ࡱ>  bjbjO O ;-a-ab0008h,$0BP4_^\AAAAAAA$gDGtA__AwB jA A :;@╜3 R\;AB0Bv;I I4;I; AA RBI : STATE OF CALIFORNIA DEPARTMENT OF EDUCATION STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST FOR A WORK PERMITCERTIFICATE OF AGE CDE Form B1-1 (Rev. 08-13) A Statement of Intent to Employ A Minor and Request for A Work PermitCertificate of Age form (CDE Form B1-1) shall be completed in accordance with California Education Code 49162 and 49163 as notification of intent to employ a minor. This form is also a Certificate of Age pursuant to California Education Code 49114. (Print Information in ink) Minor s Information FORMTEXT       FORMTEXT      Minor s Name (First and Last)Home PhoneStudent ID FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Birth DateSocial Security NumberGradeAge FORMTEXT       FORMTEXT       FORMTEXT      Home AddressCityZip Code School Information FORMTEXT       FORMTEXT      School NameSchool Phone FORMTEXT       FORMTEXT       FORMTEXT      School AddressCityZip Code To be filled in and signed by employer. (Please review the General Summary of Minors Work Regulations on reverse) FORMTEXT       FORMTEXT       FORMTEXT      Business Name or Agency of PlacementBusiness PhoneSupervisor s Name FORMTEXT       FORMTEXT       FORMTEXT      Business Address CityZip CodeDescribe nature of work to be performed: FORMTEXT       FORMTEXT      In compliance with California labor laws, this employee is covered by workers compensation insurance. This business does not discriminate unlawfully on the basis of race, ethnic background, religion, sex, sexual orientation, color, national origin, ancestry, age, physical handicap, or medical condition. I hereby certify that, to the best of my knowledge, the information herein is correct and true.  FORMTEXT      Employer s Name (Print First and Last)Employer s SignatureDate To be filled in and signed by parent or legal guardianThis minor is being employed at the place of work described with my full knowledge and consent. I hereby certify that to the best of my knowledge and belief, the information herein is correct and true. I request that a work permit be issued.  FORMTEXT      Parent or Legal Guardian s Name (Print First and Last)Parent or Legal Guardian s SignatureDate For authorized work permit issuer use ONLYMaximum number of work hours when school is in session: Maximum number of work hours when school is not in session: FORMTEXT       Mon FORMTEXT       Tues FORMTEXT       Wed FORMTEXT       Thur FORMTEXT       Fri FORMTEXT       Sat FORMTEXT       Sun FORMTEXT       Total FORMTEXT       Mon FORMTEXT       Tues FORMTEXT       Wed FORMTEXT       Thur FORMTEXT       Fri FORMTEXT       Sat FORMTEXT       Sun FORMTEXT       Total ______________________________________________ Proof of Minor s Age (Evidence Type) ______________________________________________ Verifying Authority s Name and Title (Print) ______________________________________________ Verifying Authoritys Signature Check Permit Type:  FORMCHECKBOX  Full-time  FORMCHECKBOX  Restricted  FORMCHECKBOX  General  FORMCHECKBOX  Work Experience Education, Vocational Education, or Personal Attendant  FORMCHECKBOX  Workability  STATE OF CALIFORNIA DEPARTMENT OF EDUCATION STATEMENT OF INTENT TO EMPLOY A MINOR AND REQUEST FOR A WORK PERMITCertificate of Age CDE Form B1-1 (Rev. 08-13) General Summary of Minors Work Regulations FLSA-Federal Labor Standards Act, CDE-California Department of Education, EC-California Education Code, LC-California Labor Code, CFR-California Federal Regulations, WEE-Work Experience