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Parent Authorization for Employment of a Minor This form, with copy of proof of age, is to be kept by the employer and available for department audit. Attach copy of birth certificate or other proof of age document. To be completed by hiring department. Name of Minor Minor’s Address City: State: Zip: Maximum hours/day at work: Maximum working days/week: Is minor employed at any other job? □ Yes □ No If employed, the minor will have the following duties: Working hours Between and Minor’s Meal Period: Minor’s Rest Period: Wage/hour: Department: Department Phone: Signature of Minor: Date: Signature of Supervisor: Date: Parental Authorization To be completed by minor’s parent or guardian (after hiring department completes top section). “I am willing for my child to be employed by the City of Woodburn and under the conditions stated above.” Minor’s Birth Date: Sex □ Male □ Female Signature of Parent or Guardian: Date: Address of Parent or Guardian: City: State: Zip: