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In today’s fast-paced world, many young individuals seek employment opportunities to gain experience and contribute to their financial independence. The Statement of Intent to Employ Minor and Request for Work Permit form serves as a crucial tool in this process, ensuring that minor employees enter the workforce safely and legally. Designed for both employers and parents or guardians, this form outlines the necessary steps to obtain a work permit for minors, considering factors such as age restrictions, work hours, and types of permissible employment. By filling out this form, parents confirm their approval of the minor's employment, while employers demonstrate their commitment to adhering to labor laws that protect young workers. Furthermore, the form helps to establish a clear understanding of the job responsibilities and workplace conditions, fostering a smooth transition for minors stepping into the workforce. Ensuring compliance with state regulations, this document plays a pivotal role in safeguarding minors while supporting their aspirations for work experience.

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 —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.

File Breakdown

Fact Name Description
Purpose This form is used to request permission for a minor to work and to ensure compliance with labor laws.
Eligibility Minors must meet specific age requirements, usually between 14 and 17, depending on the state.
Parental Consent A parent or guardian must sign the form to give consent for the minor to work.
State Variations Each state may have its own specific form and regulations regarding minor employment.
Working Hours There are restrictions on the number of hours and types of jobs that minors can perform.
Employment Types Certain jobs may be prohibited for minors, such as those involving hazardous materials.
Application Process The completed form must be submitted to the appropriate state agency for approval.
Renewal The work permit may need to be renewed if the minor continues employment beyond a specified period.
Record Keeping Employers should keep a copy of the work permit on file for their records.
Governing Laws Laws governing minor employment vary by state. Common examples include the Fair Labor Standards Act (FLSA) and state-specific labor laws.

Guide to Using 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 important for ensuring compliance with employment laws for minors. After completing the form, you'll submit it to the appropriate authority to obtain the necessary work permit.

  1. Gather all required information: Ensure you have the minor's personal details, including full name, date of birth, and address, as well as details about the job they will perform.
  2. Provide your business information: List your business name, address, and phone number. Include the nature of your business and any relevant licenses.
  3. Complete the employment information section: Fill in the job title, the expected hours of work, and the weekly schedule. Make sure to include any special conditions or requirements the job may have.
  4. Include the minor’s guardian information: The guardian's name, address, and contact number must be clearly stated. Their signature is also required to confirm consent.
  5. Review all information: Double-check that everything is accurate and complete. Correct any errors before submitting the form.
  6. Submit the form: Send the completed form to the designated state agency or local labor office, as instructed on the form. Keep a copy for your records.

Get Answers on Statement of Intent to Employ Minor and Request for Work Permit

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

This form is used by employers in the United States who want to hire minors. It serves as a request for permission from the state to employ a younger worker, typically under the age of 18. It ensures compliance with labor laws designed to protect minors in the workplace.

Who needs to fill out this form?

Employers looking to hire individuals under 18 years of age must complete this form. Additionally, the minor themselves, or their parents or guardians, may need to provide information or consent as part of the process.

What information is required on the form?

The form typically requests the following information:

  • Employer's name and contact information
  • Minor's name, age, and address
  • Details of the job including title and description
  • Working hours and scheduled shifts
  • Parental or guardian consent, if necessary

Do all states require this form?

Not all states require a Statement of Intent to Employ Minor form. However, most states do have regulations regarding the employment of minors. It is essential to check local laws and regulations to determine what is necessary in your state.

How do I submit the form?

Submission processes vary by state. Generally, employers can submit the form to their local labor department or a relevant state agency. Some states may allow for electronic submission, while others may require a physical copy. Be sure to check your state’s requirements.

What happens after the form is submitted?

After submission, the relevant authorities will review the request. If approved, the employer will receive confirmation, allowing them to proceed with employing the minor. If denied, the state will provide reasons for the decision.

Is there a fee associated with the form?

Fees vary by state and sometimes by the specific process of application. Some states may charge a nominal fee for processing the request, while others may not impose any costs. Always confirm with your state’s labor department.

What are the penalties for not complying with these regulations?

