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The Nj A300 form plays a crucial role in the employment process for minors in New Jersey, serving as a comprehensive certification tool that ensures both compliance with labor laws and the safety of young workers. This combined certification form encompasses several important sections, starting with personal information about the minor, including details like name, date of birth, and contact information. Following this, the form outlines the employment specifics, including the employer's business details and the minor's job title, which is key for ensuring that the position aligns with state regulations on youth employment. The signature of a parent or guardian is also required, underscoring the importance of parental involvement in the employment process. In addition, the form features a physician's certification section, which must be completed to verify the minor's fitness for work. Proof of age is another critical aspect, ensuring that appropriate documentation is provided to confirm the minor's eligibility. Lastly, there is a section for school records, where school officials affirm that the minor's work hours will not hinder their educational progress. Each of these components must be meticulously filled out and verified, making the Nj A300 form a vital document in safeguarding the interests of young workers while facilitating their entry into the workforce.

Nj A300 Example

NEW JERSEY DEPARTMENT OF EDUCATION

 

 

 

 

 

Date Printed: _____________

A300 Combined Certification Form

 

 

Date(s) of previously issued certificates (if applicable): ________________

Cooperative Education Experience (CEE) - Hazardous Occupation

CEE - Non-Hazardous Occupation

Paid Structured Learning Experience

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Minor’s Personal Information

 

 

 

 

First Name

 

M.I.

Last Name

 

 

 

Social Security No.

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address (Line 1)

 

 

 

Floor/Apt. No. (Line 2)

 

Date of Birth

Age

 

City of Birth

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

Zip Code

 

County of Birth

 

 

State/Country of Birth

 

 

 

 

 

 

 

 

 

 

Telephone No.

 

 

 

Cell/Alternate No.

 

 

Male

Height __________

Hair Color ______________

 

 

 

 

 

 

 

 

Female

Weight __________

Eye Color

______________

 

 

 

 

 

 

 

Parent/Guardian First Name

 

Parent/Guardian Last Name

 

 

Distinguishing Facial Marks (if applicable)

 

 

 

 

 

 

 

 

 

Parent/Guardian Address (if different than minor’s address)

Floor/Apt. No. (Line 2)

 

I hereby authorize the employment of my child as specified below under

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employment Information.

 

 

 

City

 

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__________________________________________________________

Parent/Guardian Telephone No.

 

 

Alternate Telephone No.

 

 

 

 

 

 

 

 

 

Signature of Parent/Guardian

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Employment

Information

 

 

 

 

Employer Business Name

 

 

 

 

 

 

Type of Business/Industry

 

 

 

 

 

 

 

 

 

 

 

Street Address (where minor will be employed)

Floor/Suite (Line 2)

 

 

Minor’s Job Title (Be specific)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

Zip Code

 

Is liquor sold on the premises?

 

Yes

No

 

 

 

 

 

 

 

 

If Yes, are the entire premises licensed?

Yes

No

Contact Person Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If No, describe what areas of the premises are licensed, including any

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

outside grounds:

 

 

 

 

Telephone No.

 

 

 

Alternate Telephone No.

 

__________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

Minor’s Hours of Work (Provide daily hours and/or start and end times)

 

 

Promise of Employment: I have offered employment to the above

 

 

 

 

 

 

 

 

named minor for the hours stated. I understand that these hours may be

_______________ ______________ ______________ ______________ ______________

flexible but may not exceed the number of hours permitted by law

Mon

Tues

 

Wed

 

Thurs

Fri

 

according to the age of the minor.

 

 

 

Sat ______________

Sun ______________

Total Hours for Week:___________

 

__________________________________________________________

 

 

 

 

 

 

 

 

Wages: Per Hour ____________

Weekly ____________

Other -

 

 

Signature of Employer

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Physician’s Certification (to be completed by licensed physician): I hereby certify that I have examined the above named minor on __________________

and I designate the minor’s physical qualifications regarding the above promise of employment as:

(Date)

Physically Qualified

Physically Qualified with the following limitations ________________________________________________________________

_____________________________________________________________________________________________________________________________________

Signature of Doctor

Date

Address

 

D. Proof of Age (for Issuing Officer): I have examined the proof of age submitted by the above named minor which was in the form of (select one):

Birth Certificate

Baptismal Certificate Passport

Other documentary proof in existence for at least one year (specify): __________________

Affidavit of Parent/Guardian together with 1) physician’s statement of opinion as to age of minor, and 2) school record of age and the above date of birth

E. School Record (to be completed by school that the minor attends)

F. Issuing Officer Certification

 

School District

County

School District

 

County

 

 

 

 

 

Name of School

 

School District Address

 

 

 

 

 

 

 

School Address

 

Telephone No.

