F700-002-000 parent/school authorization 05-2006
PARENT/SCHOOL AUTHORIZATION
For parents or legal guardians and school officials to indicate approval for
a minor employee to work according to the terms listed by the employer.
Department of Labor and Industries
Employment Standards Program
PO Box 44510
Olympia WA 98504-4510
Phone (360) 902-5316
FAX (360) 902-5300
Email: teensafety@Lni.wa.gov
OR web page: www.TeenWorkers.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 with employees under age 18. Minor work permit endorsements must be renewed
each year. Go to www.DoL.wa.gov/forms/700028.htm
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 by September 30 of each year
.
(This section to be completed by the employer and minor employee.)
C
C
O
O
M
M
P
P
L
L
E
E
T
T
E
E
A
A
L
L
L
L
S
S
E
E
C
C
T
T
I
I
O
O
N
N
S
S
I
I
N
N
F
F
U
U
L
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L.
Name of minor:
Name of minor’s school: (If home schooled, please note)
Minor’s address: School’s address:
City State ZIP City State ZIP
Minor’s Birth Date
(Must be accompanied by proof) Month Day Year
Date
Signature of MINOR EMPLOYEE:
Wage
per hour
to be paid:
$
Number of
working days per week
:
Is minor employed at any other job?
Yes
No
If answered as “yes”, list total hours
worked
per week
at other job:
Max. hours to be worked
per day
during
school year
: Max. hours to be worked
per week
during
school year:
Monday - Thursday
________
Friday – Sunday
_________ Weekly max:__________
Max. hours to be worked
per day
during
non-school year
: Max. hours to be worked
per week
during
non-school year:
Monday - Sunday
__________ Weekly max:_________
Earliest
start time during
school
year
Latest
quit time during
school
year
Sun- Thursday am-pm:________
Monday-Sunday am-pm:___________
Friday – Saturday
am-pm:________
Earliest
start time during
non-school
year
Latest
quit time during
non-school
year
Monday-Sunday am-pm:___________
Monday -Sunday am-pm:________
The minor will have the following job duties:
Name of firm Telephone number
Location address of
minor’s
workplace:
City State ZIP
UBI number for
this
business location:
Expiration date of minor work permit endorsement:
9-Digit UBI Number for business location 3-Digit business ID 4-Digit Location ID
Month Day Year
Date Title Signature of EMPLOYER or REPRESENTATIVE
PARENTAL AUTHORIZATION
(These sections to be completed by the minor’s parent or legal guardian and school after employer completes top portion.)
I CONSENT TO ALLOW THE MINOR LISTED TO BE EMPLOYED AT THE OCCUPATION AND UNDER THE CONDITIONS STATED ABOVE
Date Telephone Number
Signature of PARENT or LEGAL GUARDIAN
Address of parent or legal guardian
City State
ZIP
Note: The school may limit the hours of work for a student according to how the student will be affected by working too many
hours, e.g., homework, attendance, etc. and may reduce and approve fewer hours than the rules allow or requested by the
employer or parent.
SCHOOL AUTHORIZATION (when school is in session)
THE STATED HOURS OF EMPLOYMENT MEET THE REQUIREMENTS OF SCHOOL ATTENDANCE REGULATIONS AND ARE HEREBY APPROVED.
Date Telephone Number
Title: Signature of SCHOOL AUTHORITY
