State of Michigan
Combined Offer of Employment and Work Permit/Age Certificate
CA-6 for minors UNDER 16 years of age
Employer Information:
- The employer must have a completed work permit form on file before a minor begins work.
- The employer 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. Back of this form must have summary of requirements to be valid.
Section I: Each Box must be Completed by Minor Applicant and Parent/Guardian
Name of Minor (First, Middle, Last): 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 [ ] on-line/virtual/cyber 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 Number:
Section II: Each Box must be Completed by the Employer - Offer of Employment
Name of Business: Address: City: ZIP:
Earliest Starting Time 7:00 a.m.
No Earlier than 7:00 am
No Earlier than 7:00 am
Latest Ending Time 7:00 p.m.
7:00 pm (
Labor Day – June 1)
9:00 pm (
June 1 – Labor Day)
Non School Days:
No more than 8
work hours
non-
school days only
School Days
No More than
3 work hours
school days
Monday-Friday
Minor may
not more
than 6
days per
week
40 total combined school and work
hours per week:
No more than 3 work
hours after school Monday - Friday
Applicant’s Job Title: Hourly Wage: Name Job Duties/Tasks to be Performed by Minor: Name Equipment/Tools to be Used by Minor:
Signature of Employer:
(x)
Title: 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 Hours in School
per Week, when School is
in Session:
[ ] Birth Certificate [ ] Certificate of Arrival in the U.S.
[ ] Driver’s License [ ] Hospital Record of Birth (add + add)
Number of Hours able to
Work while Attending
School = No More than 40
[ ] School Record [ ] Baptismal Certificate
[ ] Other (describe)
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-6 (revised 2013) Combined Offer of Employment & Work Permit / Age Certificate Must Print front and back on Pink Paper.
Instructions for completing CA-6 must be printed on back of form to be valid.
Permit Number for School Use
(optional)
Summary of Requirements
CA-6 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-6 Work Permit? A minor who is 11 to13 years of age employed in certain occupations (
referenced above) or 14 and 15 years
of age not specifically exempt from the Youth Employment Standards Act (P.A. 90 of 1978). This completed pink CA-6 work permit allows a
minor to be employed only by the employer at the location listed in Section II until a minor turns 16; then, minor completes yellow CA-7 Work
Permit. A minor who does home, cyber, virtual, on-line school or who does not attend school must be issued a work permit from a State of
Michigan authorized school issuing officer or person authorized by that chief administrator in writing.
Who Issues the Work Permit? The 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 person under 18 years of age shall not be employed in, about, or in connection with an occupation that is
hazardous or injurious to the 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 pink CA-6 from the Issuing Officer of the school district and completes Section I.
2. The Minor takes the pink CA-6 form to the person (Employer) proposing to employ the minor who completes Section II.
3. The Employer gives the pink CA-6 back to the minor to return to the Issuing Officer who verifies the age of minor using the best
available evidence (
reference 409.105 of Public Act 90 of 1978) and ensures compliance with state and federal laws and regulations.
4. The Work Permit is issued by the Issuing Officer who sign and date the form in Section III.
5. The Issuing Officer makes a copy of the pink CA-6 and place in minor’s permanent school file and gives original to the Minor to return
to the Employer.
6. The Minor returns the completed original pink CA-6 work permit, front and back, to the Employer 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:
Must have a completed pink CA-6 work permit, front and back, form before a minor begins work.
Must keep the original pink work permit, front and back, form at the place of employment.
Must provide, at all times, supervision (ongoing instruction and guidance) by the employer or an employee who is 18 years of age or older.
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.
Must maintain adequate time records including number of hours worked each day along with starting and ending times required by Public
Act 90 of 1978, as amended, and be made available for inspection by an authorized representative of the department.
Must return the work permit to the issuing officer upon separation of the minor’s employment.
Must post required work place posters at work site which may be downloaded at www.michigan.gov/mde .
Issuing Officer’s Responsibilities: Upon application, in person by the minor desiring employment, examine and approve information is
not incomplete and work is not hazardous/injurious and is not in violation of state or federal laws and regulations.
14 and 15 Year Old work hours covered by Federal Law (business gross annual sales exceed $500,000 or interstate commerce):
1. No more than 3 hours on school days (Monday - Friday) after school while school is in session
2. No more than 8 hours on non-school days or when school is not in session.
3. No more than 40 combined school and work hours in one week (Sunday - Saturday).
4. Not before 7:00 a.m. and no later than 7:00 p.m. (September Labor Day – June 1).
5. Not before 7:00 a.m. and no later than 9:00 p.m. (June 1 – September Labor Day).
14 and 15 Year Old work hours covered by State Law:
1. No more than 6 days in one week.
2. No more than a weekly average of 8 hours per day.
3. No more than 10 hours in one day.
4. Not employed during school hours.
5. Not more than 5 hours continuously without a documented and uninterrupted meal or rest period, at least 30 minutes or more.
6. Not before 7:00 a.m. and no later than 9:00 p.m.
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 Education, PO Box 30712, Lansing, MI, 48909 (517-335-6041) or www.michigan.gov/mde and click “Programs &
Offices”, then click “Career & Technical” and select ‘Youth Employment’.
Federal Fair Labor Standards Act: For information about 14 and 15 years of age child labor provisions, contact the U.S. Department of
Labor, Wage and Hour Division (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 performance of school
work at a level 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
. The minor shall be informed of the appeal process and shall be given
instructions as to the initiation of the appeal process by the school.