DocuSign Envelope ID: BFA06C0C-F0AA-4992-B83A-8813C0513EA2

7AC2D9CF-A618-437B-995D-73DD239EDE55
6B0359D0-668B-43A7-A3C7-531FC1B9DE3B

EMPLOYMENT OF MINORS CONSENT FORM

To be considered for employment with Wal-Mart Stores, Inc. (Walmart) an applicant must be a
minimum of 16 years of age. Specified divisions of Walmart prohibit the employment of minors and
require applicants to be a minimum of 18 years of age.

In divisions where minors are permitted to work, Walmart's Minors in the Workplace Policy restricts the
number of hours per day/week any minor may work, the time of day such work may be performed, and
the type of work which may be assigned to and performed by the minor. In addition, where Federal or
State law is more restrictive than this policy as to the terms and conditions of employment for minors,
the applicable law will be followed.

In accordance with Walmart policy and your state law, the following restrictions will be followed:

STATE: Minnesota

School No School
Maximum number of work 8.0 8.0
hours per day
Maximum number of hours per 40.0 40.0
week
Work hours must fall between 6:00AM - 11:00PM 6:00AM - 11:00PM

Number of hours worked No more than 4 hours No more than 4 hours

before a 15-minute break is
required
No more than 6 hours No more than 6 hours
Number of hours worked
before a meal period of at least
30 minutes, is required

Hazardous Work Restrictions:

Associates who are 16 or 17 years of age may not be assigned nor perform work deemed to be
hazardous. Prohibited hazardous work includes, but is not limited to the following examples:

 Operating power-driven equipment  Operating baker machines (including dough

 Operating, loading, or unloading balers or
compactors, including placing items into the
baler
 Operating a paint mixer
 Working with open, damaged, leaking or
exposed hazardous chemicals (including wet
photographic chemicals and pesticides)
 Operating the key cutter
 Operating a motor vehicle
 Operating forklifts or other power-driven
hoists
mixers)
 Any meat processing work (including
operating power-driven meat slicers, knives,
cutters, saws, grinders, or mixers)
 Handling firearms, ammunition, fireworks,
and other articles containing explosive
components
 Working with radioactive substances
 Working on ladders that exceed 4 feet in
height, or scaffolding
 Working on or close to a roof
DocuSign Envelope ID: BFA06C0C-F0AA-4992-B83A-8813C0513EA2
7AC2D9CF-A618-437B-995D-73DD239EDE55
6B0359D0-668B-43A7-A3C7-531FC1B9DE3B

NOTE: Your state may have additional hazardous work restrictions not mentioned. Please refer to the
state specific Minors in the Workplace policy for your state’s requirements.

The “Yellow Dot/Yellow Badge” program identifies associates who are under age 18. The name badge of
every minor associate must be marked so that they are easily identified as a minor.
PHILLIP LY
By signing this, I, ______________________________________________ (Name of minor associate)
acknowledge and agree to follow the above requirements.

If I do not follow the above requirements, I understand that I may be subject to disciplinary action, up to
and including termination. I also understand that if I am asked to perform any of the above-mentioned
duties or asked to work hours that I am not allowed to work, that I may report it to the Ethics Helpline at
1-800-WMETHIC without fear of retaliation.

12/10/2022
Date: _____________ Signature of Minor: _________________________________________________

Date: _____________ Signature of Parent/Guardian: ________________________________________

Age Verification Section

The undersigned certifies that my son/daughter is _______ years old and was born on ______________.
Place of Birth: _________________________________________(City,State).

PHILLIP LY
The undersigned, as parent(s) and/or legal guardian(s) of ______________________________________,
do hereby consent to their employment by Walmart, Inc. (Walmart), a mercantile industry located at
(your facilities address): _________________________________________________________________

subject to applicable child labor laws, including the implementing rules and regulations thereof and
further consent to an appropriate background check that seeks information relevant to the job duties
PHILLIP LY
and responsibilities for which ___________________________________ will be employed.

PHILLIP LY
I hereby give my permission for ______________________________________(name of minor associate)
to work in ______________________________(position) in your facility.

I further give permission for drug testing in compliance with Walmart policy.

Date: __________________ Signature of Parent/Guardian: ____________________________________

DocuSign Envelope ID: BFA06C0C-F0AA-4992-B83A-8813C0513EA2
7AC2D9CF-A618-437B-995D-73DD239EDE55
6B0359D0-668B-43A7-A3C7-531FC1B9DE3B

Minor School Information Form

PHILLIP LY
Student Name: ______________________________

09/06/2022
School Year Start Date: ______________________________ Application ID# ___________________

School Year End Date: ______________________________

06/07/2023

Time School Day Starts: Mo Tu We Th Fr Sa Su

7:30
____ 7:30
____ 7:30
____ 7:30
____ 7:30
____ ____ ____

Time School Day Ends: Mo Tu We Th Fr Sa Su

2:00
____ 2:00
____ 2:00
____ 2:00
____ 2:00
____ ____ ____

School Breaks:
06/12/2023 09/03/2023
Summer Break Start ____________________ End ____________________
11/24/2022 11/27/2022
Thanksgiving Break Start ____________________ End ____________________
12/22/2022 01/02/2023
Christmas Break Start ____________________ End ____________________
03/27/2023 04/03/2023
Spring Break Start ____________________ End ____________________

Other Start ____________________ End ____________________

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