Free 00896.FH11 - Indiana

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INTENTION TO EMPLOY / A1
State Form 896 (R7 / 10-08)

NOTE: This card must be presented by the minor to the issuing officer in their school before a certificate will be issued. For employer's protection, the minor must also present an acceptable proof of age to obtain an employment certificate. The hours minor may work are shown on the reverse side.

Name of minor (intend to employ) Residential street address (number and street) Hours per day Hours per day List exact duties Name of business Street address (number and street) Signature of employers rep. Signature of minor Telephone no. Days of week Hours per week

Date (month, day, year) City, state, and ZIP code Is minor on school-directed Vocational Education Program with your firm? Yes No

Type of business (Mfg., Process, Retail, Restaurant) City, state, and ZIP code Signature of parent or guardian

AGES 14 and 15 - Restricted to:
- 3 hours per school day - 8 hours per nonschool day - 18 hours per school week - 40 hours per nonschool week - No work BEFORE 7 a.m. or AFTER 7 p.m. except 9 p.m. from June 1 through Labor Day (time depends on local standards)

HOURS OF LABOR (UNDER 18) AGE 17 - Restricted to:

AGE 16 - Restricted to:

- 8 hours per school day - 9 hours per nonschool day* - 30 hours per school week - 40 hours per school week* - 48 hours per nonschool week* - No work before 6 a.m. - Until 10:00 p.m. on school nights - Until midnight on nonschool nights* - No more than 6 working days per week

- 8 hours per school day - 9 hours per nonschool day* - 30 hours per school week - 40 hours per school week* - 48 hours per nonschool week* - No work before 6 a.m. - Until 10:00 p.m. on school nights - Until 11:30 p.m. on school nights* - Until 1:00 a.m. on school nights, but not on consecutive nights and not more than two school nights per week* - Not more than 6 working days per week

* Requires written permission of parents on file with employer.

PROHIBITED OCCUPATIONS (UNDER 18) NO MINOR UNDER THE AGE OF 18 MAY BE EMPLOYED IN ANY OCCUPATION DEEMED PROHIBITED UNDER THE CHILD LABOR PROVISIONS OF THE FEDERAL FAIR LABOR STANDARDS ACT.
PLEASE CHECK ADDITIONAL JOB AND HOUR RESTRICTIONS IN FEDERAL LAW WITH THE WAGE AND HOUR OFFICE, U.S. DEPARTMENT OF LABOR, NEAREST YOU. For more information, contact Indiana Department of Labor, 402 W. Washington St., Rm. W195, Indianapolis, IN 46204. (Telephone: 317-232-2655 /TT Voice 1-800-743-3333)