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Get Request For Work Permit

WISCONSIN CHILD LABOR PERMIT REQUEST Information For Obtaining a Work Permit MINOR S INFORMATION Minor Name Address Last First Street M. I. Age City Social Security No. - Date of Birth State Zip EMPLOYER S INFORMATION Employer s Business Name Business Address Type of work minor will be doing List Specific Duties Employer s Signature Date Signed PARENT S OF MINOR INFORMATION Name Signature Relationship Date MINOR EMPLOYEE MUST BRING SOCIAL SECURITY CARD AND A COPY OF BIRTH OR BAPTISMAL CERTIFICATE OR DRIVER S LICENSE WITH THIS FORM COMPLETED AND 10. WISCONSIN CHILD LABOR PERMIT REQUEST Information For Obtaining a Work Permit MINOR S INFORMATION Minor Name Address Last First Street M. I. Age City Social Security No* - Date of Birth State Zip EMPLOYER S INFORMATION Employer s Business Name Business Address Type of work minor will be doing List Specific Duties Employer s Signature Date Signed PARENT S OF MINOR INFORMATION Name Signature Relationship Date MINOR EMPLOYEE MUST BRING SOCIAL SECURITY CARD AND A COPY OF BIRTH OR BAPTISMAL CERTIFICATE OR DRIVER S LICENSE WITH THIS FORM COMPLETED AND 10. 00 to be refunded by the employer To City Hall 823-7600 50 10th Street Clintonville WI 54929 Hours 8 00A. I. Age City Social Security No* - Date of Birth State Zip EMPLOYER S INFORMATION Employer s Business Name Business Address Type of work minor will be doing List Specific Duties Employer s Signature Date Signed PARENT S OF MINOR INFORMATION Name Signature Relationship Date MINOR EMPLOYEE MUST BRING SOCIAL SECURITY CARD AND A COPY OF BIRTH OR BAPTISMAL CERTIFICATE OR DRIVER S LICENSE WITH THIS FORM COMPLETED AND 10. 00 to be refunded by the employer To City Hall 823-7600 50 10th Street Clintonville WI 54929 Hours 8 00A. .

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  • BAPTISMAL
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