Form Wh-205 - Application For Authorization To Employ A Student-Learner At Subminimum Wages

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Application for Authorization to
U.S. Department of Labor
Employ A Student-Learner at
Wage and Hour Division
Subminimum Wages
230 South Dearborn Street, Room 514
Chicago, Illinois 60604
OMB No. 1235-0001
Expires: 03-31-2014
Instructions: Form WH-205 is completed by an employer to obtain certification to employ
student-learners at wages lower than the Federal minimum wage to prevent curtailment
of opportunities for employment. Submission of this information is voluntary, but failure to
A. Control number
submit the information will prohibit the Wage and Hour Division from authorizing the
B. Effective date
employment of student-learners at subminimum rates. 29 U.S.C. § 214(a); 29 C.F.R. § 520.501.
C. Expiration date
The school officials' certification in Item 27 of the application provides temporary authority to
D. Reviewing official
employ the named student-learner under the terms proposed in the application which are in
accordance with sections 520.502 and .503 of the Student-Learner Regulations (29 C.F.R. Part
520). The authority begins on the date the application is forwarded to the Regional Office of
the Employment Standards Administration. At the end of 30 days, this authority is extended
to become the approved certificate unless the Administrator or his/her authorized represen-
tative denies the application, issues a certificate with modified terms and conditions, or ex-
pressly extends the period of review. Note that the certificate is valid for no more than 1
school year and does not extend beyond the date of graduation.
1. Name and address, including zip code, of Establishment making
3A. Name and address of student-learner:
B. Date of birth: (Month, Day, Year)
2. Type of business and products manufactured, sold, or services
4. Name and address, including zip code, of school in which student-
learner is enrolled.
5. Proposed beginning date of employment
(Month, Day, Year)
6. Proposed ending date of employment
(Month, Day, Year)
7. Proposed graduation date (Month, Day, Year)
17. Title of student-learner occupation:
18. Number of employees in this establishment
8. Number of weeks in school year
9. Total hours of school instruction per week
19. Number of experienced employees in
student-learner's occupation
10. Number of school hours directly related to
20. Minimum hourly wage rate of experienced
employment training
workers in item 19
11. How is employment training scheduled
21. Subminimum wage(s) to be paid student-learner
(if a progressive wage schedule is proposed, enter each rate and
(weekly, alternate weeks, etc.)?
specify the period during which it will be paid):
12. Number of weeks of employment training at
subminimum wages
13. Number of hours of employment training a week
22. Is an age or Employment Certificate on file in this establishment for
this student-learner? (If not, see instructions).
14. Are Federal Vocational Education Funds being used
for this program?
15. Was this program authorized by the State Board of
Vocational Education?
16. If the answer to item 15 is ''No'', give the name of the recognized
23. Is it anticipated that the student-learner will be employed in the
performance of a government contract subject to the Walsh-Healey
educational body which approved this program:
Public Contracts Act or the Service Contract Act?
Form WH-205
Rev. December 2010


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