Permission to Work Form for Minors - Template Form Pro · US-law

PERMISSION TO WORK FORM FOR MINORS

Authorization for the Employment of a Minor under the Fair Labor Standards Act and Applicable State Child Labor Law

This Permission to Work Form for Minors (this “Form”) is executed on ________ in connection with the proposed employment of the minor identified below, and is governed by the laws of the State of ________ and by applicable federal law, including the Fair Labor Standards Act of 1938, as amended (29 U.S.C. § 201 et seq.).

§ 1. Identification of the Minor.

Minor Name: ________

Minor Date of Birth: ________

Minor Address: ________

Minor Signature: __________________

Date: ________

§ 2. General Information and Federal Standards.

The federal Fair Labor Standards Act (the “FLSA”) establishes the minimum age of employment for workers in the United States, as well as certain minimum standards, including limitations on permissible hours and occupations, for minor workers. Each state also imposes its own restrictions on the employment of minors. The parties are advised to consult with an attorney licensed in the applicable state to understand fully the laws governing the employment of minors.

The standards established by the FLSA are summarized below. The standards governing the employment of minors may be more restrictive under individual state law, but may not be less restrictive than federal law in areas covered by federal law. In all applicable cases, the more restrictive standard, whether federal or state, shall control.

• Minors may not be employed in any occupation declared hazardous by the Secretary of Labor under 29 C.F.R. Part 570.
• Persons 18 years of age or older: no restrictions on work under the FLSA.
• 16- and 17-year-olds: may not work in occupations declared hazardous, but there are no FLSA restrictions on hours worked.
• 16 is the general minimum age for employment under the FLSA, unless the Secretary of Labor issues a regulation or order providing otherwise.
• 14- and 15-year-olds may work only outside of school hours, and are subject to the following limitations:
• No more than 18 hours per week while school is in session;
• No more than 40 hours per week while school is not in session;
• No more than 3 hours per day on a school day;
• No more than 8 hours per day on a non-school day;
• Not before 7:00 a.m. or after 7:00 p.m., except from June 1 through Labor Day, during which period they may work until 9:00 p.m.; and
• Only in occupations permitted under 29 C.F.R. § 570.34, such as certain retail, food service, intellectual or creative, clerical, errand, clean-up, and similar non-hazardous work.

§ 3. State Standards. The standards governing the employment of minors in the State of ________ are summarized below. This summary is not comprehensive, and the applicable statutes and regulations of the relevant state must be consulted in full.

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• An employer wishing to employ a minor must obtain any child labor certificate, employment certificate, work permit, or eligibility-to-work documentation required by the applicable state, for each location at which the minor will be employed, and must retain such documentation in the minor’s personnel file.
• For 14- and 15-year-olds, the employer must comply with all applicable state restrictions on occupations, days, and hours of work, which restrictions may be more limiting than the corresponding federal standards.
• The employer must maintain for each minor an employee information record, proof of age, and accurate time records showing the hours worked each day (including starting and ending times and break times). Proof of age may consist of a driver’s license, a government-issued identification card bearing the minor’s name and date of birth, or a copy of the minor’s birth certificate.
• The minor’s file shall include, at a minimum, the minor’s name, address, telephone number, date of birth, date of hire, proof of age, school of attendance, and time records.
• The applicable minimum age, permitted occupations, and permitted hours for the relevant state are: ________.

§ 4. Parental or Guardian Permission. I, the undersigned, am the ________ (parent or legal guardian) of the minor named above (the “Minor”). My Minor child is ________ (________) years of age. I hereby grant permission for the Minor to work in the position and for the employer described below, and I represent that I have reviewed and understand the federal and state standards summarized in this Form.

Employer Name: ________

Employer Address: ________

Position Title: ________

Hours Minor Will Be Working Per Week: ________ (________)

Days and Times of Scheduled Work: ________

Any change in the Minor’s position, title, days, or hours must be approved again in writing by the undersigned prior to taking effect.

Name of Parent/Guardian: ________

Address of Parent/Guardian: ________

Signature of Parent/Guardian: _________________________

Date: ________

§ 5. School Permission. A minor who is enrolled in school and who desires to work must provide a permission statement from his or her school where required by applicable law.

I am the principal (or duly authorized administrator) of the school the Minor currently attends. By signing below, I grant permission for the Minor to work in the position and for the employer listed above. I certify that, to the best of my knowledge, such work will be performed only outside of school hours and will not interfere with the Minor’s education.

Name of School: ________

Name of Principal: ________

Principal’s Signature: _____________________

Date: ________

§ 6. Supervisor Verification. I am the immediate supervisor of the Minor for the position and employer listed above. By signing below, I verify the position, title, and hours of work that the Minor will be performing as described in this Form. I further confirm that the work assigned to the Minor will not include any hazardous or prohibited duties and will comply with all applicable federal and state laws governing the employment of minors.

Supervisor Name: ________

Supervisor Title: ________

Supervisor Signature: __________________

Date: ________

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