Welcome to the Department of Industrial Relations
DLSE forms - wage
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.

Fill-in forms

Forms (related publications are listed separately below)
  • 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)
  • Initial Report or Claim
    • English (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (DLSE 1) (Rev. 05/2005)
    • Spanish (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (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. 2/2000)
    • Korean (acrobat small logoPdf) (DLSE 1) (Rev. 2/2000)
    • Vietnamese (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (DLSE 1) (Rev. 02/2000)
    • Tagalog (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (DLSE 1) (Rev. 02/2000)

  • Information for Subpoena (Rev. 1/09)
    • English (acrobat small logoPdf / iconDoc) (DLSE 564) (Rev. 1/09)
  • Notice of Appeal
    • English (acrobat small logoPdf) (DLSE 537) (Rev. 3/83)
    • Spanish (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (DLSE 537) (Rev. 3/83)
    • Chinese (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (DLSE 537) (Rev. 3/83)
    • Korean (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (DLSE 537) (Rev. 3/83)
    • Vietnamese (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (DLSE 537) (Rev. 3/83)
    • Tagalog (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc) (DLSE 537) (Rev. 3/83)

    Note: If your printer has a problem printing the form, try the "Fit to page" box in the Acrobat Adobe Reader's print function.

Publications (related forms are listed separately above)
  • Policies and Procedures for Wage Claim Processing
    • English (Rev. 05/2001) (acrobat small logoPdf / html)
    • Spanish (Rev. 05/2001) (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc)

  • Filing a Claim
    • English (Rev. 01/2011) (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc)
    • Spanish (Rev. 01/2011) (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc)
    • Chinese (Rev. 01/2011) (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc)
    • Korean (Rev. 01/2011) (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc)
    • Vietnamese (Rev. 01/2011) (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc)
    • Tagalog (Rev. 001/2011) (acrobat small logoPdf / ** PLEASE DESCRIBE THIS IMAGE **Doc)

    Note: Additional forms and publications may be added in the future.

Notice to Employee (Labor Code section 2810.5)