The NJ A300 form, created by the New Jersey Department of Education, is a Combined Certification Form used for various purposes such as Cooperative Education Experiences and Paid Structured Learning Experiences, among others. This comprehensive document collects essential information ranging from minor's personal details and employment information to physician’s certification and proof of age. It is a pivotal tool in ensuring that the employment of minors within the state adheres to legal requirements, safeguarding their welfare and educational commitments.
For young individuals in New Jersey eager to step into the workforce, the NJ A300 Combined Certification Form serves as a crucial starting point. This document, issued by the New Jersey Department of Education, is designed to ensure that minors are employed under conditions that prioritize their safety, health, and educational commitments. The form is comprehensive, covering minor’s personal information including age, residence, and physical attributes, along with detailed employment information that must be completed by the prospective employer. It caters to both hazardous and non-hazardous occupations, distinguishing between Cooperative Education Experiences and Paid Structured Learning Experiences. Furthermore, it outlines clear guidelines for the employment of minors, specifying permissible work hours and setting limitations based on age. The NJ A300 form also incorporates a section for a physician’s certification to affirm the minor’s physical capability to undertake the specified work, alongside a proof of age section to authenticate the minor’s age. Parental or guardian authorization is requisite, underscoring the importance of adult supervision in the employment of minors. The process is meticulously structured to ensure compliance with labor laws and protect minors' rights and well-being in the workforce, adhering to both state educational goals and employment regulations. Moreover, temporary adjustments have been made to accommodate the challenges presented by public health emergencies, showcasing the form’s adaptability and the state’s commitment to maintaining educational and employment opportunities for minors under varying circumstances.
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)
I hereby authorize the employment of my child as specified below under
Employment Information.
__________________________________________________________
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)
Is liquor sold on the premises?
Yes
No
If Yes, are the entire premises licensed?
Contact Person Name
If No, describe what areas of the premises are licensed, including any
outside grounds:
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
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
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
Name of School
School District Address
School Address
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
Signature of Principal
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
Filling out the A300 Combined Certification Form is a critical step toward employment for minors in New Jersey. This form ensures that the employment of minors adheres to state laws, safeguarding their health, well-being, and educational opportunities. By accurately completing this form, employers, guardians, and the minors themselves contribute to a compliant and safe work environment. The following steps will guide you through the detailed process of filling out this form correctly.
After following these steps, the minor, with the support of their guardian and employer, will have taken the necessary actions to ensure their employment complies with New Jersey's laws. It's a collaborative effort to protect minors' rights in the workplace, balancing work with their education and health.
The NJ A300 Combined Certification Form is a document issued by the New Jersey Department of Education that is required for minors seeking employment in the state. It combines several certifications, including proof of age, school records, and a physician's certification, to ensure that the minor is eligible and physically able to undertake the employment proposed. It is also used to certify the employment conditions comply with New Jersey's child labor laws.
The NJ A300 Form must be completed by minors who wish to work in New Jersey. The form also requires input and authorization from the minor's employer, parent or guardian, a physician, and the minor's school.
The NJ A300 Form outlines different work hour restrictions for minors based on age groups. For minors aged 14 & 15, restrictions include working no more than 3 hours on a school day and no later than 7:00 pm during the school year. During summer, they may work up to 8 hours a day and until 9:00 pm with parental permission. For those aged 16 & 17, the restrictions are up to 8 hours a day and no later than 11:00 pm, with exceptions allowing work until 3:00 am under certain conditions. All minors cannot work more than 6 consecutive days or more than 5 continuous hours without a 30-minute meal break.
The NJ A300 instructions include guidelines on prohibited jobs for minors, emphasizing certain hazardous occupations that minors are not allowed to engage in. While the form does not list these jobs in detail, it directs readers to the New Jersey Department of Labor and Workforce Development’s website for a complete list of prohibitions, which vary based on the minor's age.
Yes, pursuant to Executive Order 135 (Murphy) (2020), during a Public Health Emergency, the application process for the NJ A300 Form can be completed without in-person contact. This includes the use of audio-visual technology for live video conferences between the minor and school district issuing officers, electronic submission of documents, and electronic or other means of transmitting the signed certificate. Schools are responsible for developing procedures that fulfill these requirements securely and confidentially.
When processing employment for minors in New Jersey, especially under the guidelines specified by the A300 Combined Certification Form, several additional forms and documents often complement the application process. These materials are crucial for employers, guardians, and issuing officers to ensure the employment experience is beneficial, legal, and safe for the minor involved. Here is a selection of important documents that frequently accompany the A300 form.
Together, these documents create a framework that safeguards the minor’s well-being, rights, and educational commitments while they engage in employment. Employers, guardians, and minors must ensure that these forms are accurately completed and appropriately filed to comply with New Jersey Department of Education and Department of Labor and Workforce Development guidelines. Ensuring that all relevant documents are in order strengthens the foundation for a successful and legally compliant working experience for minors.
