Child Labor Law Complaint Form

Child Labor Act Complaint

This form is used for complaints under the Pennsylvania Child Labor Act of 2012, P.L. 1209, No. 151.

Claimant Information

 
 
 
   
 
 
 
 
 
 
 
    
  
   
 
   
 
   


Minor Information
 



Employer Information
 

First Name of Contact Person
 
 
 

First Name of Owner
 
 
 

 
 
 
 
 
 
 
 
     
   
 

  Do you wish to remain anonymous?



Violations
  1.
  If Yes, please explain:
  2. Are minors employed with working papers officially called Employment Certificates?
  3. Are minors employed more than 8 hours a day?
  4.
  If Yes, please explain:
  5. Are minors employed under age of 18 years old?
  6.
  If Yes, please explain:
  7.
  If Yes, please explain:
  8.
  If Yes, please explain:
  9.
  If Yes, please explain:
  10.



I hereby certify that to the best of my knowledge and behalf, the above information is a true statement of facts relating to the alleged Violation(s) of the Child Labor Act of the Commonwealth of Pennsylvania.
The Bureau will contact you for any further information. Please notify the Bureau if there is a change of address or telephone by which to contact you.
       

 
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