Work Permit

The Commonwealth of Massachusetts
Division of Occupational Safety
19 Staniford Street, 2nd Floor
Boston, MA 02114

Employment Permit Application for 14 through 17 Year-Olds
If you are under 18 years of age, you must obtain a work permit before starting a new job.1
M.G.L. c. 149, §§86-89. The following are the steps you should take; please note that a
Physicians Certificate of Health is required only of 14 and 15 year-olds.
Steps for Getting an Employment Permit
1. Obtain a job offer from an employer.
2. Ask the employer to complete the following section:
Promise of Employment
Name of Minor:
Name of Employer:
Business Address:
Job Title & Primary Duties:
Number of Hours per day Minor is to be Employed:
The undersigned agrees to employ this minor as stated above and in compliance with state law.
A summary of laws governing minors’ hours of work and hazardous occupations can be found at the end of this application form.

_________________________________________
Signature of Employer or Authorized Agent

______________________
Date

3. For 14 and 15 year-olds only (16 and 17 year-olds may skip this step): Ask your doctor to complete the following section:
Note: The following Certificate of Health must be signed within 12 months of the date this application is presented to the school official issuing the permit.
1

Minors who are 17 years of age, who can show documented proof of a high school diploma or the equivalent to the school official authorized to issue work permits, do not need a signed work permit, but must still complete this permit application.

Physician’s Certificate of Health

I hereby certify that I have made a thorough physical examination of the following named 14 or 15 year-old minor:
______________________________________________________________________
and that, in my opinion, said minor is in sufficiently sound health and physically able to perform the work indicated above. A summary of laws governing