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Employment
permit.
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certifies that I am the ———— father, mother, guardian or
custodian of ———— (name of child) and that (he or she)
was born at ———— (name of town or city) in the county
of ———— (name of county) and State of ———— , on the
———— day of — ——— , in year ———— , and, is now —
(number of years and months) old. Signature of
(father, mother, guardian or ———— custodian.)
Signature of ——— — child
(Date.)
There personally appeared before me the above-named
(name of father, mother, guardian or custodian of) and made
oath that the aforegoing certificate by (him or her) signed,
is true to the best of (his or her) knowledge and belief.
I hereby approve the foregoing certificate of (name of
child), height (feet and inches), eyes (color), complexion (fair
or dark), hair (color); having no sufficient reason to doubt
that (he or she) is of the age therein certified I hereby certify
that (he or she) can read at sight and write legibly simple
sentences in the English language, and that (he or she) has
reached the normal development of a child of (his or her)
age, and is in sound health and is physically able to per-
form the work which (he or she) intends to do.
This certificate belongs to (name of child in whose behalf
it is dra.wn) and is to be surrendered to (him or her) when-
ever (he or she) leaves the service of the corporation or
employer holding the same; but if not claimed by said child
within thirty days from such time it shall be returned to the
Maryland Bureau of Statistics and Information (if the
employment be in Baltimore city) or the Board of Health or
principal health officer of (if the employment be in any of
the counties or other cities outside of Baltimore city).
Signature of (person authorized to prove and
sign with official character or authority.)
Date ————
A duplicate of each employment permit shall be filled out
and kept on file by the Maryland Bureau of Statistics and
Information or Board of Health or principal health officer
of the county or city outside of Baltimore city, as the case
may be.
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