Principal's Statement to Issuing Officer - Illinois

This printable "Principal's Statement to Issuing Officer" is a document issued by the Illinois Department of Labor specifically for Illinois residents.

Download a PDF of the latest edition of the form down below or find it through the department's forms library.

ADVERTISEMENT
Principal’s Statement To Issuing Officer
State Of Illinois, Department Of Labor
Required by Section 12 of the Child Labor Law, 820 ILCS 205/1-22
Date ___________________Name of School ________________________________________
This is to certify that the undersigned has interviewed _________________________________
residing at _____________________________________________________________ and that
said minor requests that an employment certificate be issued permitting employment outside
of school hours.
The school records disclose that above-named minor was born __________________ and has
completed the _________ Grade. He or she is in school from _________
to _________
AM
PM
with _________ hour for lunch.
Parents’ names are:
Father: ________________________________ Mother _______________________________
According to the school records, above-named minor is making satisfactory progress; therefore,
I recommend an employment certificate be issued for present employment.
Principal _______________________________ By ____________________________________
MINOR, PLEASE NOTE: EMPLOYMENT CERTIFICATES ARE ISSUED BY CITY AND COUNTY
SUPERINTENDENTS OF SCHOOLS OR THEIR DULY AUTHORIZED AGENTS IN EACH SCHOOL DISTRICT.
NOTE: THIS IS NOT AN EMPLOYMENT CERTIFICATE BUT SHOULD BE DELIVERED TO THE ISSUING
OFFICER WHO WILL ISSUE NECESSARY CERTIFICATE AS REQUIRED BY LAW. THIS FORM MAY BE
REPRODUCED BY LOCAL SCHOOL AUTHORITIES AND ADDITIONAL INFORMATION ADDED IF NECESSARY
TO MEET LOCAL CONDITIONS.
Principal’s Statement To Issuing Officer
State Of Illinois, Department Of Labor
Required by Section 12 of the Child Labor Law, 820 ILCS 205/1-22
Date ___________________Name of School ________________________________________
This is to certify that the undersigned has interviewed _________________________________
residing at _____________________________________________________________ and that
said minor requests that an employment certificate be issued permitting employment outside
of school hours.
The school records disclose that above-named minor was born __________________ and has
completed the _________ Grade. He or she is in school from _________
to _________
AM
PM
with _________ hour for lunch.
Parents’ names are:
Father: ________________________________ Mother _______________________________
According to the school records, above-named minor is making satisfactory progress; therefore,
I recommend an employment certificate be issued for present employment.
Principal _______________________________ By ____________________________________
MINOR, PLEASE NOTE: EMPLOYMENT CERTIFICATES ARE ISSUED BY CITY AND COUNTY
SUPERINTENDENTS OF SCHOOLS OR THEIR DULY AUTHORIZED AGENTS IN EACH SCHOOL DISTRICT.
NOTE: THIS IS NOT AN EMPLOYMENT CERTIFICATE BUT SHOULD BE DELIVERED TO THE ISSUING
OFFICER WHO WILL ISSUE NECESSARY CERTIFICATE AS REQUIRED BY LAW. THIS FORM MAY BE
REPRODUCED BY LOCAL SCHOOL AUTHORITIES AND ADDITIONAL INFORMATION ADDED IF NECESSARY
TO MEET LOCAL CONDITIONS.

Download Principal's Statement to Issuing Officer - Illinois

1427 times
Rate
4.5(4.5 / 5) 71 votes
ADVERTISEMENT