Form Nj A300 PDF Details

Navigating the complexities of employment for minors in New Jersey is made smoother with the A300 Combined Certification Form, an essential document that facilitates the legal hiring process. This comprehensive form, designed by the New Jersey Department of Education, serves multiple purposes: it verifies a minor's eligibility to work, encompasses health certification, and outlines the specifics of the employment offer, including the nature of the job and work hours. Part A of the form gathers detailed personal information about the minor, while Part B delves into the Employment Information, requiring confirmation from the potential employer about the job's details. The significance of Parts C and D cannot be overstated, as they deal with the Physician’s Certification and Proof of Age—two critical components that ensure the minor’s physical capability to handle the job and verify their age, respectively. Furthermore, the form addresses educational considerations, with sections dedicated to the school record and issuing officer's certification, confirming that the employment will not interfere with the minor’s schooling. In response to the Public Health Emergency, the form also adapts procedures to allow for remote processing, highlighting the flexibility and prioritization of safety in these challenging times. Clearly, the A300 form is a key player in safeguarding the rights and well-being of working minors in New Jersey, laying down a structured pathway for their entry into the workforce.

Form NameForm Nj A300
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesa300 form, nj working papers form, nj working papers a300, nj working papers

Form Preview Example







Date Printed: _____________

A300 Combined Certification Form



Date(s) of previously issued certificates (if applicable): ________________

Cooperative Education Experience (CEE) - Hazardous Occupation

CEE - Non-Hazardous Occupation

Paid Structured Learning Experience

















A. Minor’s Personal Information





First Name



Last Name




Social Security No.














Street Address (Line 1)




Floor/Apt. No. (Line 2)


Date of Birth



City of Birth



















Zip Code


County of Birth



State/Country of Birth











Telephone No.




Cell/Alternate No.




Height __________

Hair Color ______________










Weight __________

Eye Color









Parent/Guardian First Name


Parent/Guardian Last Name



Distinguishing Facial Marks (if applicable)










Parent/Guardian Address (if different than minor’s address)

Floor/Apt. No. (Line 2)


I hereby authorize the employment of my child as specified below under

















Employment Information.










Zip Code





















Parent/Guardian Telephone No.



Alternate Telephone No.










Signature of Parent/Guardian




















B. Employment






Employer Business Name







Type of Business/Industry












Street Address (where minor will be employed)

Floor/Suite (Line 2)



Minor’s Job Title (Be specific)




















Zip Code


Is liquor sold on the premises?












If Yes, are the entire premises licensed?



Contact Person Name















If No, describe what areas of the premises are licensed, including any

















outside grounds:





Telephone No.




Alternate Telephone No.















Minor’s Hours of Work (Provide daily hours and/or start and end times)



Promise of Employment: I have offered employment to the above









named minor for the hours stated. I understand that these hours may be

_______________ ______________ ______________ ______________ ______________

flexible but may not exceed the number of hours permitted by law









according to the age of the minor.




Sat ______________

Sun ______________

Total Hours for Week:___________











Wages: Per Hour ____________

Weekly ____________

Other -



Signature of Employer

















C. Physician’s Certification (to be completed by licensed physician): I hereby certify that I have examined the above named minor on __________________

and I designate the minor’s physical qualifications regarding the above promise of employment as:


Physically Qualified

Physically Qualified with the following limitations ________________________________________________________________


Signature of Doctor




D. Proof of Age (for Issuing Officer): I have examined the proof of age submitted by the above named minor which was in the form of (select one):

Birth Certificate

Baptismal Certificate Passport

Other documentary proof in existence for at least one year (specify): __________________

Affidavit of Parent/Guardian together with 1) physician’s statement of opinion as to age of minor, and 2) school record of age and the above date of birth

E. School Record (to be completed by school that the minor attends)

F. Issuing Officer Certification


School District


School District








Name of School


School District Address








School Address


Telephone No.








Last Grade Completed __________


Regular Employment Certificate




Vacation Employment Certificate (summer & other school vacations)





The above named minor attends school in this district and has completed the work

Age Certificate (issued to persons 18 to 21 years of age)

Age: _______

of the above grade. To the best of my knowledge the minor can do the work




proposed without impairment of progress in school.






Signature of Minor






Signature of Principal







Signature of Issuing Officer

Date of Issue

Certificate No.

