Form Ca 6 PDF Details

In the realm of youth employment, the State of Michigan takes a proactive approach to ensure the safety and well-being of minors in the workforce through the implementation of the Combined Offer of Employment and Work Permit/Age Certificate CA-6 for individuals under 16 years of age. This comprehensive document serves not only as a work permit but also as an age certificate, delineating the legal framework within which employers and minors can engage in an employment relationship. It mandates that employers maintain a completed form on file before a minor commences work, provide competent adult supervision at all times, and comply with a myriad of federal, state, and local laws designed to protect the minor from discrimination and unsafe working conditions. The form requires detailed input from the minor and their parent or guardian, the prospective employer, and the school issuing officer, ensuring a tripartite commitment to the minor's educational continuity and physical safety. The CA-6 form encapsulates the legal requirements concerning the hours of work permissible by law, both under federal and state jurisdiction, among other critical employment conditions. As such, it is an indispensable tool in the management of minor employment in Michigan, safeguarding the interests of young workers while accommodating their desire to engage productively in the state's economy.

QuestionAnswer
Form NameForm Ca 6
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameswork permit michigan, ca 6, ca6 form, michigan ca 6 form

Form Preview Example

State of Michigan

Combined Offer of Employment and Work Permit/Age Certificate CA-6 for minors UNDER 16 years of age

Permit Number for School Use

(optional)

Employer Information:

-The employer must have a completed work permit form on file before a minor begins work.

-The employer must provide competent adult supervision at all times.

-The employer of the minor must comply with federal, state, and local laws and regulations including nondiscrimination against any applicant or employee because of race, color, religion, national origin or ancestry, age, gender, height, weight, marital status, or disability.

-The employer must return the work permit to the issuing officer upon termination of the minor’s employment.

Directions: Please type or print using an ink pen. See back of this form for summary of requirements.

Section I: To be Completed by Minor Applicant and Parent/Guardian

 

 

Name of Minor:

 

 

 

Address:

 

 

 

City:

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Age:

Date of Birth Month/Day/Year:

 

Last Four Digits of Social Security Number:

Contact Telephone Number for Minor:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of School (present or last attended):

 

Address:

 

 

 

City:

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Grade Completed:

 

 

School Status (check one): [

] in school [

] home schooled

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Minor:

 

 

 

Name of Parent/Guardian (circle one):

Parent/Guardian Telephone:

 

 

(x)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section II: To be Completed by the Employer - Offer of Employment

 

 

 

 

 

 

 

 

Name of Business:

 

 

 

Address:

 

 

 

 

City:

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Earliest Starting Time a.m./p.m.:

 

Latest Ending Time a.m./p.m.:

Hours per Day:

Number of Days per Week:

Total Hours of Employment per

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Week:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant’s Job Title:

 

Hourly Wage:

 

Job Duties/Tasks to be Performed by Minor:

 

Equipment/Tools to be Used by Minor:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Employer:

 

 

 

Title:

 

 

 

 

Telephone:

 

Date:

 

 

(x)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section III: To be Completed by School’s Issuing Officer – Must be Signed by the Issuing Officer to be Valid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of Hours in School

 

 

This is to certify that:

 

 

 

 

Evidence of Age Confirmed by (issuing officer checks one):

per Week, when School is

 

 

(1) the minor personally appeared before me,

 

 

 

 

 

 

 

 

 

in Session:

 

 

(2) this form was properly completed,

 

[

] Birth Certificate

[ ] Certificate of Arrival in the U.S.

 

 

 

 

(3) listed job duties are in compliance with state and

 

 

 

 

 

 

 

 

 

 

 

 

federal laws and regulations,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] Driver’s License

[ ] Hospital Record of Birth

Number of Hours able to

 

 

(4) listed hours are in compliance with state and

 

 

 

 

 

 

 

 

 

 

 

 

Work while Attending

 

 

federal laws and regulations,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] School Record

[ ] Baptismal Certificate

School:

 

 

(5) this form was signed by student and employer,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and I authorize the issuance of this work permit.

