Fillable State of Michigan Combined Offer of Employment and (Michigan)

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State of Michigan Combined Offer of Employment and (Michigan)

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State of Michigan
Combined Offer of Employment and Work Permit/Age Certificate
CA-7 for minors 16 and 17 years of age
Employer Information:
- The employer must have a completed front and back yellow work permit form on file before a minor begins work.
- The employer or an employee who is 18 years of age or older must provide competent adult supervision at all times.
- The employer of the minor must comply with federal, state, and local laws and regulations including nondiscrimination against any
applicant or employee because of race, color, religion, national origin or ancestry, age, gender, height, weight, marital status, or disability.
- The employer must return the work permit to the issuing officer upon termination of the minor’s employment.
Directions: Please type or print using black ink pen. ALL FIELDS MUST BE COMPLETED. Back of this form must have summary of requirements.
Section I: Each Box must be Completed by Minor Applicant and Parent/Guardian
Name of Minor:
Address:
City:
ZIP:
Age:
Date of Birth Month/Day/Year:
Last Four Digits of Social Security Number:
Contact Telephone Number for Minor:
Name of School (present or last attended):
Address:
City:
ZIP:
Last Grade Completed:
School Status (check one):
[ ] in school [ ] home school [ ] online/Cyber/Virtual school [ ] not attending school
Type of Business (i.e., fast food, manufacturing):
Signature of Minor:
(x)
Name of Parent/Guardian (circle one):
Parent/Guardian Telephone:
Section II: Each Box must be Completed by the Employer - Offer of Employment
City:
ZIP:
Earliest Starting Time 6:00 a.m.
No earlier than 6:00 am
No earlier than 6:00 am
Latest Ending Time 10:30p.m.
No later than10:30 pm(Sun-Thurs)
No later than11:30 pm (Fri-Sat)
Hours per Day:
No more than 8
Number of Days per Week:
No more than 6 per week
Total Hours of Employment:
No more than 24 when school in
session; No more than 48 when school
not in session
Applicant’s Job Title:
Hourly Wage:
Name Job Duties/Tasks to be Performed by Minor
Name Equipment/Tools to be Used by Minor
:
Will the minor be working under an hours deviation granted by the Michigan Department of Education? [ ] No [ ] Yes
If yes, attach the Individual Application for Hours Deviation for 16 and 17 Year Old Minors along with this original yellow CA-7 and mail to:
MDE/OCTE P.O. Box 30712, Lansing, Michigan 48909, for approval
(x)
Telephone:
Date:
Section III: Each Box must be Completed by School’s Issuing Officer – Must be Signed by the Issuing Officer to be Valid
This is to certify that:
(1) the minor personally appeared before me,
(2) this form was properly completed,
(3) listed job duties are in compliance with state and
federal laws and regulations,
(4) listed hours are in compliance with state and
federal laws and regulations,
(5) this form was signed by student and employer,
and I authorize the issuance of this work permit.
Evidence of Age Confirmed by (issuing officer checks one):
Number of Work Hours
per Week, when School
is in Session:
[ ] Birth Certificate [ ] Certificate of Arrival in the U.S.
No more than 24
hours per week
[ ] Driver’s License [ ] Hospital Record of Birth
Number of Work Hours
while school is not in
session (Summer,
Spring, Xmas vacation):
[ ] School Record [ ] Baptismal Certificate
[ ] Other (describe)
No more than 48
hours per week
Name of School District:
Printed Name of Issuing Officer:
Title:
Address:
City, State, ZIP:
Signature of Issuing Officer:
(x)
Issue Date:
Telephone Number:
Form CA-7 (revised 10/18/2011) Combined Offer of Employment & Work Permit and Age Certificate Must Print front and back on Yellow Paper.
Instructions for completing CA-7 must be printed on back of form to be valid.
Must submit original yellow front and back CA-7 when submitting Individual Application for Hours Deviation form.
Permit Number for School Use
(optional)
Summary of Requirements
CA-7 MICHIGAN WORK PERMIT AND AGE CERTIFICATE
The Minimum Age for Employment is 14 years except that a minor 11 years of age or older may be employed as a youth athletic program
referee or umpire for an age bracket younger than his/her own age or as a golf or bridge caddy; 13 years of age or older may be employed to
perform services which entail setting traps for formal or informal trap, skeet and sporting clays shooting events or in some farming occupations
described in section 4(3) of the Youth Employment Standards Act 90 of 1978. Adult supervision is required, at all times.
Who Needs a CA-7 Yellow Work Permit? A 16 or 17 year old minor attending any type of schooling (including but not limited to home school
– cyber school – online school – virtual school) or not attending school or is an out of state resident and not specifically exempt from the Youth
Employment Standards Act (P.A. 90 of 1978) sections
409.116; 409.117; 409.118; 409.119. This completed (all sections I, II, III) yellow CA-7
work permit allows a minor to be employed, only by the employer at the location, listed in Section II; therefore, minor shall not begin
employment in an occupation regulated by this act until the person proposing to employ the minor procures and keeps on file at the place of
employment a completed original yellow CA-7 which is valid until minor turns 18 or graduates, as long as the minor works for the same
