1. Labor Commissioner's Office

DLSE forms - wage

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)

    	English Form 1	English Instructions & Guide
    	Spanish Form 1 Reporte Inicial o Reclamo	Spanish Instructions & Guide Instrucciones Para Llenar Un Reclamo De Salario Guía Para Completar El “Reporte Inicial O Reclamo” (Forma DLSE 1)
    	Tagalog Form 1 Inisyal na Ulat o Paghahabol	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)
    	Chinese Form 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)

• Application for Exemption From Provisions of the Industrial Welfare Commission Order (Pdf) (DLSE 104) (rev 1/02)
• Application for Extension of Minor's Work Hours in Agricultural Packing Plants (Pdf) (DLSE 104-1) (rev 1/02)

• Initial Report or Claim - See “How to File a Wage Claim”
  (Rev. 07/12)

  	English Form 1	English Instructions & Guide
  	Spanish Form 1 Reporte Inicial o Reclamo	Spanish Instructions & Guide Instrucciones Para Llenar Un Reclamo De Salario> Guía Para Completar El “Reporte Inicial O Reclamo” (Forma DLSE 1)
  	Chinese Form 1 初次報告或索償	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 Form 1 초기 보고서 밎 청구	Korean  Instructions & Guide 임금청구 제기 설명서 "초기 보고서 또는 청구"양식(DLSE 1 양식서)  완료 안내서
  	Vietnamese Form 1 Khiếu nại hoặc Báo cáo Bước đầu	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 Form 1 Inisyal na Ulat o Paghahabol	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 Form 1 ਸ਼ੁਰੂਆਤੀ ਰਿਪੋਰਟ ਜਾਂ ਦਾਅਵਾ	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): ( 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):  Pdf)
  • DLSE Vacation Pay Schedule for claimants seeking vacation wages: ( Pdf).  See Sample Vacation Pay Schedule ( Pdf).
    • Instructions (Recapitulation of Vacation Pay)/ Instrucciones (Recapitulación de Pago de Vacacione): (Pdf)
• Information for Subpoena (Rev. 1/09)
  • English (Pdf) (DLSE 564) (Rev. 1/09)

• Notice of Appeal
  • English (Pdf) (DLSE 537) (Rev. 3/83)
  • Spanish (Pdf) (DLSE 537) (Rev. 3/83)
  • Chinese (Pdf) (DLSE 537) (Rev. 3/83)
  • Korean (Pdf) (DLSE 537) (Rev. 3/83)
  • Vietnamese (Pdf) (DLSE 537) (Rev. 3/83)
  • Tagalog (Pdf) (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.

• Policies and Procedures for Wage Claim Processing

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

• (Pdf)