LABOR RELATIONS DIVISION WWW.DWS.STATE.NM.US
401 Broadway Blvd NE
Albuquerque, NM 87102
Phone: 505-841-4400
Fax: 505-841-4424
226 South Alameda Blvd
Las Cruces, NM 88005
Phone: 575-524-6195
Fax: 575-524-6194
1596 Pacheco St, Suite 103
Santa Fe, NM 87505
Phone: 505-827-6817
Fax: 505-827-9676
An Equal Opportunity Employer
Work Permit Certicate – For Minors Under the Age of 16
Minors under the age of 16 are not allowed to work before 7am or after 7pm, except June 1st through Labor Day, when allowed to work until 9pm
1.
Student’s legal name Address City Zip code
2.
Student’s date of birth Type of proof of age (birth certicate, etc.)
3.
Student’s signature Parent/guardian’s signature
4.
Student’s email address Parent/guardian’s email address
5.
Employer Address City Zip code Phone number
6. $
Describe in DETAIL the work that will be conducted by the student. Rate of Pay
7. I certify and afrm that the above referenced child is not engaged in a prohibited or hazardous occupation as established
by the Fair Labor Standards Act (FLSA) or the New Mexico Child Labor Statutes. Such occupations include but are not
limited to: explosives, pornography, serving alcoholic beverages, logging, mining, meat packing, wrecking, demolition,
power driven equipment or construction related tools or apparatus. A comprehensive list may be viewed
at www.dws.state.nm.us or may be obtained from the Child Labor Section.
8.
Signature of employer Print name
9.
Employer’s email address
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10.
Issuing ofcial’s signature Title Phone number
11.
Issuing ofcial’s email address
12.
Ofce/School location Address City Zip code
NOTE: All sections of this work permit certicate must be completed to be in compliance with Child Labor Laws.
DISTRIBUTION: The issuing ofcial must make copies of the work permit certicate to be distributed as follows: The employer must
keep the original certicate for their records, and must post the certicate in a conspicuous place where the student is employed; the
issuing ofcial must keep one copy for their records, and must submit one copy to the New Mexico Department of Workforce Solutions’
Child Labor Section by fax to 505-841-4424 or by email to Linda.Coronado-Arv i@state.nm.us.
FOR OFFICIAL USE
County ___________________ Issue date _______________ Expiration date (one year after issue date) ______________