The NJ A300 Combined Certification Form shares similarities with the Federal Employment Eligibility Verification Form I-9 in terms of verifying an individual's eligibility to work in the United States. Each form requires personal information and documentation that validates the individual's legal status for employment. While the A300 specifically caters to minors in New Jersey, seeking to engage in employment while balancing educational commitments, the I-9 is utilized by employers nationwide to verify the identity and employment authorization of all employees, irrespective of age. Both forms serve a regulatory compliance function: the A300 within the state educational and labor system for minors, and the I-9 within the federal immigration and employment framework, ensuring that individuals are legally permitted to work.
Another analogous document is the Work Permit or Age Certificate, which is issued by many states to minors as a means to regulate the conditions under which young people enter the workforce. Similar to the NJ A300, these permits often require the minor's personal information, proof of age, and specifics about the prospective employment. Both documents are designed to protect minors by restricting the types of work and the hours they are legally allowed to work, ensuring these conditions do not interfere with their education and well-being.
The Occupational Safety and Health Administration (OSHA) Youth Employment Certificate also parallels the NJ A300 form. This certificate is necessary in certain states for minors to legally work, focusing on the safety and health conditions of the prospective job. Both the NJ A300 and the OSHA certificate aim to prevent youth employment in dangerous or unhealthy environments, reinforcing the commitment to minor safety across different jurisdictions. While the OSHA certificate places a strong emphasis on occupational safety, the A300 encompasses a broader range of protections, including educational considerations.
The Student Learner Permit, issued for vocational or educational training purposes, is similar to the A300 form, specifically the sections pertaining to Cooperative Education Experience (CEE). Both documents facilitate students' engagement in work experiences related to their studies, blending practical on-the-job learning with their academic education. They ensure the work performed is appropriate for the student’s age and contributes positively to their educational objectives, with a clear emphasis on balancing work and school responsibilities.
Finally, the NJ A300 form resembles the Disability Work Permits issued in some jurisdictions. These permits are designed to allow individuals with disabilities to work under adjusted conditions that consider their capabilities and health. Both the A300 and disability permits take into account the physical and mental well-being of the worker — the A300 through its requirement for a Physician’s Certification, and disability permits through assessments tailored to individual capability. While serving different populations, both aim to create a safe and equitable work environment that accommodates the specific needs of the worker.
When filling out the New Jersey Department of Education A300 Combined Certification Form, it's important to be both thorough and accurate. The success of the application largely depends on the quality and completeness of the submitted information. To guide applicants through this process, here are key dos and don'ts when completing the form:
Conversely, here are actions you should avoid:
Adhering to these guidelines will streamline the process of completing the A300 form accurately and efficiently, thereby facilitating a smoother employment certification process for minors in New Jersey.
When it comes to the NJ A300 form, which is an integral document for minors seeking employment in New Jersey, there are several misconceptions that often lead to confusion. Understanding these misconceptions can simplify the process for both minors and their guardians. Below are four common misunderstandings about the A300 form:
Understanding these facets of the NJ A300 form clarifies the employment certification process for minors. It ensures a smoother transition into the workforce while safeguarding their rights and educational needs.
Filling out the NJ A300 Combined Certification Form is an important process for minors seeking employment in New Jersey, ensuring compliance with state labor laws and protecting the rights and safety of young workers. Here are six key takeaways to guide individuals through the completion and utilization of this form:
Completion of Personal and Employment Information: At the onset, minors must provide detailed personal information in Section A and then present the form to their prospective employer. The employer is responsible for completing Section B, which includes job-specific information such as the minor's job title and work hours. This collaboration ensures that all necessary details are accurately captured for the legal employment of minors.
Requirement of Physician’s Certification: A significant aspect of the form is the health certification in Section C, signifying that the minor has been medically cleared to undertake the specified employment. If the physical examination occurs outside the school system, any associated costs fall to the minor's parents or guardians. This section underscores the importance of assessing the physical capability of minors to handle their job responsibilities without compromising their wellbeing.
Providing Proof of Age: Section D mandates the submission of proof of age, which is critical for verifying that the minor meets the age requirements for the intended position. Acceptable documents include a birth certificate, passport, or other recognized forms of identification. This step is pivotal in ensuring that employers adhere to labor laws concerning the hiring of minors.
Parent/Guardian Authorization: The involvement of a parent or guardian is crucial, as evidenced by their required authorization in Section A for the employment outlined in the form. This provision ensures that guardians are aware of and agree to their child's employment, reinforcing the minor's safety and rights.
School Record and Issuing Officer Certification: Sections E and F focus on the educational aspect, where school officials confirm that the employment will not interfere with the minor's schooling. The successful issuance of working papers hinges upon this approval, prioritizing the minor's education alongside their employment opportunity.
Important Information on Work Hours and Conditions: The form also delineates specific regulations regarding the permitted working hours and conditions for minors of different age groups, ensuring that employment does not detrimentally affect their health or education. This section is crucial for both employers and guardians to understand and adhere to, ensuring a safe and legally compliant work environment for minors.
Understanding and accurately completing the NJ A300 form is fundamental for minors engaging in employment in New Jersey. It serves as documentation that all legal requirements have been met, safeguarding the interests of young workers while ensuring that their work experience is educational and safe.
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