LS-67-2 (10-17) AI
rk certificates are required regardless of where a child attends school (public school, private school, charter school,
home school). Work certificates must be issued by either (1) the public school superintendent of the school district in
which the child resides, (2) the chief executive officer of the charter school that the child attends, (3) the public or private
school principal of the school that the child attends, (4) the designee of any of these school officials, or (5) if the child is
home-schooled, a parent of the child. The public school superintendent of the school district in which the child resides
may revoke a work certificate issued by a public or private school principal, if that is deemed to be in the best interest of
nstructions for completing the certificate are as follows:
Step 1: Complete Section A of the form, including the signature of the child’s parent or guardian.
Step 2: Take the form to the employer for completion of Section B.
te: Federal child labor law, while similar to the Missouri child labor laws, contains differing restrictions.
Employers should contact the U.S. Department of Labor regarding compliance with federal child labor law.
Step 3: After Sections A and B are completed, take the form to one of the individuals identified above as having
authority to issue a work certificate for completion of Section C. The following information will also be required
at that time:
• Proof of the child’s age (birth certificate or other evidence).
dditionally, the following information may be required by the issuing officer:
• Attendance of a parent or guardian with the child at the time the child applies for a certificate. Check
with the issuing officer for his or her policy.
• A certificate from the principal of the school that the child attends setting out the child’s grades.
(This requirement may be waived for home-schooled children.)
• A certificate from a physician that has personally examined the child stating that the child is in g
ental and physical health and is capable of performing labor without injury to his or her health a
mental development. Check with the issuing officer for his or her policy.
Step 4: After all three sections of the form have been completed, the original must be provided to the child’s employer.
The issuing officer must retain a copy, and a copy must be mailed to:
Department of Labor and Industrial Relations
Division of Labor Standards
P.O. Box 449
Jefferson City, MO 65102-0449
r fax to: 573-751-3721
or more information on Missouri’s child labor laws contact the Division of Labor Standards:
Phone: 573-751-3403 Email: email@example.com Website: www.labor.mo.gov
Missouri Department of Labor and Industrial Relations is an equal opportunity employer/program.
TDD/TTY: 800-735-2966 Relay Missouri: 711