New Jersey Department of Education Combined Certification Form
This file is a combined certification form from the New Jersey Department of Education. It includes sections for employment information, physical examination, proof of age, and more. It is used for certifying minors for various types of employment in New Jersey.
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How do I fill this out?
To fill out this form, you'll need to complete sections on the minor's personal information, employment details, and obtain necessary certifications from a physician and school officials. Make sure all information is accurate to avoid any delays. Follow the detailed instructions provided for each section to ensure the form is properly completed.

How to fill out the New Jersey Department of Education Combined Certification Form?
1
Complete the Minor's Personal Information section.
2
Have the employer fill out the Employment Information section.
3
Obtain a Physician's Certification.
4
Provide Proof of Age.
5
Get the School Record and Issuing Officer Certification.
Who needs the New Jersey Department of Education Combined Certification Form?
1
Minors seeking employment in New Jersey need this form to certify their eligibility.
2
Employers who are hiring minors need this form to ensure legal compliance.
3
Physicians use this form to certify the physical fitness of minors for the specified job.
4
School officials need this form to verify the student's academic standing and attendance.
5
Parents and guardians use this form to authorize their child's employment.
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What are the instructions for submitting this form?
Submit this form to the appropriate school district's office. Contact your local school district for the email address or physical address for submission. Make sure all sections are filled out and signed by the necessary parties before submission.
What are the important dates for this form in 2024 and 2025?
Check the New Jersey Department of Education's website for updates on important dates for 2024 and 2025.

What is the purpose of this form?
The purpose of this form is to certify that minors seeking employment in New Jersey meet all legal and health requirements. This combined certification form ensures minors have the necessary parental, educational, and medical authorizations to work legally in the state. Proper completion of this form helps protect the health and education of minors while allowing them to gain valuable work experience.

Tell me about this form and its components and fields line-by-line.

- 1. Minor's Personal Information: Includes details such as name, address, date of birth, and physical characteristics.
- 2. Employment Information: Contains the employer's details, job title, work hours, and wage information.
- 3. Physician's Certification: A licensed physician certifies the minor's physical qualifications for the job.
- 4. Proof of Age: Requires documentation to verify the minor's age, such as a birth certificate or passport.
- 5. School Record: Provides details about the minor's academic standing and confirmation from school officials.
- 6. Issuing Officer Certification: A school official certifies the form and issues working papers if all conditions are met.
What happens if I fail to submit this form?
Failing to submit this form can result in the minor being ineligible for employment. It may also lead to legal complications for the employer.
- Employment Ineligibility: Minors cannot legally work without a completed certification form.
- Legal Consequences: Employers risk legal action for hiring minors without proper certification.
How do I know when to use this form?

- 1. Job Application: When a minor is applying for a job in New Jersey.
- 2. Physical Certification: To certify the minor's physical ability to perform the job.
- 3. Parental Authorization: When parents or guardians need to authorize the minor's employment.
- 4. Proof of Age: To verify the minor's age through acceptable documentation.
- 5. School Certification: For school officials to confirm the minor's academic standing and attendance.
Frequently Asked Questions
How do I fill out the personal information section?
Enter the minor's details such as name, address, and date of birth in the designated fields.
Who needs to fill out the employment information section?
The employer who is hiring the minor should complete this section.
Do I need a physician's certification?
Yes, a licensed physician must certify the minor's physical qualifications for the job.
What documents are acceptable for proof of age?
Acceptable documents include a birth certificate, passport, or baptismal certificate.
Who signs the parent/guardian authorization?
The parent or guardian of the minor must sign this section.
What is the issuing officer certification?
A school official reviews the form and issue working papers if all conditions are met.
Can I use the same form for different jobs?
No, a new form must be completed for each job the minor applies for.
What are the working hours limits for minors?
Working hours are limited based on the age of the minor. Refer to the instructions for specific limits.
How can I verify that my form is complete?
Ensure all sections are filled out and signed by the necessary parties before submission.
Where can I get more information on prohibited work for minors?
Visit the Department of Labor and Workforce Development's website for a complete list of prohibited occupations.
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