicable in all states, it is generally recommended to submit the form and obtain the work permit before the minor starts their employment. Processing times can vary, so allowing ample time for the school or issuing officer to review the application and issue the permit is wise. Additionally, some states or schools may have specific deadlines, particularly during busy times of the year, so it’s important to inquire locally.

Common mistakes

  1. Not carefully reading the instructions before filling out the form is a common mistake. This leads to avoidable errors due to overlooking important details.

  2. Entering incorrect personal information, such as misspellings in the minor’s name or inaccuracies in the birth date, can cause delays. These errors affect the processing of the form.

  3. Failing to specify the nature of the employment accurately. Employers might provide vague job descriptions, which are not helpful in determining the suitability of the work for a minor.

  4. Omitting necessary signatures is another issue. Both the minor and the employer are required to sign the form, and missing signatures result in the request being incomplete.

  5. Not checking the legal requirements for employing a minor in the specific state can lead to violations. Each state has unique laws regarding minor employment, including permitted work hours and conditions.

  6. Miscalculating the number of working hours or scheduling errors, such as assigning work during school hours for school-age minors, can also occur. This mistake contravenes labor laws designed to protect minors.

  7. Forgetting to update the form when changes occur in employment details, such as job responsibilities or work hours, is common. Regular updates are necessary to maintain compliance with state labor laws.

Each of these mistakes can delay the issuance of the work permit or lead to non-compliance with labor laws. It is essential for both employers and minors to review the form carefully and ensure all provided information is accurate and up-to-date.

Documents used along the form

When businesses and organizations embark on the process of employing minors, a comprehensive set of forms and documents typically accompanies the Statement of Intent to Employ Minor and Request for Work Permit. Collectively, these forms ensure compliance with regulations, facilitate the hiring process, and protect the rights and safety of young workers. Below is a breakdown of commonly required documents that often accompany the Work Permit request, providing clarity and support for both employers and their future young employees.

  • Proof of Age: A crucial document, often a birth certificate or passport, that verifies the minor's age to ensure they are legally permitted to work.
  • Parental Consent Form: This form is a written agreement from the minor's parent or guardian permitting their child to work, underscoring the collaborative nature of employment decisions involving minors.
  • Employment Eligibility Verification Form (I-9): Required for all employees in the United States to verify the identity and employment authorization of individuals hired for employment.
  • Pre-Employment Background Check Authorization: Given that minors may be involved, this document, with parental consent, allows employers to conduct necessary background checks.
  • Health and Safety Training Certifications: If the job involves specific health or safety risks, proof of completed training sessions safeguarding the well-being of young workers may be required.
  • Proof of Completed Education or Enrollment: Some states require that minors be either enrolled in school or have completed a minimum educational requirement before they can be lawfully employed.
  • Emergency Contact Information: A form that lists contact information for immediate family members or guardians, ensuring the minor's safety at work.
  • Hours of Work and Schedules: Detailed schedules that comply with state laws regarding the number of hours minors are permitted to work, especially during school sessions.
  • Job Description and Duties: A clear and comprehensive outline of the job role, responsibilities, and expectations to ensure understanding and agreement among all parties.

Each document plays a pivotal role in constructing a secure and legal framework for employing minors. By carefully managing these forms, employers contribute to a positive and lawful work environment, ensuring that the energy and talents of young individuals are harnessed responsibly and beneficially. The harmony of detailed preparation and adherence to legal guidelines encapsulates the essence of successfully employing minors.

Similar forms

  • Employment Eligibility Verification (Form I-9): Similar to the Statement of Intent to Employ Minor and Request for Work Permit, the Form I-9 is required for verifying the identity and employment authorization of individuals hired for employment in the United States. Both forms are integral in the hiring process to ensure compliance with employment laws.

  • Minor's Application for Work Permit - Child Labor Law: This document is specifically designed for minors seeking employment, requiring information about the potential employer, the nature of the work, and working hours, similar to the Statement of Intent. Both documents are aimed at protecting minors in the workforce and ensuring their employment does not interfere with their education or wellbeing.

  • Employment Application Form: The Employment Application Form collects personal information, employment history, and references from applicants, akin to the Statement of Intent to Employ Minor which also collects detailed information about the minor and the job. Both forms are initial steps in the hiring process.

  • W-4 Form (Employee’s Withholding Certificate): While the W-4 Form is used for tax withholding purposes, it is similar to the Statement of Intent to Employ Minor in that it is a prerequisite for employment. Both documents need to be completed at the start of employment to ensure compliance with relevant laws and regulations.

  • Direct Deposit Authorization Form: This form authorizes the deposit of funds directly into an employee's bank account, similar to how the Statement of Intent allows for the employment of a minor under specific conditions. Both are administrative documents essential for the employment process.

  • Job Safety Analysis Form: Similar to the Statement of Intent that ensures the minor’s employment will not be detrimental to their health or schooling, the Job Safety Analysis Form evaluates potential hazards associated with a job. Both documents contribute to the safety and wellbeing of employees.

  • Employee Handbook Acknowledgement Receipt: This document acknowledges that an employee has received and understood the company's handbook, similar to how the Statement of Intent to Employ Minor indicates an understanding of the terms of employment for minors. Both forms ensure employees are aware of and agree to follow policies and regulations.

