Higher Education to Emplo
y its Full-time
Students at Subminimum Wages Under
Regulations 29 C.F.R. Part 519
U.S. Department of Labor
Wage and Hour Division
230 South Dearborn Street, Room 5
30
Chicago, Illinois 60604-1757
Note: Persons are not required to respond to this collection of information unless it displays a currently valid OMB
control number.
OMB No.: 1235-0001
Expires: 09-30-2021
This is an application for an institution of higher education to obtain authority to employ its full-time students at subminimum wage rates under Section 14(b) of
the Fair Labor Standards Act (FLSA). The wage rates paid full-time students under Section 14(b) may not be less than 85 percent of the applicable minimum
wage under Section 6 of the FLSA. Temporary authority to employ full-time students at subminimum wages is effective when this form is properly completed and
forwarded to the address listed above. This temporary authority may be effective for a period of up to one year, provided that within 30 days of the forwarding, the
Administrator of the Wage and Hour Division does not deny the application, issue a certificate with modified terms or conditions, or expressly extend the 30-day
period of review. See reverse for more information about temporary authority. Please submit one copy of the completed form to the address shown above. Retain
a completed copy for your records. No authorization may be granted unless a completed application has been received.
Name:
( )
Initial Application
/
Identification Number (EIN):
Street Address:
City: State: Zip:
City: State: Zip:
Denied Issued
/ / DO
/ / / /
4. Person USDOL should contact regarding this application:
Telephone No.:
5. If this is a renewal, list the number of full-time
students employed at subminimum wages at this
campus during the most recent 12 months.
6. List the number of full-time students employed at
this campus during the previous 12 months
regardless of wage rate:
1. This is (check one):
Renewal Application (complete following):
Current Certicate Number:
Certificate Expiration Date:
2. Name of college or university that will be employing full-time
students at subminimum wages:
Federal Employer
A separate application is required for each campus where full-
time students will be employed at subminimum wages. Provide
the address of the campus covered by this application:
3. Mailing Address (if different than street address):
FOR USDOL USE ONLY
Pending
Withdrawn Revoked Issue/W Pend.
Postmark Date RO
Print Cert. New Cert No.
Effective Expiration
Remarks:
7. Representations, certification, and signature:
I certify, as set forth in Regulations part 519 subpart B, governing the employment of full-time students at subminimum wages, that the following,
conditions exist at the above campus:
a. The granting of the authority requested is necessary to prevent curtailment of opportunities for employment;
b. The employment of full-time students at subminimum wages will not create a substantial probability of reducing the full-time employment
opportunities of other persons;
c. Full-time students are available for employment at subminimum wages;
d. Abnormal labor conditions, such as a strike or lockout, do not exist in the unit(s) of the campus for which authority is sought;
e. Full-time students will not be employed at subminimum wages in unrelated trades or businesses, as defined and applied under section 511 through
514 of the Internal Revenue Code;
f. There are no serious outstanding violations of the provisions of the previous authority to employ full-time students nor of other provisions of the
Fair Labor Standards Act;
g. The granting of the authority will not result in a reduction of a wage rate paid to a current employee
, including student employees.
8. Authorized representative (print or type) 9. Signature of authorized representative:
10. Title (print or type) 11. Date application forwarded to USDOL:
lic Burden Statement
This collection of information is estimated to vary from 16 to 31 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information, and maintaining your records. If you have any comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, send them to the U.S. Department of Labor, Wage and Hour Division, Room S-3502, 200 Constitution Avenue, N.W.,
Washington, D.C., 20210 (please do not send the completed application to this address).
Form WH-201
Rev. December 2010
