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Minor Application To Employ Form

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42 views1 page

Minor Application To Employ Form

Uploaded by

y8kh6v2bqj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application to Employ Minors Under Age 18

OFFICE OF WORKFORCE DEVELOPMENT

NOTE: This form is not an Employment Certificate.


The process for employing a minor, under the age of 18, involves a two-part process:
1. After the employer completes this application, the minor must have a parent sign the Parent’s
Consent Statement section below. Bring the form, along with proof of age (examples: birth certificate,
driver’s license, etc.) to an authorized issuing location, typically the School Board or high school).
2. The authorized official will then issue an Employment Certificate, providing all conditions regarding
hours, type of employment, etc. are in accordance with R.S. 23:151-234.

Applicant Information:

____________________________________________________ _______________ _____________ ______________


Name of minor Age Sex Date of birth

________________________________________________________________________ ________________________________
Physical address: city, state and zip code Telephone number

____________________________________________________ ____________________________________________________
Number of work hours per day Number of days per week

________________________ _________________________ _________________________ ________________________


Time shift begins Time shift ends Minors ages 14 and 15 only:
Prior to school days Time shift begins and ends during June 1 – Labor Day

Employer Information:

_____________________________________________________________________________________________________________
Name of employer (DBA)

_____________________________________________________________________________________________________________
Physical address — where work will be performed: city, state and zip code

____________________________________________________ ____________________________________________________
Employer’s telephone number Industry of employer

_____________________________________________________________________________________________________________
Job tasks to be performed by minor

_____________________________________________________________________________________________________________
Job tasks (continued)

____________________________________________________ ____________________________________________________
Name and title of employer representative Signature: Name of employer representative

Parent’s Consent Statement:

I, __________________________________________ , __________________ , ___________________ hereby give consent for


Signature of consenting parent or legal guardian Date Telephone number

____________________________________________________ , to be employed by the above named employer.


Name of child

NOTE: This form is not an Employment Certificate.


THIS FORM MUST BE COMPLETED AND SIGNED BY
AN EMPLOYER REPRESENTATIVE OF THE EMPLOYING FIRM.
July 2013 PR1021

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