 

 

 

 

 

 

 

Last Grade Completed __________

 

Regular Employment Certificate

 

 

 

Vacation Employment Certificate (summer & other school vacations)

 

 

 

 

The above named minor attends school in this district and has completed the work

Age Certificate (issued to persons 18 to 21 years of age)

Age: _______

of the above grade. To the best of my knowledge the minor can do the work

 

 

 

proposed without impairment of progress in school.

 

________________________________________________________________

 

 

_________________________________________________________________

Signature of Minor

 

Date

 

 

 

Signature of Principal

Date

________________________________________________________________

 

 

 

 

Signature of Issuing Officer

Date of Issue

Certificate No.

A300 (R-6-16-2020) New Jersey Department of Education

INSTRUCTIONS FOR A300 COMBINED CERTIFICATION FORM

Pursuant to Executive Order 135 (Murphy) (2020), for the duration of the Public Health Emergency declared in Executive Order No. 103 (2020), the provisions of N.J.S.A. 34:2-21.8 and N.J.S.A. 34:2-21.10, requiring the personal appearance of the minor, and, under certain circumstances, the minor’s parent or guardian, before school district issuing officers in order to apply for or sign employment certificates may be satisfied through the use of audio-visual technology. Each public-school district shall develop and implement procedures to satisfy the statutory requirements without requiring in-person contact between the school district issuing official and the minor, under the following conditions: a. During the application process, the child and the school district licensing officer may transmit a single copy of all required documentation by way of electronic transmission, fax, or any other means of transfer of documents developed by the school district that avoids in-person contact, is secure, and maintains the confidentiality of the documents; b. The video conference shall be live and must allow for interaction between the child and the school district issuing officer, and when applicable, the parent or guardian. During the video conference, the child shall verify his or her identity, authenticate the documents submitted, and sign the application, in a way that is visible and audible to the school district issuing officer; and c. Following the video conference, the child shall transmit the signed certificate, by electronic or other means as determined by the school district, to the issuing officer, who shall make the requisite copies and distribute the original and copies as required by N.J.S.A. 34:2-21.7

1.Employment Information (section B) – After you have completed your personal information (section A), bring your certification form to the employer. The employer completes the Employment Information and signs and dates the Promise of Employment. If any of the employment details have been pre-filled and are incorrect, the employer must cross out the incorrect information and enter, initial and date the corrections.

2.Physician’s Certification (section C) – The school district is responsible for performing the physical examination at no cost to you or your parents. A school physical (including a sports physical) performed during freshman year is good for all four years of high school (unless the school district policy specifies more frequent physicals).

If your parent/guardian prefers that you be examined by a doctor other than the one employed by the school district, you may do so at your parent/guardian’s expense. A minor is not required to obtain a physical if the parent/guardian objects (in writing) based on their religious beliefs and practices.

3.Proof of Age (section D) – If the school does not have a copy on file, you may be asked to provide a birth certificate, passport, baptismal certificate or other identification documentation to the School Issuing Officer.

4.Parent/Guardian Authorization (section A) – Your parent/guardian must indicate his/her authorization of your employment as specified in the Employment Information by signing and dating the Parent/Guardian authorization.

5.School Record/Issuing Officer Certification (sections E & F) - Present the completed certification form to your school district. A designated school official will review the form and issue the working papers only after being satisfied that the working conditions and hours will not interfere with your education. The official may refuse to issue working papers if such refusal would be in your best interest.*

* See above Executive Order 13 (Murphy) (2020) for temporary instructions.

IMPORTANT INFORMATION

Hours of Work – 14 & 15 Year Olds

no more than 3 hours a day on a school day

no more than 18 hours a week during a school week

may not work before 7:00 am or after 7:00 pm during the school year

summer vacation: may work up to 8 hours a day, 40 hours a week, and may work up to 9:00 pm with written parental permission (which must be on file with the employer)

Hours of Work – 16 & 17 Year Olds

no more than 8 hours a day

no more than 40 hours a week

may not work before 6:00 am or after 11:00 pm

Exception: may work after 11:00 pm (up to 3 am provided work begins before 11 pm) during regular school vacation and when there is no school the next day with written parental permission (which must be on file with the employer)

Hours of Work – All Minors

no more than 6 consecutive days

may not work more than 5 continuous hours without at least a 30-minute meal break

Hours of Work - School-Sponsored Cooperative Education Experiences, Apprenticeships and Paid Structured Learning Experiences - Training site experiences may not exceed five hours on any day that school is in session nor may the combination of school and work exceed eight hours on any day that school is in session.