Education, CVE-Cooperative Vocational Education If federal laws, state laws, and school district policies conflict, the more restrictive law (the one most protective of the minor) prevails (FLSA). Employers of minors required to attend school must sign a Statement of Intent to Employ a Minor and Request for a Work Permit Certificate of Age (CDE Form B1-1) (EC 49162). Employers must retain a Permit to Employ and Work (CDE Form B1-4) for each employed minor (EC 49161). Work permits (CDE Form B1-4) must be retained for three years and be available for inspection by sanctioned authorities at all times (EC 49164). A work permit (CDE Form B1-4) must be revoked whenever the issuing authority determines the employment is illegal or is impairing the health or education of the minor (EC 49164).A day of rest from work is required in every seven days, and shall not exceed six days in seven (LC 551, 552). 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""H"M"\"e"k"n"u"Ÿ婜~~~~~~n~~~~n~h^Sh6CJOJQJaJh^ShCJOJQJaJhy hCJOJQJaJh_ghCJOJQJhkhCJOJQJaJh6CJOJQJaJh"h6CJOJQJaJh|Ah6CJOJQJaJhCJOJQJaJh|AhCJOJQJaJ+ ^!"w"##*$+$$$%%.%P%c%%%%& & F $If]^`gd & F L$If^`Lgd $Ifgd & F h<$If^hgdgdu"v"""""### ######$$$($)$*$+$$$$$$$$$%%& .AVüwhh$shCJOJQJaJ(hH\h\5B*CJOJQJaJphh$sh\5CJOJQJaJh$sh5CJOJQJaJh|Ah5CJOJQJaJ h|AhUhkh6CJOJQJaJh^Sh6CJOJQJaJh^ShCJOJQJaJhCJOJQJaJ(HOURS OF WORK (PER MANTECA USD POLICY 6175.4) 16 & 17 Year Olds Must have completed 7th grade to work while school is in session (EC 49112)14 & 15 Year Olds Must have completed 7th grade to work while school is in session (EC 49112)12 & 13 Year Olds Labor laws prohibit non-farm employment of children younger than 14. Special rules apply to agricultural work, domestic work in a private home, and the entertainment industry (LC 12851312)Maximum Work Hours - School In Session 4 hours per day on any school day [EC 49112, 49116; LC 1391(a)(4)] 8 hours on any non-school day or on any day preceding a non-school day [EC 49112; LC 1391(a)(3)] 20 hours per week [LC 1391(a)(3)] WEE and CVE students & personal attendants may work more than 4 hours on a school day, but never more than 8 [EC 49116; LC 1391(a)(4)(A), 1392]3 hours per school day outside of school hours [EC 49112, 49116; LC 1391(a)(2)] 8 hours on any non-school day [LC1391(a)(1)] 18 hours per week [EC 49116; LC 1391(a)(2)] WEE and CVE students may work during school hours and up to 23 hours per week [EC 49116; LC 1391(a)(2)]2 hours per school day and a maximum of 4 hours per week (EC 49112)Maximum Work Hours - School Not In Session 8 hours per day [LC 1391(a)(3), 1392] 48 hours per week [LC 1391(a)(3)]8 hours per day [LC 1391(a)(1), 1392)] 40 hours per week [LC 1391(a)(1)]8 hours per day [LC 1391(a)(1), 1392] 40 hours per week [LC 1391(a)(1)]Spread of Hours 5 a.m.10 p.m. However, until 12:30 a.m. on any evening preceding a non-school day [LC 1391(a)(3)] WEE and CVE students, with permission until 12:30 a.m. on any day (LC 1391.1) Messengers: 6 a.m.9 p.m. [LC1297]7 a.m.7 p.m., except from June 1 through the first day of instruction in August, until 9 p.m. [LC 1391(a)(1)]7 a.m.7 p.m., except from June 1 through the first day of instruction in August, until 9 p.m. [LC 1391(a)(1)]For more information about child labor laws, contact the U.S. Department of Labor at  HYPERLINK "http://www.dol.gov/" http://www.dol.gov/, and the State of California Department of Industrial Relations, Division of Labor Standards Enforcement at  HYPERLINK "http://www.dir.ca.gov/DLSE/dlse.html" http://www.dir.ca.gov/DLSE/dlse.html.     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