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

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

The Statement of Intent to Employ Minor and Request for Work Permit form is a legally required document in the United States that must be completed by employers wishing to hire individuals under the age of 18. This form ensures that the employment of minors is conducted in compliance with federal and state labor laws, focusing on the safety and welfare of young workers. For those interested in employing a minor or young individuals seeking employment, it's essential to complete this form diligently. Click the button below to learn more about how to fill out the form properly.

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In the landscape of youth employment, navigating the regulations and ensuring compliance with labor laws is crucial both for employers and the young employees themselves. Central to this navigational process is the "Statement of Intent to Employ Minor and Request for Work Permit" form, a document that serves multiple purposes: it is a declaration by employers of their intention to hire a minor, a request to the authorities for permission to do so, and a concise encapsulation of the terms under which the minor will be employed. The form acts as a safeguard, aiming to protect the rights of young workers by ensuring that their employment does not interfere with their education and welfare. Additionally, it facilitates a legal framework within which minors can gain valuable work experience. In essence, this form is a critical tool in the balance between providing employment opportunities to minors and protecting their rights and well-being in the workforce.

Preview - 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.

Document Specs

Fact Name Description
Purpose of the Form This form is used to request and authorize employment for minors under the age of 18, ensuring compliance with child labor laws.
Who Completes It The form must be completed by the minor’s employer and signed by the minor, the employer, and in some cases, the minor's parent or guardian.
Requirement for School-Aged Minors School-aged minors are often required to obtain a work permit from their school as part of the process, ensuring that work does not interfere with their education.
Governing Laws The specific requirements and governing laws vary by state. In California, for example, the process is governed by the California Labor Code.
Age Verification Proof of age, such as a birth certificate or driver's license, is often required to accompany the form to verify the minor’s age.
Limits on Working Hours The form helps ensure compliance with laws limiting the hours that minors can work, both during school sessions and in vacation periods.
Occupational Restrictions Certain hazardous occupations are forbidden for minors, and the form helps ensure that the minor's employment will not involve prohibited work.
State-Specific Variations While the general purpose of the form is consistent, each state may have its own version with additional requirements or restrictions.
Renewal and Validity The work permit must be renewed for each new job or if the minor changes schools, and the validity period of the permit can vary by state.

Instructions on Writing Statement of Intent to Employ Minor and Request for Work Permit

After deciding to hire a young person, the next step is navigating through the paperwork to ensure everything is lawful and properly documented. One essential document in this process is the Statement of Intent to Employ Minor and Request for Work Permit form. This document needs to be filled out meticulously by both the employer and the minor's parent or guardian, then submitted to the appropriate educational or government authority. The following steps will guide you through completing the form accurately.

  1. Gather necessary information, including the minor’s personal details (such as full name, date of birth, and address), employer details, and the specifics of the job offer (such as job title, duties, and hours).
  2. Start by filling out the section designated for the minor's information. Make sure to print clearly and double-check for accuracy.
  3. Next, the employer fills out their section, which includes the business name, address, and a detailed description of the minor’s job duties, working hours, and salary.
  4. The parent or guardian must then read the information provided and complete their section, typically requiring their signature to consent to their child’s employment under the terms outlined.
  5. Review the form to ensure all sections are completed and that there are no discrepancies in the information provided.
  6. If the form requires it, the school official or another designated authority might also need to fill out a section, usually to confirm the minor’s enrollment and academic standing. Ensure this part is completed if applicable.
  7. Finally, submit the completed form to the designated receiving authority, which could be the school, district office, or a state labor department, depending on local laws. It is advisable to keep a copy for your records.

Completing the Statement of Intent to Employ Minor and Request for Work Permit form is a crucial step in hiring a minor. It not only complies with legal requirements but also protects all parties involved by ensuring the work arrangement is suitable for the young worker. Pay close attention to the details and instructions provided in each section to facilitate a smooth and compliant hiring process.

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

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

This form serves as a formal document required by many states in the United States for individuals under the age of 18 who wish to work. It outlines specific details about the proposed job, including the nature of the work, hours, and conditions, ensuring that employment does not interfere with the education and well-being of the minor. Employers, minors, and educational or legal guardians must complete it as a part of the work permit application process.

Who needs to fill out this form?

Three main parties are involved in the completion of this form: the minor seeking employment, the employer offering the job, and a designated school official or, in some cases, a legal guardian. Each party is responsible for providing accurate information relevant to their role to ensure compliance with labor laws designed to protect minors in the workforce.

Where can I obtain this form?

