Non CPS-Student Employment Permit Form

This permit is issued to 14 through 17 year-old workers in accordance with G.L. c. 149, 86-89.

Important Conditions: All students between 6 and 16 years of age must attend school, with the following exceptions:

14 and 15 year-olds who have completed the 6th grade and hold a permit for employment in private domestic service or service on a farm for 6 hours per day;
14 and 15 year-olds who have completed the 6th grade and have the written permission of the superintendent of schools to engage in non-wage earning employment at home; and
A child over the age of 14 who holds a permit for employment in a cooperating employment.

Students between the ages of 14 and 16 may work, but unless they fall within one of the three categories, they must also attend school until age 16. Full-Time Employment Permits are issued at the discretion of the Superintendent of Schools.

An Employment Permit does not authorize the employment of the minor named thereon by anyone other than the employer named. Employment of the minor named is restricted to the specific nature of the employment stated on the face of this permit.

Whoever, without authority, alters an employment permit may be punished by a fine, pursuant to G.L. c. 149, 90.

Please note: All completed MSYEP permits will be sent directly to the Mayor's Program.

Please complete the following information to submit an Employment Permit:

Minor's First Name

Minor's Last Name

Minor's Address, City, State, Zip

Email Address:

Minor's Date of Birth

Minor's Place of Birth

Eye Color:

Hair Color:

Facial Marks:

Gender:

Specific Nature of Employment:

Intern, childcare, arts, clerical, maint.

Employer's Name:

Employer's Address:

Last School Attended:

Grade Last Attended:

Years in School:

Current Age - Years:

Months:

These forms may be executed by and through electronic signature technology which is in compliance with Massachusetts law governing electronic signatures. An electronic signature is defined as an electronic symbol, sound, or process that is either attached to or logically associated with a document and executed or adopted by a person with the intent to sign the document. The electronic signature mechanism that is available to use for these forms is data verification and form CAPTCHA. Electronic signatures shall be considered as valid and binding as original signatures. Signatures, originally signed by hand, but transmitted via email or fax shall also be deemed valid and binding original signatures.

Student Signature:

Do not hit the button more than once.