A300 (R-6-16-2020) New Jersey Department of Education


Pursuant to Executive Order 135 (Murphy) (2020), for the duration of the Public Health Emergency declared in Executive Order No. 103 (2020), the provisions of N.J.S.A. 34:2-21.8 and N.J.S.A. 34:2-21.10, requiring the personal appearance of the minor, and, under certain circumstances, the minor’s parent or guardian, before school district issuing officers in order to apply for or sign employment certificates may be satisfied through the use of audio-visual technology. Each public-school district shall develop and implement procedures to satisfy the statutory requirements without requiring in-person contact between the school district issuing official and the minor, under the following conditions: a. During the application process, the child and the school district licensing officer may transmit a single copy of all required documentation by way of electronic transmission, fax, or any other means of transfer of documents developed by the school district that avoids in-person contact, is secure, and maintains the confidentiality of the documents; b. The video conference shall be live and must allow for interaction between the child and the school district issuing officer, and when applicable, the parent or guardian. During the video conference, the child shall verify his or her identity, authenticate the documents submitted, and sign the application, in a way that is visible and audible to the school district issuing officer; and c. Following the video conference, the child shall transmit the signed certificate, by electronic or other means as determined by the school district, to the issuing officer, who shall make the requisite copies and distribute the original and copies as required by N.J.S.A. 34:2-21.7

1.Employment Information (section B) – After you have completed your personal information (section A), bring your certification form to the employer. The employer completes the Employment Information and signs and dates the Promise of Employment. If any of the employment details have been pre-filled and are incorrect, the employer must cross out the incorrect information and enter, initial and date the corrections.

2.Physician’s Certification (section C) – The school district is responsible for performing the physical examination at no cost to you or your parents. A school physical (including a sports physical) performed during freshman year is good for all four years of high school (unless the school district policy specifies more frequent physicals).

If your parent/guardian prefers that you be examined by a doctor other than the one employed by the school district, you may do so at your parent/guardian’s expense. A minor is not required to obtain a physical if the parent/guardian objects (in writing) based on their religious beliefs and practices.

3.Proof of Age (section D) – If the school does not have a copy on file, you may be asked to provide a birth certificate, passport, baptismal certificate or other identification documentation to the School Issuing Officer.

4.Parent/Guardian Authorization (section A) – Your parent/guardian must indicate his/her authorization of your employment as specified in the Employment Information by signing and dating the Parent/Guardian authorization.

5.School Record/Issuing Officer Certification (sections E & F) - Present the completed certification form to your school district. A designated school official will review the form and issue the working papers only after being satisfied that the working conditions and hours will not interfere with your education. The official may refuse to issue working papers if such refusal would be in your best interest.*

* See above Executive Order 13 (Murphy) (2020) for temporary instructions.


Hours of Work – 14 & 15 Year Olds

no more than 3 hours a day on a school day

no more than 18 hours a week during a school week

may not work before 7:00 am or after 7:00 pm during the school year

summer vacation: may work up to 8 hours a day, 40 hours a week, and may work up to 9:00 pm with written parental permission (which must be on file with the employer)

Hours of Work – 16 & 17 Year Olds

no more than 8 hours a day

no more than 40 hours a week

may not work before 6:00 am or after 11:00 pm

Exception: may work after 11:00 pm (up to 3 am provided work begins before 11 pm) during regular school vacation and when there is no school the next day with written parental permission (which must be on file with the employer)

Hours of Work – All Minors

no more than 6 consecutive days

may not work more than 5 continuous hours without at least a 30-minute meal break

Hours of Work - School-Sponsored Cooperative Education Experiences, Apprenticeships and Paid Structured Learning Experiences - Training site experiences may not exceed five hours on any day that school is in session nor may the combination of school and work exceed eight hours on any day that school is in session.

Prohibited Work– Certain potentially hazardous jobs are prohibited for minors based on the age of the minor. For a complete list of prohibited occupations, visit the Department of Labor and Workforce Development’s website at and click on Wage & Hour. - New Jersey Department of Education (click on Wage & Hour) – New Jersey Department of Labor and Workforce

A300 (R-6-16-2020) New Jersey Department of Education

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part 1 to completing nj minor working papers

Write down the required particulars in City, State, Zip Code, Contact Person Name, Telephone No, Alternate Telephone No, Minors Hours of Work Provide daily, Mon Tues Wed, Thurs Fri, Sat Sun Total Hours for Week, Wages Per Hour Weekly Other, Yes No Is liquor sold on the, Promise of Employment I have, Signature of Employer, and Date part.

nj minor working papers City, State, Zip Code, Contact Person Name, Telephone No, Alternate Telephone No, Minors Hours of Work Provide daily, Mon Tues Wed, Thurs Fri, Sat  Sun  Total Hours for Week, Wages Per Hour  Weekly  Other, Yes  No Is liquor sold on the, Promise of Employment I have, Signature of Employer, and Date blanks to fill out

Write down all data you are required in the box School Address, Last Grade Completed, The above named minor attends, Signature of Principal, Date, A R New Jersey Department of, Telephone No, Regular Employment Certificate, Signature of Minor, Date, Certificate No Signature of, and Date of Issue.

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