Child Labor Special Orders

Provide the following information in writing at least two weeks prior to a special order.

If you have any question regarding the special order process, contact the Child Labor Staff.

Requestor Information

Title

First

Middle (optional)

Last

Suffix (optional)

Degree (optional)

Requestor Contact Information

Requestor Phone (optional)

Requestor Email (optional)

Minor Information

Minor's Name

First

Middle (optional)

Last

Suffix (optional)

Month and Day of Birth (optional)

Re-order	Birth Month	Birth Day	Weight	Operations
	Birth Month (optional)	Birth Day (optional)	Item weight (optional)

Age (optional)

Last Four of SSN xxx-xx-

Work Information

Work to Be Performed (optional)

Where work will be performed? (optional)

Date / Time of Work Being Performed (optional)

Date / Time of Work Being Performed
	Date / Time of Work Being Performed (optional) Date / Time of Work Being Performed: Date (optional) Date / Time of Work Being Performed: Time (optional)	Item weight (optional)

more items

Total Work Hours (optional)

All Equipment and Tools to be Used by Minor (optional)

All Chemicals Minor Will Be Exposed To (optional)

Reason for Request (optional)

Specify the Child Labor Law Exemption Requested (i.e. hours, specific work, etc.) (optional)

Specify Any Conditions/Equipment That Will Protect Minor (optional)

All Other Pertinent Information That Could Have A Bearing On The Request (optional)

Submit a completed Child Labor Permit for each minor under age 16 with your request. Please click on Child Labor Permit for a copy of this required form.

Please attach all forms to this request.

Attachments (optional)

Unlimited number of files can be uploaded to this field.
50 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Authorization Information

Provided In Writing On Letterhead Of The Company Requesting The Special Order (optional)

One file only.
20 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Signature

Signature (optional)

Sign above

Title

First (optional)

Middle (optional)

Last (optional)

Suffix (optional)

Degree (optional)

Date Signed (optional)