Wisconsin Work Permit Form – Fill Out and Use This PDF

STATE OF WISCONSIN WORK PERMIT REQUEST FORM

Allow 24 Hours for Completion

(See Ms. Winters at the front office in the morning, and pick up at the end of the school day)

The following items MUST BE PROVIDED IN PERSON before a work permit can be issued to the minor or parent/guardian:

1.REQUIRED: A duly attested birth certificate (preferred form of age documentation), or a verified baptismal certificate, or a driver’s license, or photo ID card issued by the Department of Transportation, or a school record for proof of the minor’s age.

2.REQUIRED: The minor’s Social Security card for proof of Social Security number. If the minor’s Social Security card is lost, then the Social Security number MUST be verified by contacting a Social Security representative. To do that, the minor and/or the minor’s parent, guardian, or

court-ordered foster parent must go to your office of Social Security and request a replacement card. The Social Security Representative will provide you with a print out verifying the minor’s social security number.

3.REQUIRED: Completion on this form of the employer information below; or a letter from the employer containing the employer’s name, address, telephone number, and signature, along with a statement of the intent to employ the minor, the job title, the job duties, the days of work, and the approximate number of hours of work per week.

4.REQUIRED: The signature below of the minor’s parent, guardian, or court-ordered foster parent; or a letter from the minor’s parent, guardian, or court-ordered foster parent giving consent for the minor to accept the employment being offered by the employer.

5.REQUIRED: Payment from the employer of $10.00 for the work permit fee. If the permit fee is paid by the minor rather than the employer, then the employer shall reimburse the minor for the permit fee no later than the first pay check issued to the minor.

EMPLOYER MUST COMPLETE THIS SECTION – WORK PERMIT REQUIRED INFORMATION

Employer Name							Today’s Date
Employer Mailing Address/City/State/Zip
Employer Telephone Number						Employer Fax Number
Printed Name of Minor Being Hired						Date Minor Will Begin Employment
Title of the Job Minor Will Be Performing						Approximate Number of Hours Per Week Minor Will Be Working
Days of the Week Minor Will Be Working
Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Provide a Brief Description of Job Duties:
Printed Name of Employer Representative						Signature of Employer Representative

PARENT OR GUARDIAN MUST COMPLETE THIS SECTION – REQUIRED INFORMATION

Name and Address of School that the Minor is Attending

Do Parents Own this Business?	Is the Minor a H.S. Graduate?		Is the Work Being Performed as Restitution?
Yes No	Yes No		Yes No
Printed name of Parent, Guardian, or Court-Ordered Foster Parent		Signature of Parent, Guardian, or Court-Ordered Foster Parent
		I give my permission for the minor whose name is listed above to accept the work
		that is described above.