HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
WAGE STANDARDS DIVISION - CHILD LABOR OFFICE
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 http://labor.hawaii.gov/wsd.
IMPORTANT: This application should be signed by the employer only if the minor is promised a job. Before the minor starts working,
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.
1 - 7a.
Type or print legibly and clearly the information on the minor.
Employer to complete:
Job and Title Minor Hired For
9.
Employment to Begin On
10.
Hours of Work (a to e)
Employer information
Employer/Representative Name
Parent or guardian to complete:
18.
Parent or guardian name,
signature, address, phone
Enter the job the minor will be performing if this application is approved; some jobs
are considered hazardous for 14 and 15 year olds.
Date the minor will start working.
Employer must fill in the hours the minor will be working.
Fill in requested employer information.
Employer/representative must print name, sign and date the application.
Minor's parent or guardian must print name, sign, and provide 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
Hospital record
School record (NOT school ID)
Immigration record (alien card, passport, visa)
Military ID (front and back of card)
INSTRUCTIONS FOR FORM CL-1, APPLICATION FOR MINOR'S
(Rev. 6/19)
State Building, Rm. 108, Hilo, HI 96720
Hilo
Kauai
Maui
Oahu
West Hawaii
830 Punchbowl Street, Rm. 340, Honolulu, HI 96813
3060 Eiwa Street, Rm. 202, Lihue, HI 96766
2264 Aupuni Street, Wailuku, HI 96793
Phone: (808) 586-8777
Phone: (808) 974-6464
Post Office Building, P.O. Box 49, Kealakekua, HI 96750
Phone: (808) 322-4808
Phone: (808) 274-3351
Phone: (808) 243-5322
11 - 15.
8 - 8a.
16 - 17.
Fax: (808) 586-8766
Fax: (808) 974-6460
Fax: (808) 322-4813
Fax: (808) 274-3355
Fax: (808) 984-2071
Note: Students who are homeschooled or have an alternative education arrangement should submit their DOE Form 4140
to this office when applying.
For further information, forms, and publications: Contact the Child Labor Office in your county at the locations listed below
or on the internet at http://labor.hawaii.gov/wsd. Office hours are from 7:45 a.m. to 4:30 p.m., Monday through Friday,
except State holidays. Email: dlir.wsd.childlabor@hawaii.gov
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(Rev. 6/19)
HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
WAGE STANDARDS DIVISION - CHILD LABOR OFFICE
CL-1 APPLICATION FOR MINOR'S CERTIFICATE OF EMPLOYMENT
(To be Used for Minors Under 16 Only)
WARNING: A minor is NOT permitted to work until the employer receives a Temporary Authorization slip.
The original signed CL-1 application must be completed and returned to the Child Labor Office with an acceptable
proof of age document (a legible copy is acceptable). When approved, the employer will be issued a Temporary
Authorization slip and the minor's Certificate of Employment. See additional information on the instruction sheet.
PRINT OR TYPE - MUST BE LEGIBLE: (Use black ink)
Minor's
Information
1. Last Name of Minor, First Name, Middle Initial
3.
Age
2.
Male
Female
5.
Home Phone
( )
6. Mailing Address of Minor
Apt City
Zip Code
7. Name of School Attending
7a. Email Address
Employer
to Complete
8. Job Minor Hired For
9. Employment to Begin On
10. Hours of Work (See instruction for restrictions):
a. Start Time
b. End Time
c. # Minutes
Break
d. # Hours/Day
e. # Days/Week
Monday - Friday
Saturday
Sunday
Employer
Information
11. Name of Business
12. Business Address (Mailing Address if not same) City Zip Code
13. Employer DOL Number
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
14a. Business Phone
14b. Business Fax
( )
( )
15. Type of Business
16. Signature of Employer/Representative Title
Print or Type Name of Employer/Representative
17. Date of Application
Parent or
guardian
to complete
( )
Phone
Address
Signature
18. Print Name of Parent or Guardian
This request for an employment certificate is made with my knowledge and consent:
FOR CHILD
LABOR
OFFICE
USE ONLY
Proof of Age:
BC
HDL
I
MID
SR
Date of Birth
Other
DLIR Official Date TA Issued
CL-1 Ref No.
4. Last four digits of minor's Social Security No. xxx - xx - _________
SID
Job Title
8a.
15a. Email Address