CDE B1 1 Form – Fill Out and Use This PDF

CDE B1-1 Form PDF Details

The CDE B1-1 form is California’s official “Statement of Intent to Employ a Minor and Request for Work Permit, Certificate of Age,” governed by Education Codes 49162 and 49163. California employers must submit this form to the minor’s school district before hiring anyone under the age of 18.

Information Collected on the CDE B1-1 Form

• Minor’s personal data: Full legal name, date of birth, home address, and grade level
• School information: School name, current school schedule, and school year dates
• Employment details: Employer name, business address, job title, job description, and proposed work hours per day and per week
• Parent or guardian section: Name, signature, and phone number of the minor’s parent or legal guardian, along with their consent to the employment
• Employer certification: Signed statement confirming compliance with California labor law, non-discrimination requirements, and workers’ compensation insurance coverage

The reverse side of the CDE B1-1 form details California and federal regulations on minor employment. These rules cover the maximum hours minors may work on school days and non-school days, prohibited occupations for workers under 18, and guidelines for overtime pay and rest breaks. Employers who proceed without an approved work permit risk fines and other penalties under the California Labor Code.

Once the form is completed and signed by both the employer and the parent or guardian, it is submitted to the minor’s school. A school official reviews and approves the work permit if all requirements are met. The permit is then returned to the employer before the minor starts work. For related employment documentation, see the Application for Work Permit and our full Employment Forms collection.