DLSE forms Go to Publications page

Text

Labor Commissioner's Office
DLSE forms
Go to Publications page
The forms on this server are replicas of the official DLSE forms and are in Adobe's Portable Document Format (PDF).  You will need
Adobe Acrobat Reader
to view or print the forms.  To obtain a form by mail, contact your local
DLSE office
.
Categories
Wage
Discrimination / Retaliation
Public Works
Bureau of Field Enforcement
Child Labor
Master List
Check Distribution Authorization Template
Form Name, Number, and Revision Date
Application for Exemption From Provisions of the Industrial Welfare Commission Order (DLSE 104)
(rev 1/02)
Application for Extension of Minor's Work Hours in Agricultural Packing Plants (DLSE 104-1)
(rev 1/02)
Application for Permission to Employ Minors in the Entertainment Industry (DLSE 281)
(Rev.07/2001)
DLSE 281 - Spanish
(Rev.07/2001)
DLSE 281 - Chinese
(Rev.07/2001)
DLSE 281 - Korean
(Rev.07/2001)
DLSE 281 - Vietnamese
(Rev.07/2001)
DLSE 281 - Tagalog
(Rev.07/2001)
Employer Requirement to Notify Employees of Inspection by Immigration  Agencies
Español
中文 (Chinese)
한국어 (Korean)
Tagalog
Tiếng Việt (Vietnamese)
Application for Relief from Order, Decision or Award of the Labor Commissioner by Want of Notice [Labor Code Section 98(F)] (DLSE 538)
(Rev. 05/2013)
Application for Permission to Work in the Entertainment Industry
Sexual  Harassment Prevention Training Requirements
for minors aged 14-17 years old
AB 3175 Certification of Compliance
DLSE 277 - Spanish
DLSE 277 - Chinese
DLSE 277 - Korean
DLSE 277 - Vietnamese
DLSE 277 - Tagalog
Information for Subpoena (DLSE 564)
(Rev. 1/09)
Initial Report or Claim - WAGE CLAIMS
(Rev. 07/12)
Spanish Form 1
Reporte Inicial o Reclamo
Chinese Form 1
初次報告或索償
Korean Form 1
초기 보고서 밎 청구
Vietnamese Form 1
Khiếu nại hoặc Báo cáo Bước đầu
Tagalog Form 1
Inisyal na Ulat o Paghahabol
Punjabi Form 1
ਸ਼ੁਰੂਆਤੀ  ਰਿਪੋਰਟ ਜਾਂ ਦਾਅਵਾ
English Instructions & Guide
Spanish Instructions & Guide
Instrucciones  Para Llenar Un Reclamo De Salario
Guía  Para Completar El “Reporte Inicial O Reclamo” (Forma DLSE 1)
Chinese Instructions & Guide
工資
索償
說明
“初
次
報告或索償” 表格完成指南 (DLSE 表格 1)
Korean  Instructions  & Guide
임금청구 제기 설명서
"초기 보고서 또는 청구"양식(DLSE 1 양식서)  완료 안내서
Vietnamese Instructions & Guide
HƯỚNG DẪN NỘP ĐƠN  KHIẾU NẠI TIỀN LƯƠN
Hướng dẫn Điền Đơn “Khiếu nại hoặc Báo cáo Bước  đầu”(DLSE Form 1)
Tagalog Instructions & Guide
Mga Instruksiyon Para Sa Pagsasampa Ng Isang  Paghahabol Ng Sahod
Gabay sa Pagkumpleto ng Form para sa “Inisyal na  Ulat o Paghahabol” (DLSE Form 1)
Punjabi Instructions & Guide
ਮਜ਼ਦੂਰੀ  ਦਾ ਦਾਅਵਾ ਭਰਨ ਵਾਸਤੇ ਹਿਦਾਇਤਾਂ
“ਸ਼ੁਰੂਆਤੀ ਰਿਪੋਰਟ ਜਾਂ ਦਾਅਵਾ” ਫਾਰਮ (DLSE ਫਾਰਮ 1) ਭਰਨ ਲਈ ਗਾਈਡ
Initial Report or Claim – WAGE CLAIMS / Additional  DLSE Forms to submit with Initial Report or Claim
DLSE Form 55 for claimants who worked  irregular hours
and
are claiming unpaid wages (for non-overtime or  overtime hours worked) or meal and rest period violations: DLSE-55
(Rev. 10/03). See
Sample DLSE-55
.
Instructions  (DLSE-55)/ Instrucciones (la Forma DLSE 55):
DLSE Form 155 for claimants with commission claims: DLSE-155
(Rev. 12/03).  See
Sample DLSE-155
.
Instructions (DLSE-155)/ Instrucciones (la Forma DLSE 155):
DLSE Vacation Pay Schedule for claimants seeking vacation  wages:
. See
Sample Vacation Pay Schedule
.
Instructions (Recapitulation of Vacation Pay)/  Instrucciones (Recapitulación de Pago de Vacacione):
Report of Labor Law Violation Form (BOFE 1)
(Rev. 12/2021)
RLLV - Spanish
Notice of Appeal (DLSE 537)
(Rev. 3/83)
DLSE 537 - Spanish
DLSE 537 - Chinese
DLSE 537 - Korean
DLSE 537 - Vietnamese
DLSE 537 - Tagalog
Notice to Employee, Labor Code Section 2810.5 (English)
2810.5 Supplemental Notice to H-2A Employees – English
Notice to Employee, Labor Code section 2810.5 (Spanish)
2810.5 Supplemental Notice to H-2A Employees – Spanish
Procedures for obtaining an entertainment work permit
(Rev. 12/24/2002)
Public Works - Public Complaint
Public Works - Initial Report
Instructions for Completing the "Public Works - Initial Report" form (PW-1)
DLSE-PW-Form 1 - English
(Rev. 9/2012)
DLSE-PW-Form 1 - Spanish
(Rev. 9/2012)
Retaliation/Discrimination Complaint (DLSE RCI 1)
(Rev. 11/2012)
DLSE Form RCI 1 - Spanish
(Rev. 11/2012)
DLSE Form RCI 1 - Chinese
(Rev. 11/2012)
DLSE Form RCI 1 - Korean
(Rev. 11/2012)
DLSE Form RCI 1 - Vietnamese
(Rev. 11/2012)
DLSE Form RCI 1 - Tagalog
(Rev. 11/2012)
Equal Pay Act Complaint
Form (EPA -1)
Statement of Employer Payments (PW 26)
(Rev 1/2000)
Subpoena Duces Tecum (FOR TALENT AGENT CASES ONLY)
In order to offer you as much information as possible, the DLSE website contains several sources for assistance.  We recommend that you access basic information provided in our
general information lines
.  Please also check other links to information provided on this site, such as
Frequently Asked Questions
and
Publications
which contain information sheets and brochures on many subject matters that are often the topic of questions, and the How To File a Claim sections.  In most cases, you will find an answer to your question.  If, after reviewing all the information offered at these links, you still can't find the answer to your question regarding wage, hour and labor law, please email us at
[email protected]
.

