Parent/school Authorization
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1
2Department of Labor and Industries
PARENT/SCHOOL AUTHORIZATION
Employment Standards Program
PO Box 44510
Olympia WA 98504-4510
For parents or legal guardians and school officials to indicate approval for
Phone (360) 902-5316
a minor employee to work according to the terms listed by the employer.
FAX
(360) 902-5300
teensafety@lni.wa.gov
This is not a minor work permit.
Employers must obtain a minor work permit endorsement on their Master Business License for each workplace
in which they employ workers under age 18. Minor work permit endorsements must be renewed each year.
PLEASE NOTE: This form is to be kept on file by the employer at the minor’s workplace and be available for departmental audit.
Additionally, the employer must renew this parent/school authorization each year.
(This section to be completed by the employer and minor employee.)
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Name of minor’s school: (If homeschooled, please note)
Name of minor:
School’s address:
Minor’s address:
City:
City:
State:
ZIP:
State:
ZIP:
Date:
Signature of MINOR EMPLOYEE:
Minor’s birth date:
________ / ________ / ________
(Must be accompanied by proof)
month
day
year
Number of working days per week:
Is minor employed at any other job?
If answered as “yes”, list total hours
Wage per hour to be given:
worked per week at other job:
$_________________
__________________
Yes
No
______________
Max. hours to be worked per week during school year:
Max. hours to be worked per day during school year:
Sun_______ Mon_______ Tue_______ Wed_______ Thu_______ Fri_______ Sat_______
___________ = Weekly max.
Max. hours to be worked per week during non-school year:
Max. hours to be worked per day during non-school year:
Sun_______ Mon_______ Tue_______ Wed_______ Thu_______ Fri_______ Sat_______
___________ = Weekly max.
If employed, the minor will have the following job duties:
Sun __________am/pm Latest working hours during school year:
Earliest working hours during school year:
Sun __________am/pm
Mon __________am/pm Tue __________am/pm Wed __________am/pm
Mon __________am/pm Tue __________am/pm
Wed __________am/pm
Thu __________am/pm Fri __________am/pm Sat __________am/pm
Thu __________am/pm Fri __________am/pm
Sat __________am/pm
Sun __________am/pm Latest working hours during non-school year:
Earliest working hours during non-school year:
Sun __________am/pm
Mon __________am/pm Tue __________am/pm Wed __________am/pm
Mon __________am/pm Tue __________am/pm
Wed __________am/pm
Thu __________am/pm Fri __________am/pm Sat __________am/pm
Thu __________am/pm Fri __________am/pm
Sat __________am/pm
Telephone number:
Name of firm:
Location address of minor’s workplace:
City:
State
ZIP
Expiration date of minor work permit endorsement:
UBI number for this business location:
___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___
____________ / ____________ / ____________
4-Digit Location ID
9-Digit Unified Business Identifier (UBI)
3-Digit Business ID
month
day
year
Date:
Title:
Signature of EMPLOYER or REPRESENTATIVE:
PARENTAL AUTHORIZATION
(This section to be completed by the minor’s parent or legal guardian after employer completes top portion.)
I CONSENT TO ALLOW THE MINOR LISTED TO BE EMPLOYED AT THE OCCUPATION AND UNDER THE CONDITIONS STATED ABOVE.
Telephone number:
Signature of PARENT or LEGAL GUARDIAN:
Date:
Address of parent or legal guardian:
City:
State
ZIP
SCHOOL AUTHORIZATION
(This section to be completed by school official after employer completes top portion if minor will work during the school year.)
THE STATED HOURS OF EMPLOYMENT MEET THE REQUIREMENTS OF SCHOOL ATTENDANCE REGULATIONS AND ARE HEREBY APPROVED.
Telephone number:
Title:
Signature of SCHOOL AUTHORITY:
Date:
Information on minor’s hours of work &
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L are listed on the reverse
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F700-002-000 parent/school authorization 4-02
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