Rhode Island Department of Labor and Training
INTENTION TO EMPLOY MINOR
Print in Ink, or Type, or on-line (except signature) (Adobe Reader 5.0 and above)
Employer’s Affidavit
THIS ESTABLISHMENT WILL EMPLOY THE MINOR
NAMED HEREIN, SUBJECT TO ALL PERTINENT LAWS
& REGULATIONS. EMPLOYER ASSUMES
RESPONSIBILITY TO ASCERTAIN THAT THE MINOR IS
OF LEGAL AGE FOR ANY OCCUPATION ASSIGNED.
8. Signature of Employer Date
9. Print Signer’s Name and Title
PARENT’S APPROVAL
I HEREBY GIVE PERMISSIONS FOR THE MINOR NAMED
AT LEFT TO ENTER EMPLOYMENT AS HEREIN DESCRIBED
10. Signature of Parent or Guardian (in ink)
11. Address of Parent or Guardian
Check
one:
14-15 Years of Age
SPECIAL LIMITED PERMIT
TO WORK
(Mandatory under law)
16-17 Years of Age
CERTIFICATE OF AGE
(Advisable for Employer’s
Protection)
1. Full Name of Minor first middle last
2. Address of Minor
3. Business Name of Employer
4. Business Address of Employer
5. Address where minor will perform work (if different from above)
6. Nature of Employer’s Business
7. Minor to be employed as
DLT-L-77 (Rev. 11/2000) CL-1-12/96
RESTRICTIONS -- Hours of Work
MINORS 14-15 years of age:
Maximum hours - RI 8 hours per day, 40 hours per week
Federal - 3 hours per day (school day) - 8 hours non-school day, 18 hours per week (school week - 40 hours, non-school week)
Curfew - RI Employment permitted between the hours of 6 A.M. and 7 P.M. (except 9 P.M. during school vacations)
Federal - Employment between the hours of 7 A.M. and 7 P.M. (except 9 P.M. from June 1st through Labor Day)
THE MORE RESTRICTIVE STANDARD APPLIES WHENEVER THERE IS COVERAGE BY BOTH STATE AND FEDERAL LAW.
Work is prohibited in factories, mechanical, manufacturing, or processing establishments. NO WORK WHEN SCHOOL IS IN SESSION
MINORS 16-17 years of age:
Maximum hours - RI 9 hours per day (9 3/5 per day in a 5 day work week.) 48 hours per week.
Curfew - STUDENTS: Employment permitted between the hours of 6 A.M. and 11:30 P.M. (if no classes are scheduled on the following day,
minor may be employed until 1:30 A.M.)
NON-STUDENTS: No Curfew
Certain Occupations have been declared hazardous for 16 and 17 year old workers through the provisions of the Fair Labor Standards Act.
For information regarding Federal Restrictions contact the area office: For information regarding the provisions of Rhode Island laws contact:
Employment Standards Administration Labor Standards Division
United States Dept. of Labor RI Department of Labor and Training
380 Westminister Street, Providence, RI 02903 P.O. Box 20390, Cranston, RI 02920-0944
(401) 528-4431 (401) 462-8550
This application is for employment to take place within the state of Rhode Island. When completed, it is to be presented by MINOR, IN PERSON,
to the issuing officer as designated by the School Committee in the city/town of minor’s residence. A minor who is not a Rhode Island resident must
present this form to the Issuing Officer, so designated, in the city or town where the work is being performed.
All applications must be accompanied by an acceptable proof of age, such as a (1) Birth Certificate, (2) Baptismal Certificate, (3) Bible Records, (4)
Passport, (5) Insurance policy (at least 1 year old), (6) Physician’s Certificate of Age accompanied by school records of age and parents affidavit, (7)
Rhode Island Motor Vehicle Operator’s license with photograph.
Minors 14-15 may not start work until employer has been issued the necessary permit;
Minors 16-17 may not be employed beyond the curfew until the employer has been issued a certificate of age verifying the non-student status.