Retrieval chunks

• #1

  Labor Commissioner's Office DLSE forms Go to Publications page The forms on this server are replicas of the official DLSE forms and are in Adobe's Portable Document Format (PDF). You will need Adobe Acrobat Reader to view or print the forms. To obtain a form by mail, contact your local DLSE office . Categori…

• #2

  Mga Instruksiyon Para Sa Pagsasampa Ng Isang Paghahabol Ng Sahod Gabay sa Pagkumpleto ng Form para sa “Inisyal na Ulat o Paghahabol” (DLSE Form 1) Punjabi Instructions & Guide ਮਜ਼ਦੂਰੀ ਦਾ ਦਾਅਵਾ ਭਰਨ ਵਾਸਤੇ ਹਿਦਾਇਤਾਂ “ਸ਼ੁਰੂਆਤੀ ਰਿਪੋਰਟ ਜਾਂ ਦਾਅਵਾ” ਫਾਰਮ (DLSE ਫਾਰਮ 1) ਭਰਨ ਲਈ ਗਾਈਡ Initial Report or Claim – WAGE CLAIMS / Ad…

• #3

  Frequently Asked Questions and Publications which contain information sheets and brochures on many subject matters that are often the topic of questions, and the How To File a Claim sections. In most cases, you will find an answer to your question. If, after reviewing all the information offered at these links, y…