Section 5. The employment certificate provided by this act for the use of a minor between fourteen and sixteen years of age shall be in the following form:--
This certifies that (name and residence of minor) is aged........ years.......months......days; whose complexion is ......, hair is........ and eyes are........; is able to read and write the English language intelligently, and may be employed at labor in any coal-breaker, washery or other outside workings of a coal-mine.
This certificate is a legal warrant for the employment of the minor hereon, in any of the above-named establishments and industries, under the provisions of an act approved...........one thousand nine hundred and nine, as amended by an act approved ......, one thousand nine hundred and eleven.
(Signature of person who issued certificate, official title and official address.)
(Signature of minor to whom issued.)................. (Date.)
(5 amended June 15, 1911, P.L.983, No.792)