The form is typically available through school district offices, specifically through a minor's school. It can also often be downloaded from state labor department websites. Availability may vary, so it's advisable to contact your local school district or state labor department for the most accurate and up-to-date information.

What information is required to complete the form?

Completing the form generally requires specific details about the minor, including their age, school, and potential work schedule. The employer must provide a job description, including duties, hours, and conditions of employment, ensuring compliance with regulations regarding minor labor. Finally, a school official or guardian verifies the minor’s academic standing and suitability for employment, endorsing the work arrangement.

Are there any restrictions on the type of work a minor can perform?

Yes, federal and state laws place restrictions on the types of work minors can engage in, aiming to protect them from hazardous conditions and ensure their schooling is not negatively impacted. These restrictions vary by the minor's age, the industry, and the state where employment takes place. Typically, jobs involving hazardous machinery, extreme temperatures, or certain hospitality roles have strict limitations for minors.

How long does it take to process a work permit after submitting the form?

The processing time can vary significantly depending on the locality, the volume of applications, and the time of year. Generally, one should allow at least a week for processing; however, it's advisable to apply well in advance of the intended start date to avoid any delays. Schools and employers may have specific deadlines or additional requirements that could affect processing times.

Is it possible to work without a work permit if the form cannot be submitted in time?

No, minors are generally required to obtain a work permit before they can legally begin employment. Working without a permit can lead to serious consequences for both the employer and the minor. Employers might face legal repercussions, including fines and sanctions, while minors may be removed from their job. It's crucial to start the application process as early as possible to ensure all paperwork is completed and approved before the job’s start date.

Common mistakes

Filling out legal documents correctly is vital, especially when it pertains to employment, and even more so for minors. One common error made when completing the Statement of Intent to Employ Minor and Request for Work Permit form is not double-checking the minor's personal information. It's crucial that names are spelled correctly and that the date of birth matches official records. This might seem basic, but inaccuracies can lead to delays in processing.

Another mistake often made is leaving sections incomplete. Every question on the form is there for a reason, and failing to answer each one can result in the request being denied or delayed. It's essential for both the employer and the minor to review the form thoroughly to ensure all necessary information has been provided.

Employers occasionally make the mistake of not providing a detailed job description. The authorities issuing the work permit need to understand the nature of the work to ascertain its suitability for a minor. Vague descriptions like "office work" do not offer enough insight into what the job entails. A more detailed explanation ensures the application is processed more efficiently.

Forgetting to sign the form is a surprisingly common oversight that can stall the application process. Both the minor seeking employment and their parent or guardian, as well as the employer, must sign the form to indicate their agreement to the terms and responsibilities outlined in the document. Unsigned forms are not valid and will be returned.

Another issue arises when the form is not dated. Including the date on which the form was filled out is essential, as it helps in processing the document within the relevant timelines. Dates are often used to prioritize processing, especially during busy periods.

Underestimating the importance of the school's input is another mistake. Part of the form usually requires endorsement from the minor's school. This is to ensure that the work does not interfere with the minor's education. Neglecting to get this section completed and signed by the appropriate school official could nullify the entire application.

Some people submit the form without the necessary documentation. Depending on jurisdiction, additional documents such as proof of age or school attendance may be required. Failing to attach these documents slows down the application process, as the issuing authority will need to request them before proceeding.

A common but easily avoidable mistake is using outdated forms. Government agencies periodically update forms to reflect current laws and regulations. Submitting an old form can result in an immediate rejection. Always check for the most recent version of the form before filling it out.

Lastly, incorrect submission addresses or methods can lead to delays. Whether the form needs to be submitted in person, by mail, or electronically can vary. Sending it to the wrong place or by the wrong means may mean having to start the process over again. Carefully reading the submission instructions can prevent this mistake.

Documents used along the form

When processing the Statement of Intent to Employ Minor and Request for Work Permit, several other documents are commonly required. These documents help ensure that the employment is legal, beneficial for the minor, and does not interfere with their education. Below is a list and brief descriptions of these essential forms and documents that accompany the request for a work permit.

