The Oregon WH 216 1 form is an essential document that serves as an Annual Employment Certificate Application for minors aged 14 to 17. This form is required by the Bureau of Labor and Industries' Wage and Hour Division to ensure compliance with child labor laws in Oregon. By completing this application, employers can outline their plans for hiring minors, detailing the nature of the work and the specific conditions under which these young individuals will be employed.
The Oregon WH 216 1 form serves as an essential tool for employers who wish to hire minors aged 14 to 17. This application is specifically designed to ensure compliance with child labor laws while providing a safe working environment for young individuals. Employers must provide key information, including the business name, type of business, and the anticipated number of minors to be employed over the next year. Additionally, the form requires details about the specific duties minors will perform, the locations of their work, and any machinery they may operate. It also inquires whether the employer plans to engage minors in agricultural work, which has its own set of regulations. By signing this application, employers certify the accuracy of the information provided and commit to adhering to child labor laws, including reporting any changes in employment circumstances. Understanding and correctly completing the Oregon WH 216 1 form is crucial for fostering a responsible and lawful employment practice involving minors.
BUREAU OF LABOR AND INDUSTRIES
Wage and Hour Division
ANNUAL EMPLOYMENT CERTIFICATE APPLICATION
for minors 14 through 17 years of age
Business Name _____________________________________________ Telephone (_____) ___________Ext.
Corporation Name (if any)
Type of Business____________________________________________ NAIC Code (if known) __________________
Site Address
(Street)
(City)
(State)
(Zip)
(County)
Mailing Address
(Street/P.O. Box Number)
1.ESTIMATE the number of minors to be employed in the next twelve (12) month period:
2.Do you anticipate employing 14-15 year olds? Yes ______ No ______ 16-17 year olds? Yes ______ No
3.Describe the duties of the minors to be employed, the work areas, and the address(es) where the work is to be performed, if other than the above site. Please attach a list of locations if necessary.
4.List all power-driven machinery/equipment minors will operate or assist in the operation of:
5. Do you anticipate employing minors in agriculture?
Yes _____
No _____
Operation of or riding in or on a tractor?
Operation of or riding in or on other farm machinery?
I certify that the information contained in this application is true and that I have received a summary of the child labor laws. I agree to:
1)Employ minors consistent with the application herein;
2)Comply with child labor laws; and
3)Report any changes in the above information by filing a Notice of Change (To Annual Employment Certificate) form between renewal periods within 15 days of the change.
_________________________________________________________________________ Date
(Signature of Employer or Representative)
______________________________________________ Telephone No. (_____)_________________ Ext.
(Printed Name of Employer or Representative)
RETURN THIS APPLICATION TO:
Bureau of Labor and Industries
Child Labor Unit - Suite 1045
800 NE Oregon Street
Portland, OR 97232-2180
Telephone: (971) 673-0836
Fax: (971) 673-0769
WH-216-1 (Rev. 6/08)
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