Employers who fail to submit the required form may face severe penalties, including fines and restrictions on future hiring of minors. Additionally, employing a minor without proper consent can expose the employer to lawsuits and legal action.

Can a minor work without a permit?

In most cases, minors cannot work legally without a work permit obtained through the proper channels. There are specific exceptions depending on the state and the nature of the job, but generally, a permit is required to ensure safety and compliance with labor laws.

How does this form protect minors in the workplace?

This form is a critical tool for protecting minors by ensuring that employers adhere to safe working conditions and fair hours. It reflects state laws that limit the types and hours of work that young people can engage in, safeguarding their well-being while allowing them to gain work experience.

Common mistakes

Filling out the Statement of Intent to Employ Minor and Request for Work Permit form can be a vital step in hiring a minor for employment. However, many individuals encounter pitfalls that can cause delays or even rejection of the application. One common mistake is failing to provide accurate personal information. It is essential to double-check the spelling of names, addresses, and dates. A simple typo in this section can lead to confusion with the processing team.

Another frequent error involves omitting the required signatures. Both the employer and the parent's or guardian’s signature are mandatory for the form to be valid. Many applicants forget to obtain these signatures, thinking that it is a mere formality. Without them, the application cannot proceed.

Inaccurately reporting the minor’s age also leads to complications. The law often dictates specific age ranges for certain types of employment. If the minor is younger than the legal minimum age for the job offered, the application will not meet compliance. Therefore, it is crucial to verify the age of the minor before submitting the form.

Misunderstanding the job description is another common issue. Applicants sometimes enter vague descriptions rather than specific job titles. An unclear job description can slow down the process or result in outright denial. To avoid this, ensure that the job duties are clearly defined and align with allowable tasks for minors.

Not providing the required documentation may result in significant delays. In many states, proof of age, such as a birth certificate or school identification, is necessary. Failing to attach these documents, or including incorrect documents, can lead to processing delays. Always check the requirements specific to your state.

In some cases, failing to adhere to state-specific regulations may create obstacles. Each state has its own rules regarding the employment of minors, including hours and types of permissible work. It's imperative to review local laws and ensure compliance when filling out the form.

Another mistake involves incorrect or missing emergency contact information. Accurate contact details are vital in case of emergencies or other communications. Inserting outdated or incorrect information can hinder effective communication, creating challenges both for the employer and the minor.

Rushing through the application can also lead to errors. Many individuals fill out the form in a hurry, neglecting to read the instructions carefully. Taking time to review the form thoroughly before submission can help catch mistakes and omissions that could complicate processing.

Lastly, failing to keep a copy of the submitted form is a mistake often made by applicants. Retaining a record of the submitted form ensures that both the employer and the minor can reference it in the future. This step is crucial for managing any potential future inquiries regarding the employment of the minor.

Documents used along the form

The process of employing a minor involves several essential forms and documents to ensure compliance with labor laws and to protect both the employer and the young employee. Each document plays a crucial role in this process, helping to lay a solid foundation for a safe and legal working environment for minors.

  • Parental Consent Form: This document is signed by a parent or legal guardian, granting permission for the minor to work. It outlines the hours and conditions of employment.
  • Work Permit: A work permit, often a separate document, is required for minors to legally work. It usually includes details about the minor’s age, the type of work, and the employer's information.
  • Age Verification Documents: These are typically copies of birth certificates or other official documents that confirm the minor’s age. Employers must verify the minor's age to comply with legal working age requirements.
  • Job Description: A clear job description outlines the specific duties and responsibilities of the minor's position. It helps ensure that the work is appropriate for their age and abilities.
  • Employer's Liability Insurance: This document confirms that the employer has adequate insurance coverage in case of work-related injuries or accidents involving the minor.
  • Health and Safety Policy: An employer should provide a written health and safety policy that informs the minor of potential hazards and the measures in place to ensure their safety on the job.
  • Time-Tracking Records: These documents track the hours worked by the minor. Employers must maintain accurate records to adhere to labor laws regarding work hours and conditions.
  • Termination Notice: Should employment end, this notice documents the cessation of work. It is important for record-keeping and for understanding the terms of dismissal or resignation.

