Annual Employment Certificate Application - Free Download
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WH-216-2 (Rev. 8/13)
Employer Instructions and Information
1. After submitting an initial Annual Employment Certificate Application, an Employment Certificate Renewal
Application may be submitted thereafter, once each year by employers employing minors ages 14 through 17. Complete
the attached application and if more than one location of the business entity employs minors, attach a list of locations to
the application. If during the year, a minor(s) is employed in a location other than one that has been approved, please
request a Notice of Change (to Annual Employment Certificate) form to report the new address(es) or location(s). Also
request a Notice of Change (to Annual Employment Certificate) form to report any other change in the information that is
required to be on this form.
2. Instructions for properly completing the application:
Complete the top portion of the application, identifying the business name, address, telephone number, etc.
Question 1: Enter the estimated number of minors to be employed for the coming year.
Question 2: Indicate whether you anticipate employing 14 and 15 year olds and/or 16 and 17 year olds.
Question 3: Describe ALL the duties, work areas and address(es) where the work will be performed by the minor(s)
covered by this application. This includes duties in the additional locations, if applicable.
Question 4: List ALL power driven machinery/equipment that the minor(s) will operate or assist in operating.
Question 5: If you employ minors in agriculture, complete this question.
3. If the application is properly completed and the employment complies with all laws and rules for the employment of
minors, a validated Employment Certificate will be issued to the employer. Please make a copy of the Employment
Certificate and forward a copy to each location for posting. A copy of this certificate must be posted at each of your
4. An employer must retain the validated Employment Certificate during the period of time for which it is issued and post the
certificate in a conspicuous place where all employees can readily read it.
5. If it appears that the employment will violate any law or rule pertaining to the employment of minors, the application will
be denied and returned to the employer. A telephone call will be made to notify the employer of the denial. The employer
may revise the duties in order to comply with the child labor law.
6. A summary of child labor laws is sent to employers with each application. Your signature on the application will signify
that you have received the summary and that you agree to comply with the child labor laws. If minors are employed at
multiple locations, a copy of the Summary of Child Labor Laws is required to be provided to the manager of each location
where minors will be employed. You will be sent an adequate supply of these summaries with your validated Employment
Certificate to distribute to each of your locations' managers.
7. If you have questions on the application of child labor laws to your business, you may contact the Bureau of Labor and
Industries Technical Assistance Unit in Portland at (971) 673-0824 for clarification.
8. Return the completed application to the Portland address listed on the form or to any office of the Bureau of Labor and
Industries. It is suggested that a copy of this application be made for the employer's record.
9. An Employment Certificate Renewal Application will be sent to you approximately one month prior to the expiration
date of your certificate.
THIS PROCEDURE PROTECTS EMPLOYERS AS WELL AS EMPLOYEES. EMPLOYERS WHO EMPLOY
MINORS IN VIOLATION OF THE LAW MAY BE SUBJECT TO SUBSTANTIAL PENALTIES.
BUREAU OF LABOR AND INDUSTRIES
Wage and Hour Division
ANNUAL EMPLOYMENT CERTIFICATE APPLICATION
(For Minors 14 through 17 Years of Age)