Prohibited Work– Certain potentially hazardous jobs are prohibited for minors based on the age of the minor. For a complete list of prohibited occupations, visit the Department of Labor and Workforce Development’s website at www.nj.gov/labor and click on Wage & Hour.

www.nj.gov/education - New Jersey Department of Education

www.nj.gov/labor (click on Wage & Hour) – New Jersey Department of Labor and Workforce

A300 (R-6-16-2020) New Jersey Department of Education

Form Characteristics

Fact Name Details
Purpose The NJ A300 form is used to authorize the employment of minors in New Jersey. It combines certification from parents, employers, and schools.
Governing Laws This form operates under N.J.S.A. 34:2-21.8 and N.J.S.A. 34:2-21.10, which regulate the working conditions for minors.
Sections Included The form includes five main sections: personal information, employment information, physician certification, proof of age, and school records.
Parental Authorization A parent's or guardian's signature is required to authorize the minor's employment as described in the form.
Physical Certification A licensed physician must certify that the minor is physically qualified for the job. This certification often occurs through a school physical.
Work Hour Restrictions Specific restrictions apply based on the minor’s age. For example, 14- and 15-year-olds have limited work hours compared to 16- and 17-year-olds.

Guidelines on Utilizing Nj A300

Completing the NJ A300 form is an important step toward securing employment for minors under New Jersey law. Be sure to provide accurate and complete information throughout the form, as this can affect processing times and compliance with state laws. Following the steps below will help ensure that all necessary details are included, ultimately leading to a smoother certification process.

  1. Begin with the Minor’s Personal Information section (A). Fill in the minor's first name, middle initial, last name, Social Security number, street address, and date of birth. Include the city, state, zip code, and county of birth. Don't forget to provide a phone number along with height, weight, hair color, and eye color, as well as the parent or guardian's information.
  2. In section A, check the appropriate gender box and provide any distinguishing facial marks if applicable. Then, proceed to fill in the parent/guardian's address and contact details.
  3. Next, move on to the Employment Information section (B). Provide the employer's business name and type of industry. Fill in the full street address where the minor will work, along with the job title and any relevant details about the hours of work.
  4. Indicate whether liquor is sold on the premises. If yes, specify if the entire area is licensed and provide contact information for the employer. Ensure to detail the promise of employment, including flexible hours and total weekly hours.
  5. For section C, Physician’s Certification, arrange for the minor to be examined by a licensed physician. The doctor will need to certify the minor’s physical qualifications. This section requires the physician’s signature and date.
  6. In section D, Proof of Age, select what type of age proof you will provide, such as a birth certificate or a passport. Be prepared to include this documentation with the application.
  7. Section E requires information from the school regarding the minor's educational status. The school official must verify that the employment will not interfere with the minor's progress.
  8. Lastly, ensure that the issuing officer signs and dates section F after all details have been confirmed and necessary documentation provided. The officer will issue the working papers based on proper evaluation.

After completing these steps, double-check for any errors or incomplete sections before submitting the form to the appropriate authority. This diligence will help facilitate a swift review and approval process.

What You Should Know About This Form

What is the NJ A300 form?

The NJ A300 form is a combined certification form that enables minors to obtain work permits in New Jersey. This form is essential for working under the age of 18 and requires completion by the minor, their parent or guardian, their employer, and a licensed physician. It ensures that the working environment and hours are conducive to the minor's education and well-being. The form helps to document important information, including personal details, employment information, and proof of the minor's age.

Who needs to fill out the NJ A300 form?

Both minors looking for employment and their parents or guardians must fill out the NJ A300 form. Additionally, it requires the involvement of the employer, who will provide details about the employment offering, and a licensed physician to certify the minor's physical health for work. All parties need to contribute accurate information to ensure compliance with state regulations regarding youth employment.

What is included in the minor's personal information section?

