Special Limited Permit To Work - Rhode Island Department Of Labor And Training

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Make 3 Copies

Permit

1. Employer

Number

Rhode Island Department of Labor and Training

2. Labor Dept.

Date

SPECIAL LIMITED PERMIT TO WORK

3. Issuer

Check

Orig

Reissue

for a Minor 14-15 Years of Age

Print in Ink, or Type on-line, (except signatures) CL-2-6/80

1. Full Name of Minor

first

middle

last

15. Name of Parent or Guardian

2. Address of Minor

16. Address of Parent or Guardian

3. Age

4. Date of Birth

5. Sex

17. Evidence of Age presented by minor

6. Currently Registered for School?

Yes

18. Signature of Minor

7. Last Grade Completed

8. Name of School

9. Business Name of Employer

19. I hereby certify that I am duly appointed and authorized by the

School Committee for

to issue this

special limited permit to the employer named herein for employment of this

10. Business Telephone

minor in the occupation and at the address described. I also certify that I

have reason to believe that the minor named is of the age herein stated.

11. Business Address of Employer

20. Signature of Issuing Officer

12. Address where minor will perform work (if different from above)

21. Telephone Number of Issuing Officer

13. Nature of Employer’s Business

22. Title of Issuing Officer

14. Nature of work to be performed by minor

23. Date Signed

DLT-L-75 (Rev. 08/2015 mdf) CL-2-6/80

NOTICE TO EMPLOYER

1. This document is valid for employment in Rhode Island only.

2. This document is your property and must be kept with your payroll records. Upon termination of employment, note in your records

for this employee, the certificate number, date of issuance, and city or town from which it was issued, and return this document to the

issuing officer.

3. HOURS OF WORK MINORS 14-15 years of age:

Maximum hours - RI 8 hours per day, 40 hours per week

Federal - 3 hours per day (school day) - 8 hours non-school day, 18 hours per week (school week), 40 hours, non-school week

Curfew - RI Employment permitted between the hours of 6 A.M. and 7 P.M. (except 9 P.M. during school vacation)

Federal - Employment between the hours of 7 A.M. and 7 P.M. (except 9 P.M. from June 1st through Labor Day)

THE MORE RESTRICTIVE STANDARD APPLIES WHENEVER THERE IS COVERAGE BY BOTH STATE AND FEDERAL LAW.

Work is prohibited in factories, mechanical, manufacturing, or processing establishments, docks, warehouses, storage rooms, dispensing gasoline, car washes

and parking lot attendants.

Minors 14-15 may not start work until employer has been issued the necessary permit.

NO WORK WHEN SCHOOL IS IN SESSION.

For information regarding Federal Restrictions contact the area office:

For information regarding the provisions of Rhode Island laws contact:

Employment Standards Administration

Labor Standards Unit

United States Dept. of Labor

RI Department of Labor and Training

380 Westminister Street, Providence, RI 02903

P.O. Box 20390, Cranston, RI 02920-0944

(401) 490-2370