  • Age Certificate: This document verifies the minor's age and is crucial for employers to ensure compliance with child labor laws.
  • Proof of Education: It may include a report card or a school enrollment form, demonstrating that the minor is enrolled in school, as education takes precedence over employment.
  • Parent's Consent Form: A written consent from the minor's parent or guardian, acknowledging the nature of the employment and giving permission for the minor to work.
  • Employer's Agreement: Outlines the terms of the minor's employment, including duties, hours, and conditions, ensuring they are appropriate and safe.
  • Physician's Certificate: A statement from a doctor certifying the minor is physically fit for the specific type of work, ensuring the job does not pose a risk to their health.
  • School Authorization: Confirmation from the minor's school stating that the employment will not interfere with their education, often including authorized work hours during school terms.
  • Copy of Minor’s Birth Certificate: Used along with the Age Certificate for age verification, helping to prevent underage employment.
  • Recent Photo of the Minor: Sometimes required for identification purposes, ensuring that the work permit is being issued to the correct individual.

Together with the Statement of Intent to Employ Minor and Request for a Work Permit, these documents form a comprehensive dossier that respects the minor's welfare, educational needs, and legal rights. Employers and minors should ensure that all paperwork is accurately completed and submitted to avoid any delays or legal complications in the employment process.

Similar forms

The Statement of Intent to Employ Minor and Request for Work Permit form shares similarities with the Employment Eligibility Verification Form I-9. Both forms are crucial in the employment process, validating the eligibility and legality of candidates for work. Where the Statement of Intent primarily focuses on minors seeking employment, ensuring compliance with labor laws, the Form I-9 is used for all employees in the United States to verify their identity and eligibility to work in the country. Each serves as a protective measure, aiming to maintain lawful and ethical hiring practices.

Similarly, the Work Opportunity Tax Credit (WOTC) Pre-screening Notice and Certification Request form is akin to the Statement of Intent to Employ Minor and Request for Work Permit form. Both documents serve as initial steps in the employment process, though their purposes differ. The WOTC form is used by employers to claim a tax credit for hiring individuals from certain groups that have significant barriers to employment, while the Statement of Intent focuses on the permissions and restrictions in hiring minors. Nonetheless, both facilitate opportunities for employment for individuals in specific demographics.

The Child Labor Laws Poster, which outlines the rights and restrictions on minor employment, resonates with the purpose behind the Statement of Intent to Employ Minor and Request for Work Permit form. Both aim to inform and protect the rights of young workers, stipulating age-appropriate tasks and working hours. The poster serves as a constant reminder of these stipulations in the workplace, while the Statement of Intent acts as a formal agreement that those laws will be followed.

The Occupational Safety and Health Administration (OSHA) Form 300, which logs work-related injuries and illnesses, is another document related to the safety and well-being of employees, much like the Statement of Intent form does for minors. This connection is rooted in the emphasis on safety and legal compliance within the workplace. While the OSHA form tracks incidents to ensure safe working conditions, the Statement of Intent ensures that minors are employed in environments that are suitable and legal for their age group, highlighting a mutual aim of protecting workers.

Comparable to the Statement of Intent to Employ Minor and Request for Work Permit form is the Application for Employment. This document is broadly used by individuals seeking employment, offering a comprehensive overview of an applicant's qualifications and work history. Both forms initiate the employment process, though the Statement of Intent specifically addresses the regulatory requirements related to hiring minors, ensuring employers adhere to child labor laws.

Similarly, the Minor’s Work Permit itself is closely linked to the Statement of Intent to Employ Minor and Request for Work Permit form. The permit is the next step after the request form and officially authorizes the minor to work under the conditions approved within the paperwork. Both documents ensure the employment is lawful, adhering to the specific regulations governing minor labor, such as work hours and environment suitability.

The Confidentiality Agreement for employees is another related document, addressing the importance of safeguarding sensitive company information. While this agreement focuses on protecting proprietary information, the Statement of Intent safeguards the rights of minors by ensuring their employment conditions are legally and ethically sound. Both forms underscore the employer’s responsibility towards their employees, whether it's protecting the company’s interests or the employee's well-being.

Additionally, the Equal Employment Opportunity (EEO) Self-Identification Form shares a goal of promoting fair hiring practices with the Statement of Intent to Employ Minor and Request for Work Permit form. While the EEO form collects demographic data to ensure compliance with laws that prevent discrimination, the Statement of Intent ensures compliance with child labor laws, both aiming to foster an equitable and lawful hiring environment.

Last, but not least, the Employment Contract, which formalizes the terms and conditions of employment between an employer and the employee, resonates with the essence of the Statement of Intent to Employ Minor and Request for Work Permit form. Though one is a contract and the other a permission form, both delineate roles, responsibilities, and expectations, ensuring clarity and mutual agreement in the employment relationship. Each document plays a foundational role in establishing a lawful and effective work arrangement.

