CHILDREN and YOUNG PERSONS ACTS 1933 to 1963 (As Amended)

Children’s and Adults’ Services

CHILDREN AND YOUNG PERSONS ACTS 1933 TO 1963 (as amended)

Bye-laws with respect to the employment of children

APPLICATION FOR ISSUE OF EMPLOYMENT PERMIT TO CHILD BELOW

SCHOOL LEAVING AGE

Note: Employers should return this form to Ealing Council, School Attendance Service, 2nd Floor, Perceval House, 14-16 Uxbridge Road, Ealing, W5 2HL, Tel No. 020 8825 5040 Fax No. 020 8825 8299 . Within one week of the child starting work.

They should ask parents to complete part 2.

Part 1:

To be completed by the Employer

Employer’s Name
Registered Address
Tel
Fax
e-mail
Nature of business

The Child

Name
Sex
Age
Date of Birth
School Attended

The Job

Manager/Owner Name
Address at which the child will
be employed
Telephone
Email
Nature of employment
Please outline all tasks to be undertaken
by the child

YOUNG PERSON’S RISK ASSESSMENT

The employer needs to carry out risk assessments before any young person starts work. Risk assessments should

take account of any existing control measures in place and identify where risk remains.

I have carried out a Young Person’s Risk Assessment, which has been discussed with the child’s parent/guardian.
Also confirm that the appropriate insurance cover is in place.
Signature of Employer / Date

Days and times of proposed employment

School Term Time / School Holidays
Start Time / End Time / Start Time / End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Name

Signed

Date

Part 2

To be completed by the Parent/Guardian

Name
Relationship to child
Address
Tel:
Email

I consent to my child being employed under the conditions set out in this application form

I confirm my child is fit and able to work and does not have any medical condition or disability which might affect his/her suitability for proposed employment.

I would like the work permit sent to the email address above

Parent/Guardian name

Parent/Guardian Signature

Date