Get MD Application for Work Permit for a Minor

Take this Application the on-line Application Receipt and your Proof of Age to any Issuing Officer and request a Maryland Minor Work Permit. STATE OF MARYLAND DEPARTMENT OF LABOR LICENSING REGULATION DIVISION OF LABOR INDUSTRY 1100 N EUTAW STREET - BALTIMORE - MARYLAND - 21201 APPLICATION FOR WORK PERMIT FOR A MINOR 1. Complete your section of the this application* Type or print and make sure it is legible. Use your correct legal name. 2. Have the Employer complete the Employer section* 3. Have your parent or guardian sign this application* 4. Use the data to complete the on-line application www. dllr. state. md. us/labor/empm*shtml First Name To The Minor Last Name Street Address City For Proof of Age You may use Birth Certificate School Records Valid Maryland Driver s License Any official Government document County State Zip Code Home Telephone Date Of Birth Month Day Year School Name 5. 6. Deliver the official Work Permit to your employer. A new permit must be obtained for each job To The Employer 2. Do not allow minor to work until the official work permit is in your possession* 3. Work permits are not transferable and are required until the minor s 18th birthday. Company Name Select - Type of Business X Accommodation Food Services Administrative Waste Services Agriculture Forestry Fishing Hunting Arts Entertainment Recreation Construction Educational Services Finance Insurance Health Care Social Assistance Information Telephone Extension Management of Companies Enterprises Manufacturing Employer Rep Name Mining Employer Rep Signature Other Services except Public Administration Professional Technical Services Public Administration Real Estate Renting Leasing Work Duties Retail Trade Transportation and Warehousing Unknown Utilities Wholesale Trade To The Parent or Guardian This minor is being employed at the place of work described above with my full knowledge and consent. I hereby certify that to the best of my knowledge the information herein is correct and true. I request that a work permit be issued for the above named minor. Signature of Parent or Guardian Date 1. Verify the minor has signed and dated the correct and true statement below. Issuing Officer I hereby certify that to the best of my knowledge the information herein is correct and true. Control Number Signature of Minor 2. Do not accept an incomplete application* 3. The Division of Labor and Industry requires you retain this application in your file for 2 years from date of issuance. Complete your section of the this application* Type or print and make sure it is legible. Use your correct legal name. 2. Have the Employer complete the Employer section* 3. Have your parent or guardian sign this application* 4. 2. Have the Employer complete the Employer section* 3. Have your parent or guardian sign this application* 4. Use the data to complete the on-line application www. dllr. state. md. us/labor/empm*shtml First Name To The Minor Last Name Street Address City For Proof of Age You may use Birth Certificate School Records Valid Maryland Driver s License Any official Government document County State Zip Code Home Telephone Date Of Birth Month Day Year School Name 5. .