Baraboo Area Chamber Of Commerce Child Labor /work Permit Request Form printable pdf download

CHILD LABOR/WORK PERMIT REQUEST FORM

STATE OF WISCONSIN DEPARTMENT OF WORKFORCE DEVELOPMENT

FOR MINORS UNDER 18 YEARS OF AGE

Permits can be obtained at the Baraboo Area Chamber of Commerce, 600 West Chestnut,

located in the Visitor’s Center in the Westdayl Shopping Plaza. You will need the following:



Proof of Minor I.D.—1 of the following—birth certificate, driver’s license,

baptismal certificate, passport, tribal I.D ., or state I.D. (student I.D.’s are not

accepted)



Social Security Number



$10.00 processing fee—cash or check—employers responsibility to refund no

later than by the first pay check



Completed form or similar form from employer

Parent/legal guardians may obtain a work permit for their child without the presence of the

minor. Minors can obtain a work permit without the presence of their parent/legal guardian only

with written permission from parent/guardian—signature line below.

TO BE COMPLETED BY EMPLOYER:

NAME OF MINOR______________________________________________________________________________

ADDRESS____________________________________________________________________________________

CITY, STATE & ZIP_____________________________________________________________________________

EMPLOYER/BUSINESS NAME____________________________________________________________________

ADDRESS____________________________________________________________________________________

CITY, STATE & ZIP_____________________________________________________________________________

PHONE______________________________________________________________________________________

NATURE OF BUSINESS_________________________________________________________________________

TYPE OF WORK MINOR WILL DO_________________________________________________________________

SUPERVISOR’S SIGNATURE____________________________________________________________________

TO BE COMPLETED BY MINOR:

Do your parents own this business?

_____ YES

_____ NO

Are you a high school graduate?

_____ YES

_____NO

Is this work being performed as restitution? _____ YES

_____NO

Are you home schooled?

_____ YES

_____NO

School you attend?

________________________________________________________

SIGNATURE OF PARENT/GUARDIAN GRANTING PERMISSION_______________________________________

SERVICE PROVIDED BY:

BARABOO AREA CHAMBER OF COMMERCE

600 WEST CHESTNUT ST, BARABOO, WI 53913

608-356-8333 Fax 608-356-8422

MONDAY – FRIDAY 8:30 AM – 5:30 PM, SATURDAYS (Seasonally 9:00AM-1:00PM) Call to Verify

Baraboo Area Chamber Of Commerce Child Labor /work Permit Request Form

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