Guardian Signature Date Employer Representative Signature Date Union Representative Signature Employer Representative Address Union / IL DEPARTMENT OF LABOR / Zipcode Union / /
Person
Tele / Supervising Minor / / /
Position
Female AM PM / authorized representative / Representative / Director of Labor / /
IL DEPARTMENT OF LABOR Fair Labor Standards Division Compliance Processing Section 160 North LaSalle, Suite C-1300 Chicago, IL[removed]Tel # ([removed]