The Oregon WH-216-1 form serves as a crucial link between employers and the legal framework governing the employment of minors. Managed by the Bureau of Labor and Industries’ Wage and Hour Division, this form is an Annual Employment Certificate Application, specifically designed for minors aged 14 through 17. Required by businesses that intend to hire young workers, it gathers essential details such as the business name, the type of business, and the anticipated number of minors to be employed in the upcoming year. Furthermore, it probes into whether the employment will involve 14-15 year olds, or 16-17 year olds, and details the nature of the duties, work areas, and any power-driven machinery the minors might operate. Significantly, it also queries about the potential employment of minors in agriculture, pinpointing activities like the operation of or riding in tractors or other farm machinery. Filling out this form truthfully and accurately is not just a matter of bureaucratic compliance; it's an affirmation of the employer's commitment to adhering to child labor laws and ensuring a safe, lawful work environment for minors. By signing the form, employers vow to employ minors in alignment with their application's declarations, to abide by child labor regulations, and to report any change in the provided information within a stipulated timeframe, thereby safeguarding the rights and safety of young workers in Oregon.
| Question | Answer |
|---|---|
| Form Name | Oregon Form Wh 216 1 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | wh 216 1 wh 216 1 form |
BUREAU OF LABOR AND INDUSTRIES
Wage and Hour Division
ANNUAL EMPLOYMENT CERTIFICATE APPLICATION
for minors 14 through 17 years of age
Business Name _____________________________________________ Telephone (_____) ___________Ext.
Corporation Name (if any)
Type of Business____________________________________________ NAIC Code (if known) __________________
Site Address
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(Street) |
(City) |
(State) |
(Zip) |
(County) |
Mailing Address |
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|
|
|
|
(Street/P.O. Box Number) |
(City) |
(State) |
(Zip) |
(County) |
1.ESTIMATE the number of minors to be employed in the next twelve (12) month period:
2.Do you anticipate employing
3.Describe the duties of the minors to be employed, the work areas, and the address(es) where the work is to be performed, if other than the above site. Please attach a list of locations if necessary.
4.List all
5. Do you anticipate employing minors in agriculture? |
Yes _____ |
No _____ |
Operation of or riding in or on a tractor? |
Yes _____ |
No _____ |
Operation of or riding in or on other farm machinery? |
Yes _____ |
No _____ |
I certify that the information contained in this application is true and that I have received a summary of the child labor laws. I agree to:
1)Employ minors consistent with the application herein;
2)Comply with child labor laws; and
3)Report any changes in the above information by filing a Notice of Change (To Annual Employment Certificate) form between renewal periods within 15 days of the change.
_________________________________________________________________________ Date
(Signature of Employer or Representative)
______________________________________________ Telephone No. (_____)_________________ Ext.
(Printed Name of Employer or Representative)
RETURN THIS APPLICATION TO:
Bureau of Labor and Industries
Child Labor Unit - Suite 1045
800 NE Oregon Street
Portland, OR
Telephone: (971)
Fax: (971)