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
Prior to school days Time shift begins and ends during June 1 – Labor Day
Time shift begins Time shift ends Minors ages 14 and 15 only:
- 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, , ,
Signature of consenting parent or legal guardian Date Telephone
number
hereby give consent for
, 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.
October 2020 PR1021
