The Statement of Intent to Employ Minor and Request for Work Permit form is an essential document for employers who wish to hire minors. This form ensures compliance with labor laws and helps protect young workers. Understanding its purpose and how to complete it correctly is crucial for both employers and parents.
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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
School telephone
For Employer to Complete (Please review rules for employment of minors on reverse.)
Name of business
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:
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.
When a minor seeks employment, various forms and documents are often required to ensure compliance with labor laws and regulations. Each document plays a crucial role in the process of obtaining a work permit and ensuring that the minor's rights and safety are protected. Below is a list of important documents that may accompany the Statement of Intent to Employ Minor and Request for Work Permit form.
Each of these documents contributes to a comprehensive approach to employing minors responsibly and legally. By ensuring that all necessary paperwork is completed, employers can foster a safe and supportive work environment for young employees.