This section requires various personal details about the minor, such as their full name, date of birth, address, and contact information. Additionally, it seeks information regarding distinguishing facial marks and the parent or guardian's details, including their name and contact information. This information is critical for identification purposes and ensures that the proper authorizations are in place for the minor's employment.

How does the Employment Information section work?

In this section, the employer must provide details about the business, the specific job title the minor will hold, and the work hours expected. It is crucial that the employer signs the document, confirming their promise of employment. Any corrections made to pre-filled information need to be initialed and dated by the employer. These details help ensure that the employment complies with child labor laws in New Jersey, as they include information about work hours and any applicable conditions related to alcohol sales on the premises.

What is the role of the physician in the certification process?

A licensed physician must complete the Physician’s Certification section, confirming that they have examined the minor and determining their physical fitness for the job. The physician can either certify that the minor is physically qualified or that there are certain limitations to their capabilities. It is imperative for the minor's health and safety to be considered before commencing employment.

What documents are required to verify the minor's age?

To ensure compliance with state regulations, proof of age must be submitted with the A300 form. Acceptable documents include a birth certificate, baptismal certificate, passport, or any other form of official identification that has been in existence for at least one year. If the school already has this documentation on file, it may not be necessary to provide additional copies. This verification is critical for maintaining legal employment standards for minors.

Common mistakes

Completing the New Jersey A300 Combined Certification Form requires careful attention to detail, as many individuals can easily overlook essential elements. One common mistake is the failure to provide accurate personal information. For instance, omitting the middle initial or miswriting the minor's full name can lead to complications later in the application process. Additionally, ensuring that the Social Security number is correct is crucial, as inaccuracies in this section may delay the issuance of the work certificate or raise questions about eligibility.

Another frequent error occurs in the Employment Information section. Applicants may neglect to specify the minor’s job title clearly. A vague description can create confusion for school officials who review the application. Employers, too, might make hasty assumptions, which can lead to misunderstandings about the type of work the minor is expected to perform. Properly detailing job responsibilities helps to prevent potential conflicts or issues regarding safety and compliance with labor laws.

Inadequate attention often extends to the Physician’s Certification section as well. Individuals sometimes fail to have a licensed physician complete this crucial part of the form. If a doctor merely signs off on the application without conducting a thorough physical examination, this could result in the inability to meet state requirements for the minor’s employment. It’s essential for parents or guardians to ensure that the physician clearly indicates any physical limitations if they exist, as this information is pivotal for evaluating the minor’s fitness for the promised employment.

Lastly, many people overlook the significance of obtaining the necessary signatures in the Parent/Guardian Authorization section. If the parent or guardian fails to sign or date the authorization, the application may be deemed incomplete. Such omissions can lead to unforeseen delays in processing the application, leaving the minor without the opportunity to begin working as intended. Thus, it is essential to double-check that all required signatures are secured before submitting the form.

Documents used along the form

The NJ A300 form, also known as the Combined Certification Form, is essential for minors seeking employment in New Jersey. This document works in conjunction with several other forms to ensure that all necessary information and authorizations are properly obtained before a minor can start working. Below is a list of related forms and documents often used alongside the NJ A300 form.

  • Employment Certificate - This document confirms that a minor is legally eligible to work in New Jersey. It specifies the hours and types of work the minor can perform, protecting their rights and educational commitments.
  • Physician’s Certification - Completed by a licensed physician, this form ensures that a minor is physically fit to perform the job duties assigned. The physician indicates any physical limitations that should be noted.
  • Proof of Age - Minors must provide documentation that verifies their age. Acceptable forms of proof include a birth certificate, passport, or baptismal certificate. This document is crucial to ensuring compliance with child labor laws.
  • School Record - This document is filled out by the minor’s school, confirming that the child is enrolled and attending. It also indicates that the minor's potential work will not interfere with their educational progress.
  • Parent/Guardian Authorization - This form requires the signature of a parent or guardian, granting permission for their child to work. It serves to protect the rights and interests of the minor and assures that the parent is aware of the employment situation.

Each of these forms plays a critical role in the process of obtaining a work permit for minors in New Jersey. By ensuring that all documentation is complete and accurate, parents, guardians, and schools can help facilitate a safe and legal work environment for young individuals.

Similar forms

  • Employment Certificate: Like the A300 form, an Employment Certificate verifies that a minor is legally allowed to work. It documents the minor's personal information, age, and the specifics of the job they will undertake.

