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Content Overview

For many young people, entering the workforce is an important step toward gaining independence and valuable experience. The Statement of Intent to Employ Minor and Request for Work Permit form plays a crucial role in this process, ensuring that minors can work safely and legally. This form serves as a formal agreement between the employer, the minor, and their parent or guardian, outlining the intention to employ the minor and specifying the details of the job. It includes essential information such as the minor's name, age, and the type of work they will be performing. Additionally, the form requires the employer to provide their business details and the proposed work hours. By obtaining this permit, employers not only comply with labor laws but also demonstrate their commitment to the welfare of young workers. It is important for all parties involved to understand the requirements and implications of this form, as it helps create a safe and supportive working environment for minors. Navigating the rules surrounding youth employment can be complex, but with the right information, the process can be straightforward and beneficial for everyone involved.

Key takeaways

When filling out and using the Statement of Intent to Employ Minor and Request for Work Permit form, consider the following key takeaways:

  1. Eligibility Requirements: Ensure that the minor meets the age and eligibility requirements for employment in your state.
  2. Complete Information: Fill out all sections of the form accurately. Incomplete forms may delay the work permit process.
  3. Signature Requirement: Obtain necessary signatures from both the employer and the minor’s parent or guardian before submission.
  4. Submission Process: Submit the completed form to the appropriate state or local agency responsible for issuing work permits.
  5. Keep Copies: Retain copies of the submitted form for your records. This can be useful for future reference.
  6. Compliance with Labor Laws: Familiarize yourself with local labor laws regarding the employment of minors to ensure compliance.
  7. Renewal and Expiration: Be aware of the permit’s expiration date and the process for renewal if the minor continues to work.

Following these guidelines will help ensure a smooth process in employing minors and obtaining the necessary work permits.

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

Once you have the Statement of Intent to Employ Minor and Request for Work Permit form ready, you'll need to fill it out accurately to ensure compliance with labor laws. Completing this form is essential for legally employing a minor. Follow these steps carefully to fill out the form correctly.

  1. Begin with the employer's information. Fill in the name, address, and contact details of the business or organization.
  2. Provide the minor's personal information. Enter the minor's full name, date of birth, and home address.
  3. Indicate the type of work the minor will be performing. Be specific about the job title and duties.
  4. Fill in the work schedule. Include the days and hours the minor will be working each week.
  5. Complete the parent or guardian information. Provide the name, address, and contact details of the minor's parent or legal guardian.
  6. Sign and date the form. Ensure that both the employer and the parent or guardian sign where indicated.
  7. Submit the completed form to the appropriate state agency or school district as required.

After filling out the form, keep a copy for your records. Then, ensure that you submit it promptly to avoid any delays in processing the work permit. Compliance with local regulations is crucial for a smooth hiring process.

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Form Preview 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.

Documents used along the form

When hiring a minor, it's essential to have the right documents in place to ensure compliance with labor laws. Along with the Statement of Intent to Employ Minor and Request for Work Permit form, several other forms and documents may be required to facilitate the employment process. Here’s a list of common documents that you might encounter:

  • Parental Consent Form: This form is often required to obtain permission from a minor’s parent or guardian before they can start working. It ensures that the parent is aware of the employment and agrees to it.
  • Job Description: A detailed description of the job responsibilities and duties helps clarify what is expected from the minor. This document can also assist in ensuring that the work is appropriate for their age.
  • Age Verification Document: Employers may need to verify the minor's age through documents such as a birth certificate or school identification. This helps ensure compliance with age-related labor laws.
  • Work Schedule: A written work schedule outlines the days and hours the minor will be working. This document is crucial for ensuring that the minor does not exceed the legal working hours allowed for their age group.
  • Tax Forms: Depending on the minor's earnings, they may need to fill out tax forms such as the W-4 to ensure proper tax withholding. This is an important step in the employment process.
  • Trailer Bill of Sale Form: To safeguard your trailer transactions, refer to our comprehensive Trailer Bill of Sale resources for proper documentation.
  • Emergency Contact Form: This form provides essential information about whom to contact in case of an emergency during work hours. It’s vital for the safety and well-being of the minor.
  • Workplace Safety Guidelines: A document outlining safety protocols and procedures ensures that the minor understands how to work safely and responsibly. This is especially important in environments that may pose risks.

Having these documents prepared and organized can help streamline the hiring process for minors. It also ensures that both the employer and the minor are protected and informed throughout the employment journey.