CDE Form B1-1 at a glance
What it is: CDE Form B1-1 is the Statement of Intent to Employ a Minor and Request for a Work Permit-Certificate of Age.
Who signs: To be filled in and signed by parent or legal guardian. To be filled in and signed by employer. Enter the Student's Signature.
To be filled in and signed by parent or legal guardian.
To be filled in and signed by employer.
A filled-in CDE Form B1-1 example: a student, a parent and an employer
How to fill out CDE Form B1-1, box by box
Minor's Information
Under Minor's Information, enter the Minor's Name (First and Last), Home Phone and Grade.
Enter the Home Address, City and Zip Code.
Enter the Birth Date, Social Security Number and Age.
Enter the Student's Signature.
School Information
Under School Information, enter the School Name, School Phone, School Address, City and Zip Code.
Parent's Name, Parent's Signature and Date
This minor is being employed at the place of work described with my full knowledge and consent. I hereby certify that to the best of my knowledge and belief, the information herein is correct and true.
Enter the Parent's Name (Print First and Last), Parent's Signature and Date.
Business Name, Maximum Work Hours and Employer's Signature
Enter the Business Name or Agency of Placement, Business Phone and Supervisor's Name.
Enter the Business Address, City and Zip Code, and the Employer's Maximum Expected Work Hours: hours per day and hours per week.
Describe nature of work to be performed. In compliance with California labor laws, this employee is covered by workers' compensation insurance. This business does not discriminate unlawfully on the basis of race, ethnic background, religion, sex, sexual orientation, color, national origin, ancestry, age, physical handicap, or medical condition. I hereby certify that, to the best of my knowledge, the information herein is correct and true.
Enter the Employer's Name (Print First and Last), Employer's Signature and Date.
More rules for CDE Form B1-1
A Statement of Intent to Employ a Minor and Request for a Work Permit-Certificate of Age (CDE Form B1-1) shall be completed in accordance with California Education Code 49162 and 49163 as notification of intent to employ a minor.
This form is also a Certificate of Age pursuant to California Education Code 49114.
For authorized work permit issuer use ONLY.
Maximum number of work hours when school is in session. Maximum number of work hours when school is not in session.
Proof of Minor's Age (Evidence Type), Verifying Authority's Name and Title (Print) and Verifying Authority's Signature.
Check Permit Type: Work Experience, Full-time, Education, Vocational Education, or Personal Attendant, Restricted, General, Workability.
Where to get help with CDE Form B1-1
For more information about child labor laws, contact the U.S. Department of Labor at http://www.dol.gov/, and the State of California Department of Industrial Relations, Division of Labor Standards Enforcement at http://www.dir.ca.gov/DLSE/dlse.html.
Sources
[1] CDE Form B1-1 (Rev. 02-14), Statement of Intent to Employ a Minor and Request for a Work Permit-Certificate of Age, California Department of Education (the Official source link on this page).