Parental Permission Form - New Hampshire Department Of Labor
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1STATE OF NEW HAMPSHIRE DEPARTMENT OF LABOR
PARENTAL PERMISSION AS DEFINED IN RSA 276-A: 4 VIII AND LAB 1002.02
FOR THE EMPLOYMENT OF YOUTH AGE 16 OR 17
Youth’s Name:________________________________________________ Date of Birth ____/____/______
(please print)
(month, day, year)
Youth’s Address:___________________________________________________________________________
Street
City
State
Zip
I, _____________________________________________, grant permission for my son, daughter or legal ward
(Name of parent or legal guardian)
to be employed with ________________________________________________________________________
(Name of employer)
Located at ________________________________________________________________________________
Street
City
State
Zip
Description of work ________________________________________________________________________
___________________
__________________________________________________________
Date
Signature of parent or legal guardian
For information regarding the requirements of RSA 276-A, the New Hampshire Youth Employment Law, please contact
the New Hampshire Department of Labor at 271-6294 or 271-1492.
RSA 276-A:4
I. No youth shall be employed or permitted to work in any hazardous occupation, except in an apprenticeship, vocational
rehabilitation, or training program approved by the commissioner.
VI. No youth 16 or 17 years of age who is duly enrolled in school shall be permitted to work more than 6 consecutive days
or more than 30 hours during the school calendar week, which shall be Sunday through Saturday.
VII. No youth 16 or 17 years of age who is duly enrolled in school shall work for more than 6 consecutive days or 48 hours
in any one week during school vacations, including summer vacation. For purposes of this paragraph, ""summer vacation''
means June 1 through Labor Day
VIII. No youth 16 or 17 years of age, except a youth 16 or 17 years of age who has graduated from high school or
obtained a general equivalency diploma, shall be employed by an employer unless the employer obtains and
maintains on file a signed written document from the youth’s parent or legal guardian permitting the youth’s
employment.
RSA 276-A:13 Night Work. – No such youth shall be employed or permitted to work at night work more than 8 hours in
any 24 hours nor more than 48 hours during the week. If any youth is employed or permitted to work more than 2 nights
each week, for any time between the hours of 8 o'clock p.m. and 6 o'clock a.m. of the day following, such employment
shall be considered night work.
Lab 1002.03 Hours Limitations.
(c) Pursuant to RSA 276-A: 13, any youth scheduled to work more than 2 nights in a week past 8 o'clock p.m. shall not be
permitted to work more than an 8 hour shift during that particular week.
Hazardous Occupations are as defined in Federal Child Labor Bulletin Requirements in Nonagricultural
Occupations “Child Labor Bulletins No. 101” Order No. 1 through Order No. 17
This form must be on file with this employer prior to 16 or 17 year old youth performing any work.
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