Application For Working Papers

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APPLICATION FOR WORKING PAPERS
PLEASE NOTE: AS OF 1/1/16 THE MINIMUM WAGE IN CT IS $9.60 PER HOUR
Today’s Date _________
Your Name _______________________________________________________
Address
________________________________________________ City _______________
Phone
__________________________
If you are a DHS student, your current address must match the address we have on file
Date of Birth ___________
Age _______
ORIGINAL document must be submitted as proof (see below)
Are you currently attending school? ____Yes
_____No
If so, where? __________________________________
Are you currently employed? ____ Yes ____ No
With whom do you live? (Name/s) _______________________ Relationship to you_________
You must submit a comprehensive Promise of Employment completed by your potential employer on their letterhead (sample
attached) along with an original document proving your date of birth (birth certificate, passport, government-issued photo ID.)
---------------------------------------------------------------
I understand that while I may be employed at more than one location at the same time, my total work hours for permitted
occupations may not exceed the guidelines outlined by the Department of Labor.
Signature of Applicant _________________________________

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