Hours Deviation Form PDF Details

In today's structured work environment, adhering to legally mandated hours, especially for minors, is crucial for both employers and employees. The Application for General Hours Deviation serves as a pivotal tool for businesses within Michigan looking to employ minors under conditions that deviate from the norm, acknowledging the necessity of balancing work, education, and rest for young workers. Governed by the Department of Energy, Labor & Economic Growth's Wage & Hour Division, this application facilitates businesses in legally extending or altering the working hours for 16 and 17-year-old individuals. Applicants are mandated to ensure that work does not infringe upon the minors' education, restrict their work to no more than six days a week, and provide necessary adult supervision alongside maintaining detailed pay and time records available for inspection. This form reflects a comprehensive approach to securing a balance between employment opportunities for minors and their physical and educational well-being, mandating parental or guardian permission for such deviations. Additionally, the document outlines the responsibilities of the employer to comply with the Youth Employment Standards Act, delineating the conditions under which deviations are granted, as well as the possible scenarios leading to the modification, denial, or revocation of the deviation by the department. Furthermore, it highlights the process an employer must follow should they choose to appeal a decision made regarding their application, ensuring a fair and transparent procedure is available for dispute resolution. Through setting forth these stipulations, the Hours Deviation form plays an essential role in safeguarding the interests of young workers in Michigan, emphasizing the importance of regulation in fostering a safe and conducive work environment.

QuestionAnswer
Form NameHours Deviation Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesmichigan deviation form, mi hours form template, michigan deviation latest, application general hours deviation

Form Preview Example

Department of Energy, Labor & Economic Growth

Wage & Hour Division

P.O. Box 30476

Lansing, MI 48909-7976

517.322.1825

www.michigan.gov/wagehour

Before submitting an Application for General Hours Deviation, please read these instructions carefully. If the application is not completed as indicated in these instructions, it will be returned to you.

COMPLETE THIS APPLICATION IF:

1.Records will be maintained on the premises where the minor is employed certifying that work hours do not exceed 48 work and school combined, AND

2.A valid work permit issued by a public, charter or private school is obtained, AND

3.All minors at this establishment will be employed in compliance with the provisions of Act 90, PA 1978, the Youth Employment Standards Act, AND

4.Pay and time records will be maintained and made available for inspection by an authorized representative of the Michigan Department of Energy, Labor & Economic Growth, AND

5.No minor will be employed for more than six days in one week, work longer than a weekly average of eight hours per day, or work more than five consecutive hours without a 30 minute recorded rest period, AND

6.Adult supervision is provided at all times, AND

7.Your business is requesting approval to employ 16 and 17 year olds attending school Monday through Thursday from 6:00 a.m. until 11:30 p.m., Friday from 6:00 a.m. to 12:30 a.m., Saturday from 5:00 a.m. until 12:30 a.m., Sunday from 5:00 a.m. until 11:30 p.m., AND

8.Your business is requesting approval to employ 16 and 17 year olds not attending school Monday through Sunday from 5:00 a.m. until 12:30 a.m., AND

9.Written parental permission must be on file at the location the minor is working.

COMPLETE THIS APPLICATION BY:

1.Entering complete business name and telephone number.

2.Entering complete corporate name.

3.Entering complete business mailing address.

4.Entering DETAILED description of duties to be performed by minors.

5.Entering address where the work requiring deviated hours will be performed.

6.Affixing the signature of employer or employer's representative.

7.Indicating the title of employer or employer's representative.

8.Printing name of employer or employer's representative.

9.Entering date of application.

WHD-9404 (12/09)

APPLICATION FOR GENERAL HOURS DEVIATION FOR 16 AND 17 YEAR OLD MINORS

Michigan Department of Energy, Labor & Economic Growth

Wage & Hour Division

 

Mailing Address:

Street Address:

P.O. Box 30476

7150 Harris Drive

Lansing, MI 48909-7976

Lansing, MI 48913

Telephone: 517.322.1825

 

www.michigan.gov/wagehour

 

FOR OFFICE USE ONLY

Approval Date:

Expiration Date: None

Authority: Act 90, Public Acts of 1978 as amended

DELEG is an equal opportunity employer/program. Auxiliary aids, services, and other reasonable accommodations are available, upon request, to individuals with disabilities. Call 517.322.1825 to make your needs known to this agency.

EMPLOYER INFORMATION

IMPORTANT: Deviation of hours cannot be granted unless this form is completed and returned for review and approval.

Business Name:

 

 

 

Telephone:

Corporate Name:

 

 

 

 

 

 

Mailing Address:

 

 

 

 

 

 

City:

 

 

State:

 

 

Zip:

 

Duties to be performed by minors:

Address where minors will work the deviated hours if approved by the department:

Street Address:

 

City:

 

Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The business listed above requests approval to employ 16 and 17 year olds attending school, before the hour of 6:00 a.m. or after the hour of 10:30 p.m. as follows:

Sunday through Thursday general approval granted from 6:00 a.m. until 11:30 p.m.

Friday and Saturday general approval granted from 6:00 a.m. until 12:30 a.m.

Saturday and Sunday only general approval granted from 5:00 a.m. until 6:00 a.m.

The business listed above requests approval to employ 16 and 17 year olds not attending school:

Sunday through Saturday general approval granted from 5:00 a.m. until 12:30 a.m.

Signature of Employer or Representative

 

 

Title

 

 

 

 

Print Name of Employer or Representative

 

 

Date Application Signed

 

Please refer to other side

WHD-9404 (12/09)

I certify that all statements in this application are true and that:

1.The employment of all minors at this establishment will comply with the provision of Act 90.

2.Adult supervision will be present at all times.

3.Records required by Act 90 will be maintained and made available to an authorized representative of the department for inspection.

4.A record will be maintained of the beginning and ending times of rest periods provided to minors.

5.The establishment employing minors will keep on the premises: (a) work permit for each minor employed, (b) parent/guardian approval for each 16 or 17year old covered by the deviation, and (c) a validated hours deviation.

The Michigan Department of Energy, Labor & Economic Growth may:

1.Approve an application for a deviation.

2.Deny or Revoke a deviation when:

a.any of the information submitted in the application is determined to be false or in error, or

b.there is a change in the conditions under which the deviation was granted, or

c.the employer is in violation of any standard of the department, or

d.the employer fails to comply with a corrective action notice or citation issued by the department.

3.Modify a deviation to comply with a federal or state standard or guideline.

A Parent or Guardian may deny or revoke approval for the minor to work the deviated hours requested.

This deviation covers the period and hours listed and is subject to the conditions stated. Any request for hours not contained on the deviation must be submitted on an individual basis. The deviation is not valid without a work permit and the written permission of a parent/guardian expressly approving employment for hours stated on the deviation.

An employer may request a hearing to review a modification or denial by submitting written notice to the department. Upon receipt of the written appeal, a hearing will be scheduled before an administrative law judge, providing the employer an opportunity to justify the deviation.

THIS APPROVAL DOES NOT APPLY IF FEDERAL LAW OR A MUNICIPAL ORDINANCE ESTABLISHES A MORE RESTRICTIVE HOURS STANDARD.

WHD-9404 (12/09)

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