Application for Authorization to
Employ A Student-Learner at
Subminimum Wages
OMB No. 1235-0001
Expires: 09-30-2021
Instructions: Form WH-205 is completed by an employer to obtain certification to employ
student-learners at
wages lower than the Federal minimum wage to prevent curtailment
of opportunities for
employment. Submission of this information is voluntary, but failure to
submit the information
will prohibit the Wage and Hour Division from authorizing the
employment of student-learners
at subminimum rates. 29 U.S.C. § 214(a); 29 C.F.R. § 520.501.
OFFICIAL USE ONLY
A. Control number
B. Effective date
C. Expiration date
D. Reviewing official
The school officials' certification in Item 27 of the application provides temporary authority to
employ the named student-learner under the terms proposed in the application which are in
accordance with sections 520.502 and .503 of the Student-Learner Regulations (29 C.F.R. Part
520). T
he authority begins on the date the application is forwarded to the Regional Office of
the E
mployment Standards Administration. At the end of 30 days, this authority is extended
to become the approved certificate unless the Administrator or his/her authorized represen-
tative denies the application, issues a certificate with modified terms and conditions, or ex-
pressly extends the period of review. Note that the certificate is valid for no more than 1
school year and does not extend beyond the date of graduation.
READ CAREFULLY THE INSTRUCTIONS FOR COMPLETING THIS FORM. PRINT OR TYPE ALL ANSWERS
3A. Name and address of student-learner:
1. Name and address, including zip code, of Establishment making
application:
B. Date of birth: (Month, Day, Year)
2. Type of business and products manufactured, sold, or services
rendered:
4. Name and address, including zip code, of school in which student-
l
earner is enrolled.
7. Proposed graduation date (Month, Day, Year)
17. Title of student-learner occupation:
10. Number of school hours directly related to
employment training
20. Minimum hourly wage rate of experienced
workers in item 19
21. Subminimum wage(s) to be paid student-learner
11. How is employment training scheduled
(weekly, alternate weeks, etc.)?
specify the period during which it will be paid):
22. Is an age or Employment Certificate on file in this establishment for
this student-learner? (If not, see instructions).
Yes
No
15. Was this program authorized by the State Board of
Vocational Education?
23. Is it anticipated that the student-learner will be employed in the
16. If the answer to item 15 is ''No'', give the name of the recognized
educational body which approved this program:
performance of a government contract subject to the Walsh-Healey
Public Contracts Act or the Service Contract Act?
Yes
No
5. Proposed beginning date of employment
(Month, Day, Year)
6. Proposed ending date of employment
(Month, Day, Year)
12. Number of weeks of employment training at
subminimum wages
13. Number of hours of employment training a week
14. Are Federal Vocational Education Funds being used
for this program?
8. Number of weeks in school year
18. Number of employees in this establishment
9. Total hours of school instruction per week
19. Number of experienced employees in
student-learner's occupation
(if a progressive wage schedule is proposed, enter each rate and
ATTACH SEPARATE PAGES IF NECESSARY
Form WH-205
Rev. December 2010
U.S. Department of Labor
Wage and Hour Division
230 South Dearborn Street, Room 530
Chicago, Illinois 60604
