Welcome to the Department of Industrial Relations
Division of Labor Standards Enforcement (DLSE)

DLSE forms

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 Master List

Form Name, Number, and Revision Date
  • Application for Exemption From Provisions of the Industrial Welfare Commission Order (acrobat small logoPdf / word small logoDoc) (DLSE 104) (rev 1/02)
  • Application for Extension of Minor’s Work Hours in Agricultural Packing Plants (acrobat small logoPdf / word small logoDoc) (DLSE 104-1) (rev 1/02)
  • Application for Permission to Employ Minors in the Entertainment Industry
    • English (acrobat small logoPdf) (DLSE 281) (Rev.07/2001)
    • Spanish (acrobat small logoPdf / iconDoc) (DLSE 281) (Rev.07/2001)
    • Chinese (acrobat small logoPdf / iconDoc) (DLSE 281) (Rev.07/2001)
    • Korean (acrobat small logoPdf / iconDoc) (DLSE 281) (Rev.07/2001)
    • Vietnamese (acrobat small logoPdf / iconDoc) (DLSE 281) (Rev.07/2001)
    • Tagalog (acrobat small logoPdf / iconDoc) (DLSE 281) (Rev.07/2001)
  • Application for Permission to Work in the Entertainment Industry
    • English (acrobat small logoPdf) / iconDoc) (DLSE 277) (Rev. 12/2008)
    • Spanish (acrobat small logoPdf / iconDoc) (DLSE 277) (Rev. 12/2008)
    • Chinese (acrobat small logoPdf / iconDoc) (DLSE 277) (Rev. 12/2008)
    • Korean (acrobat small logoPdf / iconDoc) (DLSE 277) (Rev. 12/2008)
    • Vietnamese (acrobat small logoPdf / iconDoc) (DLSE 277) (Rev. 12/2008)
    • Tagalog (acrobat small logoPdf / iconDoc) (DLSE 277) (Rev. 12/2008)
  • Information for Subpoena (Rev. 1/09)
    • English (acrobat small logoPdf / iconDoc) (DLSE 564) (Rev. 1/09)
  • Initial Report or Claim
    • English (acrobat small logoPdf / iconDoc) (DLSE 1) (Rev. 05/2005)
    • Spanish (acrobat small logoPdf / iconDoc) (DLSE 1) (Rev. 05/2005)

      • Commission Summary/Nomina de Comisiones (DLSE-155) (Rev.12/03) and Sample DLSE-155
        • Instructions for completing: Commission Summary (Corresponds to DLSE Form 155)/Instrucciones para completar: Resumen de Comisiones (Corresponde a la forma 155 de DLSE) (acrobatPdf / wordDoc)

      • Overtime, Rest Period, Meal Period Computation Form/Formulario para Calcular Sobretiempo, Descansos Y Comidas (DLSE-55) (Rev. 10/03) and Sample DLSE-55
        • Instructions for completing: Overtime, Rest Period, Meal Period Computation Form (Corresponds to DLSE-55)/Instrucciones para completar: Formulario de Horas Extras, Por Tiempo de Descanso y Comida(Corresponde a DLSE-55) (acrobatPdf / wordDoc)

      • Vacation Pay Schedule (mw wordDoc) and Sample Vacation Pay Schedule (acrobatPdf)
        • Instructions for completing: Recapitulation of Vacation Pay/Instrucciones para completar: Recapitulación de Pago de Vacaciones (acrobatPdf / wordDoc)
    • Chinese (acrobat small logoPdf) (DLSE 1) (Rev. 02/2000)
    • Korean (acrobat small logoPdf) (DLSE 1) (Rev. 02/2000)
    • Vietnamese (acrobat small logoPdf / iconDoc) (DLSE 1) (Rev. 02/2000)
    • Tagalog (acrobat small logoPdf / iconDoc) (DLSE 1) (Rev. 02/2000)
  • Notice of Appeal
    • English (acrobat small logoPdf / iconDoc) (DLSE 537) (Rev. 3/83)
    • Spanish (acrobat small logoPdf / iconDoc) (DLSE 537) (Rev. 3/83)
    • Chinese (acrobat small logoPdf / iconDoc) (DLSE 537) (Rev. 3/83)
    • Korean (acrobat small logoPdf / iconDoc) (DLSE 537) (Rev. 3/83)
    • Vietnamese (acrobat small logoPdf / iconDoc) (DLSE 537) (Rev. 3/83)
    • Tagalog (acrobat small logoPdf / iconDoc) (DLSE 537) (Rev. 3/83)
  • Procedures for obtaining an entertainment work permit (acrobat small logoPdf / iconDoc) (Rev. 12/24/2002)
  • Public Record Act requests
    • Guidelines for accessibility of public records of the Division of Labor Standards Enforcement
    • Public Records Act request form (iconPdf / iconDoc)
  • Public Works - Initial Report
    • English (acrobat small logoPdf) (DLSE-PW-Form 1) (New 9/96)
    • Spanish (acrobat small logoPdf / iconDoc) (DLSE-PW-Form 1 Spanish) (New 9/96)
    • Chinese (acrobat small logoPdf / iconDoc) (DLSE-PW-Form 1 Chinese) (New 9/96)
    • Korean (acrobat small logoPdf / iconDoc) (DLSE-PW-Form 1 Korean) (New 9/96)
    • Vietnamese (acrobat small logoPdf / iconDoc) (DLSE-PW-Form 1 Vietnamese) (New 9/96)
    • Tagalog (acrobat small logoPdf / iconDoc) (DLSE-PW-Form 1 Tagalog) (New 9/96)
  • Retaliation/Discrimination Complaint
    • English (acrobat small logoPdf / wordDoc) (DLSE 205) (Rev. 4/2008)
    • Spanish (acrobat small logoPdf / wordDoc) (DLSE 205) (Rev. 4/2008)
    • Chinese (acrobat small logoPdf / wordDoc) (DLSE 205) (Rev. 4/2008)
    • Korean (acrobat small logoPdf / iconDoc) (DLSE 205) (Rev. 02/2006)
    • Vietnamese (acrobat small logoPdf / iconDoc) (DLSE 205) (Rev. 02/2006)
    • Tagalog (acrobat small logoPdf / iconDoc) (DLSE 205) (Rev. 02/2006)
  • Sheltered Workshops and Special Minimum Wage Workers
    • Application for Sheltered Workshop License (Labor Code section 1191.5) (acrobat small logoPdf) / iconDoc) (DLSE 177) (Rev. 11/2008)
    • Application for Special Minimum Wage License (Labor Code section 1191) (acrobat small logoPdf / iconDoc) (DLSE 106) (Rev. 11/2008)
    • General Information and Instructions for Completing Application for Sheltered Workshop License or Application for Special Minimum Wage License (iconDoc) (DLSE 177-A) (Rev. 11/2008)
  • Statement of Employer Payments (acrobat small logoPdf) (PW 26)
  • Subpoena Duces Tecum (FOR TALENT AGENT CASES ONLY) (mw wordDoc)

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 dlse2@dir.ca.gov.

 
 
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