Dept. of Industrial Relations logo

DLSE forms - wage

The forms on this server are replicas of the official DLSE forms. 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

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)

  • Use a computer to fill-in forms
    • Initial Report or Claim (Rev. 07/12)
          ** PLEASE DESCRIBE THIS IMAGE ** English Form 1          ** PLEASE DESCRIBE THIS IMAGE ** English Instructions & Guide
          ** PLEASE DESCRIBE THIS IMAGE ** Spanish Form 1
      Reporte Inicial o Reclamo
      ** PLEASE DESCRIBE THIS IMAGE ** Spanish Instructions & Guide
      Instrucciones Para Llenar Un Reclamo De Salario>
      Guía Para Completar El “Reporte Inicial O Reclamo” (Forma DLSE 1)
          Adobe Tagalog Form 1
      Inisyal na Ulat o Paghahabol
      ** PLEASE DESCRIBE THIS IMAGE ** 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)
Forms (related publications are listed separately below)
  • Application for Exemption From Provisions of the Industrial Welfare Commission Order (acrobat small logoPdf) (DLSE 104) (rev 1/02)
  • Application for Extension of Minorís Work Hours in Agricultural Packing Plants (acrobat small logoPdf) (DLSE 104-1) (rev 1/02)
  • Initial Report or Claim - See “How to File a Wage Claim”
    (Rev. 07/12)
        ** PLEASE DESCRIBE THIS IMAGE ** English Form 1          ** PLEASE DESCRIBE THIS IMAGE ** English Instructions & Guide
        ** PLEASE DESCRIBE THIS IMAGE ** Spanish Form 1
    Reporte Inicial o Reclamo
    ** PLEASE DESCRIBE THIS IMAGE ** Spanish Instructions & Guide
    Instrucciones Para Llenar Un Reclamo De Salario>
    Guía Para Completar El “Reporte Inicial O Reclamo” (Forma DLSE 1)
        ** PLEASE DESCRIBE THIS IMAGE ** Chinese Form 1
    初次報告或索償
    ** PLEASE DESCRIBE THIS IMAGE ** Chinese Instructions & Guide
    工資索償說明
    “初報告或索償” 表格完成指南 (DLSE 表格 1)
        ** PLEASE DESCRIBE THIS IMAGE ** Korean Form 1
    초기 보고서 밎 청구
    ** PLEASE DESCRIBE THIS IMAGE ** Korean  Instructions & Guide
    임금청구 제기 설명서
    "초기 보고서 또는 청구"양식(DLSE 1 양식서)  완료 안내서
        ** PLEASE DESCRIBE THIS IMAGE ** Vietnamese Form 1
    Khiếu nại hoặc Báo cáo Bước đầu
    ** PLEASE DESCRIBE THIS IMAGE ** 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)
        Adobe Tagalog Form 1
    Inisyal na Ulat o Paghahabol
    ** PLEASE DESCRIBE THIS IMAGE ** 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)
        ** PLEASE DESCRIBE THIS IMAGE ** Punjabi Form 1
    ਸ਼ੁਰੂਆਤੀ ਰਿਪੋਰਟ ਜਾਂ ਦਾਅਵਾ
    ** PLEASE DESCRIBE THIS IMAGE ** Punjabi Instructions & Guide
    ਮਜ਼ਦੂਰੀ ਦਾ ਦਾਅਵਾ ਭਰਨ ਵਾਸਤੇ ਹਿਦਾਇਤਾਂ
    “ਸ਼ੁਰੂਆਤੀ ਰਿਪੋਰਟ ਜਾਂ ਦਾਅਵਾ” ਫਾਰਮ (DLSE ਫਾਰਮ 1) ਭਰਨ ਲਈ ਗਾਈਡ
  • 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): (Adobe Pdf )
    • 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): Adobe Pdf)
    • DLSE Vacation Pay Schedule for claimants seeking vacation wages: (Adobe Pdf).  See Sample Vacation Pay Schedule (Adobe Pdf).
      • Instructions (Recapitulation of Vacation Pay)/ Instrucciones (Recapitulación de Pago de Vacacione): (AdobePdf)
  • Information for Subpoena (Rev. 1/09)
    • English (acrobat small logoPdf) (DLSE 564) (Rev. 1/09)
  • Notice of Appeal
    • English (acrobat small logoPdf) (DLSE 537) (Rev. 3/83)
    • Spanish (acrobat small logoPdf) (DLSE 537) (Rev. 3/83)
    • Chinese (acrobat small logoPdf) (DLSE 537) (Rev. 3/83)
    • Korean (acrobat small logoPdf) (DLSE 537) (Rev. 3/83)
    • Vietnamese (acrobat small logoPdf) (DLSE 537) (Rev. 3/83)
    • Tagalog (acrobat small logoPdf) (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)

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

Notice to Employee (Labor Code section 2810.5) (Rev 4/2012)