Children Services & Skills   				          
Education Inclusion Service
Elmwood Place  37 Burtons Way,
Birmingham,  B36 0UG
Tel: 0121-704 6663
inclusion@solihull.gov.uk

APPLICATION TO EMPL0Y A CHILD
(Children & Young Persons Act 1933 ant the Council’s byelaws)

TO BE COMPLETED BY EMPLOYER IN BLOCK CAPITALS

COMPANY NAME:							TRADE:

ADDRESS:									POST CODE:

TELEPHONE NO:								EMAIL:

SURNAME:									FORENAME:						TITLE:

I hereby make application to the Solihull Metropolitan Borough Council for the issue of an Employment permit for the under mentioned child.

SURNAME:						FORENAME:					DATE OF BIRTH:

ADDRESS:														POST CODE:

TEL NO:

SCHOOL ATTENDING:

NATURE OF PROPOSED EMPLOYMENT (PLEASE DESCRIBE MAIN TASKS)

PLACE OF EMPLOYMENT:

Date and times of employment (please use 24 hour clock and state the exact hours worked)
	    	School	Days			Holidays			

Days	AM
From	
To	PM
From	
To	AM
From	
To	PM
From	
To	

MONDAY									

TUESDAY									

WEDNESDAY									

THURSDAY									

FRIDAY									

SATURDAY									

SUNDAY									
Have you completed a Risk Assessment    Yes / No

Employers Signature:   …………………………………………..

TO BE COMPLETED BY PARENT

1. Has your son/daughter had an Employment Permit before?			Yes  /  No

2. If yes does he/she still carry out the work stated in that Employment Permit.      Yes  /  No

Name of previous Employer

Nature of previous Employment

3. I consent to the new employment referred to overleaf and certify that the above particulars are correct.

4. I confirm that my child is in good health and able to carry out Employment as described without detriment.

5. Has the child been absent from school for more than one week during the last term.      Yes / No

6. If so for what reason?  …………………………………………………………………………………………

I understand that my child should be registered and issued with an Employment permit prior to starting the employment.

Parents Signature:   ……………………………………………………..   Date:   ……………………………

Parents telephone no: …………………….

Parents Address:   ……………………………………………………………………………………………….

Email Address: ……………………………………………………………………………………………………

E.W.O. Check re: School Attendance Progress			SATISFACTORY/UNSATISFACTORY
										
Signed by Education Inclusion Officer:  ………………………………  Attendance % …………..
																		
Date: ……………………..

FOR OFFICE USE ONLY

Please tick category:

News Delivery		
Hotel/catering/waitressing/washing up		

Shopwork/Sales Assistant		
Packing/labelling		

Cleaning		
Horticultural/agricultural/gardening		

Shelf stacking/till work		
Office work		

Caring for people		
Animal care		

Uncategorised (please describe)

Employment Permit No:  ………………………				Issue Date:  …………………………….