[

] Other (describe)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of School District:

 

 

 

 

Printed Name of Issuing Officer:

 

 

Title:

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Issuing Officer:

 

 

Issue Date:

Telephone Number:

(x)

Form CA-6 (revised 6/2010) Combined Offer of Employment & Work Permit / Age CertificateMust Print on Pink Paper.

Instructions for completing CA-6 must be printed on back of form for form to be valid.

Summary of Requirements

CA-6 MICHIGAN WORK PERMIT AND AGE CERTIFICATE

Who Needs a CA-6 Work Permit? A minor who is 14 to 15 years of age and not specifically exempted from the Youth Employment Standards Act (P.A. 90 of 1978) and minors 11-13 employed in certain occupations. This completed form permits a minor to be employed only by the employer and at the location listed in Section II. CA-6 Work Permits are valid until a minor turns 18 or graduates as long as the minor works for the same employer. Home schooled students must be issued a work permit from an authorized issuing officer.

Who Issues the Work Permit? The issuing officer is the chief administrator of a school district, intermediate school district, public school academy, or nonpublic school, or a person authorized by that chief administrator, in writing, to act on his/her behalf. The work permit may be issued by the school the minor attends or the school district where the minor resides or will be employed.

Employment of Minors: A person under 18 years of age shall not be employed in, about, or in connection with an occupation which is hazardous or injurious to the minor’s health or personal well-being or which is contrary to standards established by state and federal acts, i.e., construction, slicers, motor vehicle operation, power-driven machinery. The minimum age for employment is 14 years except that a minor 11 years of age or older may be employed as a golf or bridge caddy or youth athletic program referee, and a minor 13 years of age or older may be employed in some farming occupations or as a trap-setter. Adult supervision is required.

Instructions for Completing and Issuing:

1.The Minor obtains the CA-6 from the Issuing Officer of their school district and completes Section I.

2.The Minor takes the form to the prospective Employer who completes Section II.

3.The Issuing Officer verifies the age of Minor using the best available evidence and ensures compliance with state and federal laws and regulations.

4.The Work Permit is issued by the Issuing Officer signing and dating the form in Section III.

5.The Issuing Officer makes a copy for the school file and gives the original to the Minor to return to the Employer.

6.The Minor returns the completed original form to the Employer before beginning work.

The failure or refusal to issue a work permit by the school may be appealed by the minor in accordance with Public Act. 306 of 1969.

Employer’s Responsibilities:

Must have a completed work permit form before a minor begins work. Shall keep the original work permit form at the place of employment. Must provide competent adult supervision at all times.

Must comply with federal, state, and local laws and regulations including nondiscrimination against any applicant or employee because of race, color, religion, national origin or ancestry, age, gender, height, weight, marital status, or disability.

Records required by Public Act 90 of 1978, as amended, will be maintained and made available for inspection by an authorized representative of the department.

Must return the work permit to the issuing officer upon termination of the minor’s employment.

Must post required work place posters at work site; posters may be downloaded at www.michigan.gov/wagehour.

Issuing Officer’s Responsibilities: A copy of the CA-6 shall be filed in the minor’s permanent school file. Work permits shall not be issued if the work is hazardous, information is incomplete, or if the minor’s employment is in violation of state or federal laws and regulations.

Hours of Work Covered by Federal Law (business gross annual sales exceed $500,000 or interstate commerce): Minors 14 and 15 years of age may work:

1.3 hours a day while school is in session; 8 hours a day on non-school days.

2.40 hours in a non-school week; 18 hours in a school week.

3.Not before 7:00 a.m., only after school and only until 7:00 p.m., while school is in session.

4.From 7:00 a.m. until 9:00 p.m. during school summer vacation (June 1 - Labor Day).

Hours of Work Covered by State Law: Minors under 16 years of age may work:

1.6 days in 1 week.

2.A weekly average of 8 hours per day.

3.10 hours in one day.

