Fillable Printable Form 700-168-000
Fillable Printable Form 700-168-000
Form 700-168-000
F700-168-000 Parent AuthorizationforSummer Work11-2017 Page 1of2
Employment Standards Program
PO Box 44510
Olympia WA 98504-4510
Parent Authorizationfor Summer Work
For parents or legal guardians to indicate approval for a minor
employee to work according to the terms listed by the employer and
within the limitsof the child labor regulations.
Phone:866-219-7321
This is not a Minor Work Permit
Employers must have a Minor Work Permit endorsement on their Business
License for each work location where minors areemployed and renew it each
year. To apply, go to: http://bls.dor.wa.gov/minorworkpermit.aspx
Fax:
360-902-5300
Email:
TeenSafety@Lni.wa.gov
Web:
www.Lni.wa.gov/TeenWorkers
Do not mail this form to L&I.This formmustbe kept on file by the employerat the minor’s workplace and be
available for department audit. If minor continues employment into the school year, the employer must complete the
Parent/School Authorization
by September 30 of each year or when work schedule changes.
EmployeeInformation― To be completed by the employee
Employee Name
Date of Birth (mm/dd/yyyy) ― (Must be accompanied byproof)
Address
Phone Number
City
State
Zip Code
Are you employed at another job?
Yes No
If “Yes”, how many hours do you work per week?
Employer Information
Before allowing a minor to begin work,you must obtain and keep on file, at the minor’s workplace, a fully
completed Parent Authorization for Summer Work. As the employer, it is your responsibility to ensure that this
form is completed by you before collecting signatures.
EmployerBusiness Name
Phone Number
Washington Unified Business Identifier (UBI)
Expiration Date of Minor WorkPermit
-
-
Location Address (Physical location where minorwill be working)
City
State
Zip Code
Contact Name
Wage per Hour
$
List of Specific Job Duties
Employers:Please fill out the anticipated hours and work scheduleon the following page according to the
corresponding hours chart and age group.
Parents/legal guardians may adjust these hours and schedule as needed.
C
ontinue to Next Page
F700-168-000 Parent AuthorizationforSummer Work11-2017 Page 2 of2
Hours and Work Schedule― Parents may adjust hours and schedule as needed.
Hours and Schedules Minors are Permitted to Workin Non-Agricultural Jobs
Summer
Weeks
Age Group
Hours/Day
Hours/Week
Days/Week
Begin
Quit
14 ― 15
Years Old
8 hours40 hours6 days7 a.m.7 p.m. (9 p.m. June 1 to Labor Day)
16 ― 17
Years Old
8 hours48 hours6 days5 a.m.Midnight
•An adult must supervise minors working after 8 p.m. in service occupations such as restaurants and retail businesses.
•Overtime rules apply for all hours worked over 40in oneweek.
Requested Hours of Work in Non-Agriculture Jobs
Hours per Day
Hours per Week
Start Time
Quitting Time
Employer
Parent
Adj.
Employer
Parent
Adj.
EmployerParent Adj.EmployerParent Adj
A.M. / P.M.A.M. / P.M.A.M. / P.M.A.M. / P.M.
Hours and Schedules Minors are Permitted to Work in AgriculturalJobs
Summer
Weeks
AgeGroup
Hours/Day
Hours/Week
Days/Week
Begin
Quit
12 ― 13
Years Old
8 hours40 hours6 days5 a.m.9 p.m.
14 ― 15
Years Old
8 hours40 hours6 days*5 a.m.9 p.m.
16 ― 17
Years Old
10hours
50hours
(60 hours/week in mechanical
harvest of peas, wheat, and hay)
6 days* 5 a.m.10 p.m.
•12 – 13 year-olds may work only during non-school weeks hand-harvesting berries, bulbs, cucumbers, and spinach.
*Exception ― 14 – 17 year-olds are allowedto work 7 days a week in dairy, livestock, hay harvest, and irrigation during
school and non-school weeks.
Requested Hours of Work in AgriculturalJobs
Hours per Day
Hours per Week
Start Time
Quitting Time
Employer
Parent
Adj.
Employer
Parent
Adj.
EmployerParent Adj.EmployerParent Adj
A.M. / P.M.A.M. / P.M.A.M. / P.M.A.M. / P.M.
Required Signatures
Employee’s Signature
Print Name
Employee’s Signature
Date
Employer’s Signature
Print Name
Employer Representative Signature
Title
Date
Parental Authorization
I consent to allow the minor listed to be employed at the occupation and under the conditions stated above.
Print Name
Parent or Guardian Signature
Phone Number
Date
Comments by Parental Authority
RESET