employer.
Who Issues the Work Permit? A State of Michigan issuing officer is the chief administrator of a school district, intermediate school district,
public school academy, or nonpublic school, or a person authorized by that chief administrator in writing to act on his/her behalf.
Employment of Minors: A minor under 18 years of age shall not be employed in, about, or in connection with an occupation that is hazardous
or injurious to minor’s health or personal well-being or which is contrary to standards established by state and federal acts, (i.e., construction,
slicers, motor vehicle operation, power-driven machinery).
Instructions for Completing and Issuing:
1. The Minor obtains the yellow CA-7 from a State of Michigan Issuing Officer of the school district and completes Section I.
2. The Minor takes the yellow CA-7 to the Person/Employer proposing to employ the minor to complete Section II.
3. The Employer/Person gives the yellow CA-7 back to the minor to return to the State of Michigan Issuing Officer who verifies age of
minor (using best available evidence
409.105 of Public Act 90 of 1978) and ensures compliance with state and federal laws and regulations.
4. The State of Michigan Issuing Officer, after reviewing all information in Sections I, II and III then sign and date in Section III.
5. The State of Michigan Issuing Officer makes copy of CA-7 and place copy in minor’s permanent school file and returns original to the
minor.
6. The Minor gives completed original yellow CA-7 Work Permit to the Employer/Person listed in Section II before beginning work.
The failure or refusal to issue a work permit by the school may be appealed by the minor in accordance with Public Act 306 of 1969.
Employer’s Responsibilities: The issuance of a work permit does not authorize employment of minors contrary to state or federal laws and
regulations.
Must have a valid (front and back) and completed original yellow CA-7 Work Permit form before a minor begins work.
Shall keep the original yellow work permit form and any approved deviation with parental consent on file at the place of employment.
Must provide competent adult supervision, at least 18 years of age or older, at all times.
Must comply with federal, state, and local laws and regulations including nondiscrimination against any applicant or employee because of
race, color, religion, national origin or ancestry, age, gender, height, weight, marital status, or disability.
Records required by Public Act 90 of 1978, as amended, must be maintained and made available for inspection by an authorized
representative of the department.
Must return the work permit to the issuing officer upon termination of the minor’s employment.
Must post all required work place poster at work site/work location; “Posting Requirement” may be downloaded at www.michigan.gov/mde.
Issuing Officer’s Responsibilities: A copy of the CA-7 and any Michigan Department of Education deviation forms shall be filed in the
minor’s permanent school file. Work permits shall not be issued if the work is hazardous or injurious, information is incomplete, or if the
minor’s employment is in violation of state or federal laws and regulations.
Minors 16 or 17 Years of Age Work Hours:
1. No more than 6 days in one (1) week.
2. No more than a weekly average of 8 hours in one (1) day.
3. No more than 10 hours in one (1) day.
4. No more than 24 work hours in one (1) week when school is in session regardless of the number of school hours.
5. No more than 48 work hours in one (1) week when school is not regularly in session (Christmas, Spring or Summer vacation, etc.)
6. Not more than 5 hours continuously without a documented and uninterrupted 30 minutes or more meal or rest period.
7. Sunday - Thursday between the hours of 6:00 a.m. and 10:30 p.m.
8. Friday - Saturday between the hours of 6:00 am and 11:30 p.m., and not regularly attending school (i.e., summer vacation, etc).
Hours Deviations: At any time an employer may apply through the Office of Career and Technical Preparation for a General Hours or an
Individual Application for Hours Deviation allowing the minor to work beyond the legal hours of employment allowed by the act (409.120(2)).
Michigan Youth Employment Standards Act (P.A. 90 of 1978): For information about the law, rules, and regulations contact the Office of
Career and Technical Preparation, PO Box 30712, Lansing, MI, 48909, phone 517/373-3373, www.michigan.gov/octp and click on ‘Career
Preparation System’, then select ‘Work Based Learning Guide For Risk Management’ and go to section 6.
Federal Fair Labor Standards Act: For information about federal child labor provisions contact the U.S. Department of Labor, Wage and
Hour Division, at 1-866-4USWAGE or www.youthrules.dol.gov.
Revocation of Permit: A permit may be revoked by the school issuing officer if: (1) poor school attendance results in a level of school work
lower than that prior to beginning employment or (2) the Michigan Department of Education/U.S. Department of Labor informs the school of an
employer’s violations of state or federal laws or regulations. Any minor who has a permit revoked shall be informed of the appeal process by
the school.
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State of Michigan Combined Offer of Employment and (Michigan)

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Completed 1 October 2020

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