Changes Notification Form

							Application to employ a Young Person
Education Welfare Service
Under the Children & Young Persons Act 1933 (as amended)
and the Essex County Council Byelaws (1998)
The employer must complete all relevant sections.
Parent/carer to sign the declaration.
The permit will be issued by Essex County Council in line with the Child Employment Byelaws
and Regulations. Essex County Council is not responsible for undertaking the provision of
local authority checks in accordance with the named employer.
The information on this form will be held on computer files and will be shared with other
relevant educational establishments and agencies for the purpose of providing the
appropriate service or meeting legislative requirements.

Young persons details (write in ink using block capitals)
Last name:

First name:
Date of birth:                                                  Male         Female
Address:
Town/city:
County:                                                      Postcode:
Tel. no:
Email address:
School:
Employing company’s details
Company name:

Address:
Town/city:
County:                                                      Postcode:
Tel. no.
Email address:
Type of business:




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Line manager’s details
Last name:
First name:
Direct phone no:
Details of the employment
Young person’s place of employment: (If different from above)




Job title:
Main tasks of the employment:




Date started or to start:
Please state how you became aware of Child Employment Regulations:




Days and times of employment:
(Please refer to the byelaws or guidelines for permitted hours and required breaks and holidays, or contact the
Child Employment Team)
Term time
       Sunday        Monday         Tuesday       Wednesday        Thursday          Friday        Saturday
     From     To   From     To    From      To    From      To    From      To    From     To    From      To
a
m
p
m

School holidays
       Sunday        Monday         Tuesday       Wednesday        Thursday          Friday        Saturday
     From     To   From     To    From      To    From      To    From      To    From     To    From      To
am
pm



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Declaration by the employer

Risk assessment
The Health & Safety (Young Persons) Regulations 1997 requires all employers to carry out a
risk assessment before a young person starts work and to inform the parent/carer of the
outcome and measures introduced in the risk assessment to minimise the risk towards the
young person. (For more information on risk assessments contact your local office of the
Health & Safety executive).
I declare that I have carried out an appropriate ‘Risk Assessment’ and that my Employers
Liability Insurance covers the employment of Young People of Compulsory School Age.
I declare that I will employ this Young Person in the way set out in this application and in
accordance with the requirements of the law. I also understand that this information will be
shared with other relevant educational establishments and agencies for the purpose of
providing the appropriate service or meeting legislative requirements.

Signature:                                             Print name:

Position in the company:                                               Date:

To be completed by the parent/carer
Does the young person carry out any other part-time work?        Yes           No (please tick)

If yes, please give the other employer’s details:
Name of the company:
Address of the company:
Town/city:
County:                                                        Postcode:
Tel. no:
Declaration by parent/carer

I consent to the employment as set out in this form.

I declare that, as far as I am aware the young person named in this application is fit and this
employment will not be harmful to his/her health or physical development, and will not render
him/her unfit to obtain proper benefit from his/her education. I also understand that this
information will be shared with other relevant educational establishments and agencies for
the purpose of providing the appropriate service or meeting legislative requirements.

Signature:                                                           Date:
Last name:                                             First name:
Daytime phone no:




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Data Protection Act
Appropriate information contained on this form will be held on computer files and may be shared with
other relevant educational establishments and agencies for the purpose of providing the appropriate
service or meeting legislative requirements.

If further advice is needed you should speak to a member of the Education Welfare Service on
the telephone number below.
An application form that is incomplete or illegible will be returned to the employer thereby
delaying the issuing of the work permit.
When complete, this form must be returned by the employer to:
Education Welfare Service,
E Block - 2nd Floor,
County Hall,
Chelmsford CM1 1LD
Tel: 01245 436743/5
Fax: 01245 436752
Email: child.employment@essex.gov.uk
Internet: www.essex.gov.uk




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