APPLICATION FOR EMPLOYMENT OF A CHILD

COVID-19 DECLARATION
Children and Young Persons Act 1933 & 1963,
The Education Act 1996, Byelaws on the Employment of Children 2010,
The Children Protection at Work Regulations 1998 & 2000

Before completing an application please ensure that you have read and understood the Southampton City Council
byelaws which outline the permitted work for children aged 13 to 16.

Please return completed forms via email to Child.Employment@Southampton.gov.uk

Electronic signatures are permitted.

EMPLOYER’S DETAILS
Full name of employer and job title: Name of business/organisation:
Newsquest Newsquest Media Group
Newspaper Distributor
Address of business/organisation: Telephone:
Newspaper House 023 80 424436
Test Lane
Southampton Email:
Postcode: SO16 9JX cs.servicedesk@newsquest.co.uk

 I, the employer, confirm that an appropriate Risk Assessment, taking into account the child’s age has been carried
out and the child’s parent(s) or carer(s) has been informed. I will also distribute guidance and advice to minimise
the risks associated with COVID-19.
 I, the employer, confirm that the child’s health and safety will not be placed at risk by this employment, and that
their education will not be negatively affected.
 I, the employer, understand that children’s education should be a priority and that children should not be working
over their legal hours or during school hours where they or their carer has indicated that they have education to
complete. I understand that the Local Authority may withdraw permits if the school have concerns that a child is
prioritising employment.
 I, the employer, confirm that we will provide suitable Personal Protective Equipment (PPE) to the child and ensure
all precautions are taken to reduce risk of exposure to COVID-19.
 I, the employer, confirm that we will provide a letter of consent to work to all children with a valid work permit.
 I, the employer, confirm that I will adhere to Government guidance and allow children to self-isolate should they be
required to due to symptoms, vulnerability, shielding requirement in themselves or those they reside with.
 I, the employer, confirm that I have gained parental consent for their child to continue working during the current
health emergency. Any child without parental consent will temporarily cease employment.
Signature: Date:

Print Name: Julia Dowle, Group Distribution Admin Manager 12/05/2020

Forename(s): Emma Surname: Ford-Bailey

Date of birth: 5th May 2006 Age: 14 ☐ Male ☒ Female

5 Upper Brownhill Road
Address: Maybush Home
023 80363520
Southampton telephone:

Postcode: SO16 5NG Email: emma@ford-bailey.net

Name of school: The Mountbatten School

 I declare that I am the parent/carer and have parental responsibility, and I give permission for my child to undertake
the employment stated above during the COVID-19 outbreak.
 I have been provided with, and have seen, a copy of the findings of the completed risk assessment and guidance /
advice documents relating to COVID-19 in this employment by the employer.
 I declare that I am aware of all aspects of their employment and Local Byelaws and I confirm, that in my opinion, the
above work would not jeopardise my child’s heath, welfare or ability to take full advantage of her/his education.
 I confirm that my child is not classed as shielded, vulnerable or required to self-isolate in line with Government
legislation, and will not be adding additional risk to those who they reside with due to vulnerabilities or requirement to
 self-isolate.
 I understand that the child should be completing all school work provided by their education provision, and that this
should be a priority over employment. I understand that if at any time the child’s education appears to be
deteriorating and the Local Authority is contacted by the school, the Local Authority have the right to withdraw the
work permit and inform both the employer and parent/carer of this decision.
 I will ensure that my child follows Government guidelines with regard to social distancing, and that they wear
appropriate Personal Protective Equipment.
 I will ensure that my child carries their letter of consent to work on them at all times, and that my child is aware that
they may be stopped by an officer of the Local Authority or Police force.
 I understand that I am not required to provide consent for my child to undertake employment should I feel that they
are unsafe.
 I understand that the information on this form will be held on a database to be used for the purpose of monitoring
child employment throughout the COVID-19 period.
 I understand that at this current time my child must not deliver with anyone who is not from the same household.

Signature: Michael Bailey Date: 16th June 2020

Print Name: Michael Bailey Relationship to child: Father