Application For Work Permit For A Minor printable pdf download

STATE OF MARYLAND

APPLICATION FOR

1100 N EUTAW STREET - BALTIMORE - MARYLAND – 21201

WORK PERMIT FOR A MINOR

DIVISION OF LABOR & INDUSTRY

DEPARTMENT OF LABOR, LICENSING & REGULATION

Directions For The Minor

First Name: __________________________________________________________

1. Complete your section of this application.

Type or print and make sure it is legible.

Last Name: __________________________________________________________

Use your correct legal name.

2. Have your Employer complete the Employer section.

Street Address: _______________________________________________________

3. Have your parent or guardian sign this application.

4. Use this data to complete the on-line application at:

City

________________________________________________________________

County: ______________________________________________________________

For Proof of Age - You may use:

Birth Certificate

State: _______________________________________________________________

School Records

Valid Maryland Driver's License

Zip Code: ____________________________________________________________

Any official Government document

Home Telephone: _____________________________________________________

5. Take this Application, the online Application Receipt and

your Proof of Age to any Issuing Officer and request

Date Of Birth:

Month: ___ ___ Day: ___ ___ Year: ___ ___ ___ ___

Maryland Minor Work Permit.

6. Deliver the official Work Permit to your employer.

School Name: ________________________________________________________

* A new permit must be obtained for each job *

Directions for the Employer

1. Complete your section of this application and return it to the minor for validation.

2. Do not allow minor to work until the official work permit is in your possession.

3. Work permits are not transferable and are required until the minor's 18th birthday.

√

Company Name: ____________________________________________________________

Select - Type of Business

…….. ……………………………………..

Street Address: _____________________________________________________________

_____ Accommodation & Food Services

_____ Administrative & Waste Services

City: ______________________________________________________________________

_____ Agriculture, Forestry, Fishing & Hunting

_____ Arts, Entertainment & Recreation

County:____________________________________________________________________

_____ Construction

_____ Educational Services

State: _____________________________________________________________________

_____ Finance & Insurance

_____ Health Care & Social Assistance

Zip Code: __________________________________________________________________

_____ Information

_____ Management of Companies & Enterprises

Telephone: _________________________________________________________________

_____ Manufacturing

_____ Mining

Telephone Extension: ________________________________________________________

_____ Other Services except Public Administration

_____ Professional & Technical Services

Employer Rep Name: _________________________________________________________

_____ Public Administration

_____ Real Estate & Renting & Leasing

Employer Rep Signature: ______________________________________________________

_____ Retail Trade

_____ Transportation and Warehousing

Work Duties: ________________________________________________________________

_____ Unknown

_____ Utilities

___________________________________________________________________________

_____ Wholesale Trade

Directions for the Parent or Guardian

Please sign and date the knowledge and consent statement.

This minor is being employed at the place of work described above with my full knowledge and consent. I hereby certify that, to the

best of my knowledge, the information herein is correct and true. I request that a work permit be issued for the above named minor.

_________________________________________________________________________________________________________

Signature of Parent or Guardian

Date

Directions for the Issuing Officer

1. Verify the minor has signed and dated the correct and true statement below.

I hereby certify that, to the best of my knowledge, the information herein is correct and true.

_________________

Control Number

_________________________________________________________________________________________________

Signature of Minor

Date

2. Do not accept an incomplete application.

_________________

3. The Division of Labor and Industry requires you retain this application in your file for 2 years from date of issue.

Date of Issue

Application For Work Permit For A Minor

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