Ffurflen Cyflogwr ar gyfer manylion Cyflogi Plant

1Eich Manylion 2Manylion yr Ymholiad

Eich Manylion

Cyfeiriad

Manylion yr Ymholiad

Your relationship to child

Forename of child

Surname of child

Child's gender

Male Female

Child's date of birth

School Attended by Child

Proposed Employer

Employer Name

Employer Address

Nature of employment proposed for child

Dates and Times Employed

School days between the hours of

and

Saturdays and holidays between the hours of

and

Sundays between the hours of

and

Parent/Guardian Declaration

I consent to my child/ward undertaking the employment specified above, and to medical examination by the School Medical Officer if necessary. I certify that the information is correct and that my child is medically fit to carry out the above duties of the employment. The employer has explained about the risk assessment carried out prior to the commencement of the employment and I understand the findings.