Fillable approval for a minor employee to work accordingly (Clark College)

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approval for a minor employee to work accordingly (Clark College)

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F700-002-000 Parent/School Authorization 04-2018 Page 1 of 3
Employment Standards Program
PO Box 44510
Olympia WA 98504-4510
Parent/School Authorization
For parents or legal guardians and school officials to indicate
approval for a minor employee to work accordingly to the terms
listed by the employer and within the limits of child labor regulations.
Phone:
866-219-7321
This is not a Minor Work Permit
Employers must have a Minor Work Permit endorsement on their Business
License for each work location where minors are employed and renew it each
year. To apply, go to: http://bls.dor.wa.gov/minorworkpermit.aspx
Fax:
360-902-5300
Email:
TeenSafety@Lni.wa.gov
Web:
www.Lni.wa.gov/TeenWorkers
Do not mail this form to L&I. This form must be kept on file by the employer at the minor’s workplace and be
available for department audit. A copy should also be maintained by the minor’s school representative. Additionally, the
employer must renew this parent/school authorization by September 30 of each year or when work schedule
changes.
Employee Information ― To be completed by the employee
Employee Name
Date of Birth (mm/dd/yyyy) (Must be accompanied by proof)
Address
Phone Number
State
Zip Code
School’s Name (if home schooled/not enrolled in school/online classes please note)
School’s Phone (include area code)
City
State
Zip Code
Are you employed at another job?
Yes No
If “Yes”, how many hours do you work per week?
Employer Information
Before allowing a minor to begin work, you must obtain and keep on file, at the minor’s workplace, a fully
completed Parent/School Authorization. As the employer, it is your responsibility to ensure that this form is
completed by you before collecting signatures.
Employer Business Name
Phone Number
Washington Unified Business Identifier (UBI)
Expiration Date of Minor Work Permit
-
-
Location Address (Physical location where minor will be working)
City
State
Zip Code
Contact Name
Wage per Hour
$
List of Specific Job Duties
Employers: Please read before filling out the anticipated hours and work schedule on the following page.
Per WAC 296-125-027 ― Minors cannot work during the hours that school is in session. Employers should
refer to the minor’s neighborhood school’s website for the hours of school to determine what hours the minor
is eligible to work. This rule also applies to homeschooled students. No students should work during the
hours that their neighborhood school is in session unless the employer has been granted a variance from
the Department of Labor & Industries.
Clark College
(360) 992-2902
91
0826
4167
06/30/2021
1933 Fort Vancouver Way
Vancouver
WA
98663
Meleani Bates
TBD
TBD
F700-002-000 Parent/School Authorization 04-2018 Page 2 of 3
Hours and Work Schedule ― Parents & schools may adjust hours and schedule as needed.
Minors cannot work during the hours that school is in session. Employers should refer to the school’s website to determine what these hours are.
Hours and Schedules Minors are Permitted to Work in Non-Agricultural Jobs
Age Group
School Week
Hours/Day
Hours/Week
Days/Week
Begin
Quit
14 ― 15
Years Old
School Week 3 hours (8 hrs Sat-Sun) 16 hours 6 days 7 a.m. 7 p.m.
Non-School Week 8 hours 40 hours 6 days 7 a.m. 7 p.m. (9 p.m. June 1 to Labor Day)
16 ― 17
Years Old
School Week 4 hours (8 hrs Fri – Sun) 20 hours 6 days 7 a.m. 10 p.m. (Midnight Fri – Sat)
School Week with a special variance 6 hours (8 hrs Fri – Sun) 28 hours 6 days 7 a.m. 10 p.m. (Midnight Fri – Sat)
Non-School Week 8 hours 48 hours 6 days 5 a.m. Midnight
• An adult must supervise minors working after 8 p.m. in service occupations such as restaurants and retail businesses.
• Overtime rules apply for all hours worked over 40 in one week.
• Special Variance does not apply to home-schooled students.
Hours and Schedules Minors are Permitted to Work in Agricultural Jobs
Age Group
School Week
Hours/Day
Hours/Week
Days/Week
Begin
Quit
12 ― 13
Years Old
Non-School Week 8 hours 40 hours 6 days 5 a.m. 9 p.m.
14 ― 15
Years Old
School Week
3 hours
(8 hrs. non-school days)
21 hours 6 days*
7 a.m.
(6 a.m. in animal agriculture &
irrigation)
8 p.m.
Non-School Week 8 hours 40 hours 6 days* 5 a.m. 9 p.m.
16 ― 17
Years Old
School Week
4 hours
(8 hrs non-school days)
28 hours 6 days* 5 a.m.
10 p.m.
(No later than 9 p.m. on more than 2
consecutive nights before a school day)
Non-School Week 10 hours
50 hours
(60 hours per week in mechanical
harvest of peas, wheat, and hay)
6 days* 5 a.m. 10 p.m.
• 12 – 13 year-olds may work only during non-school weeks hand-harvesting berries, bulbs, cucumbers, and spinach.
*Exception ― 14 – 17 year-olds are allowed to work 7 days a week in dairy, livestock, hay harvest, and irrigation during school and non-school weeks.
Days
Hours per Day
Hours per Week
Start Time
Circle A.M. or P.M.
Quitting Time
Circle A.M. or P.M
Employer
Parent/
School Adj.
Employer
Parent/
School Adj.
Employer
Parent/
School Adj.
Employer
Parent/
School Adj.
School
Weeks
Mon ― Thurs
A.M. / P.M. A.M. / P.M. A.M. / P.M. A.M. / P.M.
Fri ― Sun
A.M. / P.M. A.M. / P.M. A.M. / P.M. A.M. / P.M.
Non-
School
Weeks
Sun ― Sat
Parents adjust
only
A.M. / P.M. A.M. / P.M. A.M. / P.M.
A.M. / P.M.
4
17
6
10
4
17
6
10
8
17
6
10
F700-002-000 Parent/School Authorization 04-2018 Page 3 of 3
Required Signatures
Employee’s Signature
Print Name
Employee’s Signature
Date
Employer’s Signature
Print Name
Employer Representative Signature
Title
Date
Note: Parents and school representatives should not sign this form unless the Hours and Work Schedule for
daily and weekly work schedules are completely filled out to reflect the anticipated maximum hours of work.
The school or parent may limit the hours of work for a minor according to how the minor will be affected by
working too many hours, e.g., homework, attendance, etc., and may reduce and approve fewer hours than the
rules allow or are requested by the employer.
Parental Authorization
I consent to allow the minor listed to be employed at the occupation and under the conditions stated above.
Print Name
Parent or Guardian Signature
Phone Number
Date
Comments by Parental Authority
School Authorization
The stated hours of employment meet the requirements of school attendance regulations and are hereby
approved.
Print Name
School Representative Signature
Title
Phone Number
Date
Comments by School Representative
Optional School Week Special Variance Authorization
For 16 – 17 Year Old Minors in Non-Agricultural Employment Only
A Special Variance allows a 16 – 17 year-old minor to work up to 28 hours per week with 6-hour shifts during the school
week with approval of the authorized school official and the parent. All parties must agree to these additional hours.
[Pursuant to WAC 296-125-0700]
School officials should not sign for any additional hours allowed by the Special Variance if a review of the
student’s progress indicates the additional work hours will be detrimental to the minor’s educational activities.
Please note: The Special Variance is only for minors enrolled in public or private school. This does not apply
to homeschooled students.
Are you planning to use the Special Variance for additional school-week work hours?
Yes No If checked “Yes”, both signatures below are required.
Parental Authorization
School Authorization
Meleani Bates
Program Manager
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Completed 4 February 2021

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