  • Confidentiality Agreement: Although primarily serving to protect proprietary information, a Confidentiality Agreement shares the aspect of formalizing an agreement between parties before employment commences, akin to the Statement of Intent to Employ Minor. Both are preventative measures, ensuring that all parties understand and agree to certain conditions before the start of employment.

Dos and Don'ts

Filling out the Statement of Intent to Employ Minor and Request for Work Permit form is a crucial step for minors seeking employment. The process should be approached with care to ensure accuracy and compliance with regulations. Here are some essential do's and don'ts to consider:

Do's:
  • Ensure all information is accurate and up-to-date. Double-check details like the minor's personal information, job description, and employer details to prevent any mistakes.
  • Have the minor's parent or guardian sign the form if required. Their approval is often necessary for processing the work permit.
  • Include the employer's information, such as the business name, address, and supervisor's contact details, to provide clear employment context.
  • Describe the nature of the work and hours accurately. It's crucial for the issuing authority to understand the minor's working conditions.
  • Keep a copy of the completed form for your records. It’s good practice to have a personal backup in addition to the official submission.
  • Contact the appropriate issuing authority if you have any questions or need clarification on the form's requirements.
Don'ts:
  • Don't leave any required fields blank. Incomplete forms may be returned or delayed, affecting the minor's ability to start work.
  • Don't provide false or misleading information. This can lead to legal issues or the revocation of the work permit.
  • Don't forget to check the minor's eligibility for employment, including age restrictions and permitted work hours.
  • Don't overlook the need for additional documentation that may be required apart from the Statement of Intent to Employ Minor and Request for Work Permit form.
  • Don't assume the form's submission is the final step. Follow up to ensure the permit is processed and issued.
  • Don't underestimate the importance of reading all instructions carefully before filling out the form. This helps avoid common mistakes.

Misconceptions

Many people have misconceptions about the Statement of Intent to Employ Minor and Request for Work Permit form. Understanding what these documents entail and clarifying common misunderstandings can help both employers and young workers navigate the process more effectively.

  • All minors can self-certify for work permits. This is a common misconception. In reality, the process requires approval from several parties. The minor, a parent or guardian, and the prospective employer must all complete their respective sections of the form. In some cases, a school official's signature is also necessary to validate the minor's eligibility to work, emphasizing the importance of a shared responsibility in this process.

  • Once obtained, the work permit is valid indefinitely. This is not the case; work permits are usually issued for a specific job with a particular employer and are only valid for a set period. If a minor wants to change jobs, they must obtain a new permit. Additionally, there may be renewals required for continuous employment, often coinciding with the school year.

  • The form is the same in every state. Each state has its own laws governing the employment of minors, and as such, the form and its requirements can significantly vary. It's crucial for both employers and employees to verify they are using the correct state-specific form and adhering to its unique guidelines and restrictions.

  • Minors can work in any job once they have a work permit. Even with a work permit, there are restrictions on the types of jobs minors can hold, especially for those under certain ages. These restrictions are in place to ensure the safety and well-being of young workers, focusing on prohibiting employment in hazardous occupations and limiting working hours to accommodate schooling commitments.

  • Employers do not need to keep a copy of the work permit on file. On the contrary, employers are generally required to keep a copy of the work permit on file for all minor employees. This serves as proof of age and that the minor is legally allowed to work, as well as to ensure compliance with labor laws. Failure to maintain these records can lead to penalties and fines.

Clearing up these misconceptions is essential for both employers looking to hire minors and for young individuals seeking employment opportunities. By understanding the specific requirements and limitations of the Statement of Intent to Employ Minor and Request for Work Permit form, all parties involved can ensure a smooth and lawful employment process.

Key takeaways

The Statement of Intent to Employ Minor and Request for Work Permit form is a critical document for employers who wish to hire individuals under the age of 18. It serves to ensure that minors are engaged in safe work environments and that their employment does not interfere with their education. Understanding how to accurately fill out and use this form is essential for maintaining compliance with labor laws. Here are four key takeaways to assist employers and educators in navigating this process:

  • Accuracy is paramount when completing the form. Every section should be filled out with precise information regarding the minor’s potential role, working hours, and the nature of the work to be performed. Errors or omissions can delay the process or result in non-compliance with labor laws.
  • Both the employer and the minor’s parent or guardian, as well as the minor themselves, need to provide signatures. This ensures all parties are informed and consent to the terms of employment. It's a safeguard designed to protect minors by involving their guardians in the decision-making process.
  • The document must be submitted to, and approved by, the minor’s school or a designated issuing officer. This step is crucial for the work permit to be valid. Schools play a role in certifying that the job will not negatively impact the minor's education.
  • The issuance of the work permit is not the final step. Employers are required to keep the work permit on file and accessible for inspection for as long as the minor is employed. Furthermore, adherence to the specific terms outlined in the permit regarding hours and types of work permitted is mandatory. Any changes in the minor’s job role or hours require a new permit.

In summary, the Statement of Intent to Employ Minor and Request for a Work Permit form is a tool designed to protect minors in the workforce. Employers, guardians, and educators must collaborate to ensure that the employment opportunity is safe, legal, and beneficial to the minor’s development and education. Comprehensively understanding and following the stipulated process aids in fostering a responsible and lawful work environment for young workers.

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