  • Work Permit: A Work Permit serves a similar purpose as the A300 form by ensuring that the minor meets age restrictions and has parental consent to work. It is often required by employers to prevent legal issues regarding child labor laws.

  • Health Certificate: Much like the Physician’s Certification section of the A300 form, a Health Certificate confirms the physical fitness of a minor for employment. It may also outline any limitations based on the minor's health condition.

  • Parental Consent Form: This document, similar to the Parent/Guardian Authorization in the A300 form, indicates that a parent or guardian has authorized a minor to work and is aware of the job's conditions.

  • School Record: Comparable to the School Record section of the A300 form, this document may be requested to confirm a minor's enrollment and progress in school, ensuring that work won't interfere with their education.

  • Proof of Age Documentation: Similar to the Proof of Age section in the A300 form, documents such as birth certificates or passports establish a minor's age, which is crucial for compliance with labor laws.

  • Worker’s Compensation Insurance Information: Like the employment details in the A300 form, this information is essential for protecting minors in case of workplace injuries and ensuring they receive appropriate compensation.

  • Job Description Form: Comparable to the Employment Information section in the A300 form, this form outlines the specific responsibilities and expectations for a minor's job role, providing clarity to both the employer and the minor.

Dos and Don'ts

When completing the NJ A300 form, keep the following tips in mind:

  • Do gather all necessary documents ahead of time, such as birth certificates or proofs of age.
  • Do ensure all personal information is accurate and complete.
  • Do include all required signatures, especially from a parent or guardian.
  • Do check that the employer has filled out their section correctly before submission.
  • Do confirm your physical examination is done and documented as required.
  • Don't submit an incomplete form; this will delay processing.
  • Don't overlook the hours of work and conditions; make sure they comply with labor laws.
  • Don't forget to keep copies of the submitted documents for your records.
  • Don't hesitate to seek help from school officials if you have questions about the process.

Misconceptions

Understanding the NJ A300 form can pose challenges for many, leading to a myriad of misconceptions. Here is a list of seven common misunderstandings regarding this important employment certification.

  • The NJ A300 form is only for minors seeking summer jobs. In reality, this form can be used for various employment types, including part-time jobs during the school year, providing the minor meets age and hour requirements.
  • Obtaining a NJ A300 form is a cumbersome process. While it may seem complex, most of the required steps can be completed efficiently with proper documentation and a little guidance, making the process much more manageable.
  • You must have a physical examination done by a school doctor. Though the school district usually provides physicals at no cost, parents can opt for a private physician if they prefer, as long as it's at their own expense.
  • All employment fields require a NJ A300 form. This form is mostly essential for minors working in environments involving specific hazards or restrictions. Some jobs do not mandate this documentation, but it is always wise to check.
  • A physical examination must occur before job placement. While a physical is necessary for certification, it can happen at any point in the process as long as it is completed before the actual start of employment.
  • You need to be present in person to submit the form. Thanks to recent adaptations, many school districts now allow submissions through digital means, reducing the need for in-person visits.
  • Once issued, the NJ A300 form remains valid indefinitely. This is not true. The certification typically has a specific duration, and reevaluation may be necessary for ongoing employment.

By addressing these misconceptions, parents and minors alike can navigate the employment certification process with ease and confidence. Knowledge lends clarity to a process that can seem daunting at first glance.

Key takeaways

Filling out and using the New Jersey A300 form requires careful attention to detail. Here are some important takeaways to keep in mind:

  • Minor's Information: Ensure that all personal information for the minor is accurate, including full name, Social Security number, and date of birth.
  • Employment Information: The employer must fill out their section completely, including job title and business address, before it's submitted to the school district.
  • Parental Authorization: A parent or guardian must sign the form to authorize the child’s employment. This signature is essential for the process to proceed.
  • Physician's Certification: A licensed physician must certify the minor's physical qualifications. This step can often be done at the school district's expense if the examination is performed by school personnel.
  • Proof of Age: Present valid proof of age, such as a birth certificate or passport, when requested by the school issuing officer.
  • School Records: The school district will check that the minor’s work does not interfere with educational progress before issuing the working papers.
  • Adherence to Work Hours: Understand the legal limits for working hours based on the minor’s age to avoid violations of labor laws.
  • Potential Restrictions: Be aware that certain hazardous occupations are off-limits for minors, which may affect job availability.

Following these guidelines will help ensure the successful completion and use of the NJ A300 form.