Fillable Certificate Of Employment printable pdf download

HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS

WAGE STANDARDS DIVISION - CHILD LABOR OFFICE

INSTRUCTIONS FOR FORM CL-1, APPLICATION FOR MINOR'S

CERTIFICATE OF EMPLOYMENT

(To be Used Only for Minors Under 16)

Minors 16 and 17 years of age should apply for a Certificate of Age, by presenting an *acceptable proof of age document to the Child Labor

Office. You may also apply through the department's website at

IMPORTANT:

Before the minor starts working,

This application should be signed by the employer only if the minor is promised a job.

a completed application (form CL-1) and an *acceptable proof of age document must be submitted to this office. A minor is NOT

permitted to work until the employer receives a Temporary Authorization slip.

The minor is not required to appear in person - anyone may return this application and the proof of age document either in person or by

mail. You may fax the application, but the original CL-1 is required to be returned to this office before a certificate can be issued. If the

employment is allowable under the Child Labor Law, a Certificate of Employment will be mailed to the employer. Certificates are issued

only for employment with the employer named on this application.

RESTRICTIONS ON HOURS

Minors 14 and 15 years of age may work:

•

Not more than 3 hours per day on a school day

•

Not more than 8 hours per day on a non-school day

•

During a school week, not more than 18 hours per week

•

During a non-school week, not more than 40 hours per week

•

On school days and the day before a school day: Between 7:00 a.m. and 7:00 p.m.

•

On non-school days and the day before a non-school day: Between 6:00 a.m. and 9:00 p.m.

Other limitations:

Not more than 6 consecutive days of work; Not more than 5 consecutive hours without at least a 30-minute rest or

meal period.

This employment may also be subject to the federal child labor provisions under the Fair Labor Standards Act. For information, contact

the U.S. Department of Labor (USDOL), Wage and Hour Division.

Type or print legibly and clearly the information on the minor.

1 - 7.

Employer to complete:

Enter the job the minor will be performing if this application is approved;

8 - 8a.

Job and Title Minor Hired For

some jobs are considered hazardous for 14 and 15 year olds.

Date the minor will start working.

Employment to Begin On

Employer must fill in the hours the minor will be working.

10.

Hours of Work (a to e)

11 - 15.

Fill in requested employer information.

Employer information

16 - 17.

Employer/Representative Name

Employer/representative must print name, sign and date the application

Parent or guardian to complete:

18.

Parent or guardian name,

Minor's parent or guardian must print name, sign, and provide

signature, address, phone

information.

*ACCEPTABLE PROOF OF AGE DOCUMENTS:

Birth certificate

•

Court record

NOTE: A social security card is NOT an

•

Driver's license

Baptismal certificate

acceptable proof of age document.

•

Bible record

State of Hawaii ID

•

School record (NOT school ID)

Hospital record

•

Immigration record (alien card, passport, visa)

•

Military ID (front and back of card)

For further information, forms, and publications: Contact the Child Labor Office in your county at the locations listed below

or on the internet at

Office hours are from 7:45 a.m. to 4:30 p.m., Monday through Friday,

except State holidays.

Phone: (808) 974-6464

Hilo

State Building, Rm. 108, Hilo, HI 96720

Phone: (808) 274-3351

3060 Eiwa Street, Rm. 202, Lihue, HI 96766

Kauai

Phone: (808) 984-2075

Maui

2264 Aupuni Street, Wailuku, HI 96793

Phone: (808) 586-8777

830 Punchbowl Street, Rm. 340, Honolulu, HI 96813

Oahu

Phone: (808) 322-4808

Post Office Building, P.O. Box 49, Kealakekua, HI 96750

West Hawaii

Visit our Website at for ALL interactive and downloadable forms.

(Rev. 12/12)

Certificate Of Employment

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