4.48 hours in 1 week, school and work combined.

5.Not more than 5 hours continuously without a 30 minute uninterrupted meal or rest period.

6.Between 7:00 a.m. and 9:00 p.m., but not during school hours.

Michigan Youth Employment Standards Act (P.A. 90 of 1978): For information about the law, rules, and regulations contact the Michigan Department of Energy, Labor & Economic Growth, Wage & Hour Division; PO Box 30476, Lansing, MI, 48909, phone 517/322-1825, www.michigan.gov/wagehour or for questions regarding work permits; contact the Office of Career and Technical Education, PO Box 30712, Lansing, MI, 48909, phone 517/373-3373, www.michigan.gov/octe and click on ‘Instructional Programs’, then select ‘Work Based Learning Guide For Risk Management’ and go to section 6.

Federal Fair Labor Standards Act: For information about federal child labor provisions, contact the U.S. Department of Labor, Wage and Hour Division, at 1-866-4USWAGE or www.youthrules.dol.gov.

Revocation of Permit: A permit may be revoked by the school issuing officer if: (1) poor school attendance results in a level of school work lower than that prior to beginning employment or (2) the Michigan Department of Labor & Economic Growth/U. S. Department of Labor informs the school of an employer’s violations of state or federal laws or regulations. Any minor who has a permit revoked shall be informed of the appeal process by the school.

How to Edit Form Ca 6 Online for Free

Any time you would like to fill out form ca 6, you don't need to download and install any sort of programs - simply give a try to our online PDF editor. Our editor is continually developing to give the best user experience attainable, and that is thanks to our resolve for constant improvement and listening closely to comments from users. To start your journey, consider these simple steps:

Step 1: Click on the "Get Form" button above. It'll open our pdf editor so that you could begin filling out your form.

Step 2: With our online PDF file editor, it's possible to accomplish more than simply complete blank fields. Try each of the features and make your docs seem sublime with custom text put in, or fine-tune the original content to excellence - all that accompanied by an ability to insert your own images and sign it off.

It is actually an easy task to fill out the document with this practical tutorial! This is what you must do:

1. Begin filling out your form ca 6 with a number of necessary fields. Gather all the information you need and be sure nothing is forgotten!

Filling out segment 1 in ca 6 work permit

2. When this array of fields is completed, it's time to include the needed specifics in Section II To be Completed by the, Address, City, ZIP, Earliest Starting Time ampm, Latest Ending Time ampm, Hours per Day, Number of Days per Week Total, Week, Applicants Job Title, Hourly Wage, Job DutiesTasks to be Performed by, EquipmentTools to be Used by Minor, Signature of Employer x, and Title so you can proceed to the next part.

Week, City, and ZIP of ca 6 work permit

3. The following part will be about Address, City State ZIP, Telephone Number, Signature of Issuing Officer x, Issue Date, Form CA revised Combined Offer of, and Must Print on Pink Paper - fill out each one of these blank fields.

Issue Date, Address, and Form CA revised Combined Offer of in ca 6 work permit

4. This next section requires some additional information. Ensure you complete all the necessary fields - representative of the department, cid Must return the work permit to, Issuing Officers Responsibilities, Hours of Work Covered by Federal, hours a day while school is in, Hours of Work Covered by State Law, days in week A weekly average, Michigan Youth Employment, and Federal Fair Labor Standards Act - to proceed further in your process!

Filling in section 4 in ca 6 work permit

People generally get some points incorrect while completing Hours of Work Covered by State Law in this section. Don't forget to double-check everything you enter right here.

Step 3: Go through all the details you've entered into the form fields and then click the "Done" button. Right after starting afree trial account here, you'll be able to download form ca 6 or email it right away. The PDF will also be easily accessible through your personal cabinet with your every change. With FormsPal, it is simple to complete forms without stressing about database breaches or data entries getting distributed. Our protected system makes sure that your private information is stored safely.

Form Ca 6 isn’t the one you’re looking for?

Related Documents