As the employer, you must provide the following information:

1. (1) The location of the minor's workplace(s).
2. (2) A description of the minor's duties.
3. (3) The earliest and latest hours the minor would be working.
4. (4) The total number of hours the minor would work per week.
5. (5) Your minor work permit endorsement number and expiration date.
6. (6) Your unified business identifier (UBI) number.
7. (7) Your signature or the signature of your authorized agent.

[Statutory Authority: RCW 49.12.121. WSR 99-02-041, § 296-125-0264, filed 12/31/98, effective 1/31/99.]