Having these documents in place fosters a legal and safe working environment for minors, allowing them to gain valuable experience while ensuring compliance with state and federal labor laws. Each piece plays its part in protecting the rights and well-being of young workers.

Similar forms

  • Employment Certificate: This document certifies that a minor is legally allowed to work. Similar to the Statement of Intent, it often includes details about the minor's job, employer, and hours of work.
  • Guardian Consent Form: This form provides proof of parental or guardian permission for a minor to work. It is necessary to ensure that the young worker's rights and safety are considered, just like the work permit form.
  • School Approval Letter: This letter confirms that the minor's school is aware of and permits their employment, if applicable. It serves to ensure that work does not interfere with education, similar to how the work permit regulates hours.
  • Job Description Form: This outlines the specific duties a minor will perform at work. Like the Statement of Intent, it clarifies what the job entails and ensures compliance with relevant labor laws.
  • Safety Training Certification: This document indicates that a minor has completed safety training relevant to their job. It is similar to the work permit form in that it prioritizes the health and safety of young workers.
  • Employment Eligibility Verification Form (I-9): Though primarily used for verifying identity and employment eligibility, it shares a similar purpose of ensuring that all employment-related legal requirements are met for a minor.

Dos and Don'ts

When filling out the Statement of Intent to Employ Minor and Request for Work Permit form, it's important to keep certain guidelines in mind. Here are five things you should do and five things you shouldn't do:

  • Do ensure all sections of the form are complete.
  • Do verify that the information is accurate and up-to-date.
  • Do provide required signatures from both the employer and the minor's parent or guardian.
  • Do check for any specific state requirements or additional documentation needed.
  • Do submit the form well in advance of the desired start date for employment.
  • Don't leave any blank fields unless specifically instructed to do so.
  • Don't include any misleading or false information.
  • Don't forget to double-check for spelling errors and typos.
  • Don't assume that electronic submissions are always accepted; confirm the method of submission accepted.
  • Don't wait until the last minute to submit the form, as processing may take time.

Misconceptions

Many people have a misunderstanding about the Statement of Intent to Employ Minor and Request for Work Permit form. Clarifying these misconceptions can help parents and employers navigate the hiring process for minors more effectively.

  • Misconception 1: This form is only required for certain types of jobs.
  • In reality, any organization wishing to employ a minor, regardless of the job type, must complete this form. It applies broadly to various industries and roles.

  • Misconception 2: Minors can start working immediately after submitting the form.
  • Submitting the form does not grant immediate permission to work. It is essential to await the issuance of the work permit, which indicates official approval.

  • Misconception 3: Only the minor’s parents need to sign the form.
  • The form requires signatures from both the employer and the minor’s parents or guardians, ensuring that all parties are aware of and agree to the employment arrangement.

  • Misconception 4: Once a work permit is obtained, it remains valid indefinitely.
  • Work permits for minors are typically valid for a limited time and may need renewal. Employers and minors should be mindful of the expiration dates to maintain compliance with labor laws.

  • Misconception 5: The form can be disregarded if the minor is over a certain age.
  • Even if a minor is nearing the age of majority, employers must still complete the form as long as the individual is technically classified as a minor for employment purposes.

Key takeaways

When filling out the Statement of Intent to Employ Minor and Request for Work Permit form, it's essential to keep several key points in mind:

  • Accurate information is crucial. Ensure all details about the minor and the employer are correct.
  • The form requires signatures from both the employer and the minor’s parent or guardian.
  • Understand the age restrictions. Different rules apply depending on the minor's age.
  • Confirm work hours. There are limits on how many hours a minor can work, depending on their age.
  • Familiarize yourself with state-specific regulations. Some states may have additional requirements.
  • Keep a copy of the completed form for your records. This can be important for future reference.
  • Submit the form to the appropriate local authority. Check where to send it based on your state’s guidelines.
  • Review the requirements for the type of work being performed. Not all jobs are suitable for minors.

By following these takeaways, the process can be smoother for both the minor and the employer.