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APPLICATION FOR CERTIFICATE OF AGE WORK PERMIT

(FOR AGES 16 & 17 YEARS)

Required fields are marked with a *
   
Last Name (as it appears on your ID)*
First Name*
Middle Initial
Gender*
Male Female
Age*
16 17
Proof of Age*
Date of Birth (mm/dd/yyyy)*
Email* (Please provide only one email address)
Address*
City*
State (e.g. HI)*
Zip Code*
Phone Number*
(xxx)xxx-xxxx
Last 4 digits of your Social Security Number*
Local Office Nearest You*

Any person who knowingly violates any provision of the Child Labor Law shall be guilty of a misdemeanor.

By proceeding, I represent that the information submitted on the application is true and correct to the best of my knowledge.

I agree to the terms of service

 

(Please click "Submit" only once- it may take a few moments to register your information)

 

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