Dos and Don'ts

Filling out the Statement of Intent to Employ Minor and Request for Work Permit form requires attention to detail and an understanding of the process. Here are essential dos and don'ts that can help ensure the form is correctly completed and processed without unnecessary delays.

Do's:

  1. Ensure all information provided is accurate and current. Double-check details such as the minor’s personal information, the employer's details, and the job description.
  2. Include the minor’s Social Security Number if it is required by the state or school district. This helps in accurately processing the work permit.
  3. Obtain signatures from all required parties, including the minor, the parent or guardian, and the employer. This step is crucial for the validation of the form.
  4. Keep a copy of the completed form for your records. It's always good practice to have a backup in case of any discrepancies or questions that may arise later.
  5. Contact the issuing authority, typically the school or school district office, for any clarifications regarding the form or the process. They can provide valuable guidance and ensure compliance with local laws.
  6. Submit the form before the employment is set to begin. This allows adequate time for processing and ensures the work permit is issued in time.

Don'ts:

  • Don’t leave sections incomplete. Every field should be filled out unless it is clearly marked as optional. Incomplete applications can lead to delays or outright rejection.
  • Don’t use incorrect or outdated forms. Always download or request the latest version of the form from the proper authority to ensure compliance with current regulations.
  • Don’t guess information. If you’re unsure about specifics, such as job duties or hours, confirm these details with the employer before completing the form.
  • Don’t ignore the legal requirements related to the employment of minors. Each state has its own laws concerning work permits, hours, and types of employment allowed for minors.
  • Don’t alter the form after it has been signed. If changes are needed, fill out a new form to maintain the integrity of the provided information.
  • Don’t forget to monitor the minor's work conditions and hours after the permit has been issued. Ensuring compliance with the initial terms set in the form is essential for the well-being of the minor.

Misconceptions

When it comes to employing minors, the Statement of Intent to Employ Minor and Request for Work Permit form plays a crucial role. However, several misconceptions surround this document, leading to misunderstandings among employers, minors, and their guardians. Let's debunk some of these myths for a clearer understanding.

  • Misconception #1: Any minor can fill out and submit the form on their own.

    This is incorrect. While minors play a significant part in the process, the form requires input and signatures from the employer, the minor, and a parent or legal guardian. This collaborative effort ensures that all parties are aware of the employment terms and conditions.

  • Misconception #2: Once obtained, the work permit is valid for any job.

    Not true. The work permit is job-specific. It is only valid for the employer and position listed on the completed form. If the minor wants to switch jobs, a new form must be completed and a new permit obtained.

  • Misconception #3: The form serves as an immediate approval to start working.

    This belief is mistaken. After the form is submitted, it must be reviewed and approved by the issuing authority, typically a school official. Only after the permit is issued can the minor legally begin work.

  • Misconception #4: The process is the same in every state.

    Actually, the requirements and process for obtaining a minor's work permit can vary significantly from one state to another. Each state has its own labor laws and regulations concerning minor employment, influencing how the form is processed and issued.

  • Misconception #5: There are no restrictions once the permit is granted.

    This is false. Even with a work permit, there are still regulations that govern the number of hours a minor can work, the time of day they can work, and the types of work they can do. These restrictions are designed to ensure that work does not interfere with a minor's education or well-being.

Key takeaways

Filling out the Statement of Intent to Employ Minor and Request for Work Permit form is a crucial step for minors seeking employment. There are important considerations to keep in mind to ensure the process is smooth and compliant with legal requirements.

  • Accuracy is paramount: When completing the form, it's essential that all information provided is accurate and truthful. This includes personal details about the minor, the employer’s information, and the specifics of the job the minor is being hired for. Inaccuracies can lead to delays or denial of the work permit.
  • Parental or guardian consent: A signature from a parent or guardian is required on the form. This serves as an acknowledgment and consent for the minor to be employed, ensuring that the guardian is aware of and agrees to the employment terms.
  • Understanding the limitations: The form will detail any restrictions on the hours and types of work a minor is legally allowed to perform. Employers and minors should review these restrictions carefully to ensure compliance with state and federal regulations, which are designed to protect the welfare and education of minors.
  • Approval by school authorities: In many cases, the form needs to be signed by a school official. This step verifies that the employment does not interfere with the minor’s education and that the minor is in good standing academically. School approval is a vital part of the process, emphasizing the importance of balancing work and education.

Once the form has been filled out completely and accurately, submitted to the proper authorities, and approved, the minor can legally start their employment. Employers should keep a copy of the work permit on file and ensure that work conditions remain within the legal requirements for employing minors.

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