For Issuance of EMPLOYMENT CERTIFICATE (WORK PERMIT) - roe54 k12 il 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student information. Fill in the name, date of birth, address, and social security number in the designated fields.
3. Next, provide the school name where the student is enrolled.
4. In the Parent/Guardian Statement section, ensure that a parent or guardian reads and agrees to the rules set by the Illinois Department of Labor. They must sign and date this section.
5. For the Employer’s Statement of Intent to Employ, input the company name, address, telephone number, type of business, job title, and description of duties for the student.
6. Specify how many school days and non-school days per week the student will work along with hours per day. Ensure compliance with working hour regulations.
7. Complete the Statement of Physical Health by having a health official certify that a physical examination has been completed within the past year. The official must sign and date this section.

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